Developmental Stuttering: Possible Causes and Treatments

The uncontrolled pauses, repetition or prolongation of words or syllables (i.e. dysfluency) characteristic of stuttering is normal for a tiny percentage of everyday speech (Weir and Bianchet 2004). But for about 55 million people worldwide (B�¼chel and Sommer 2004), stuttering is a lasting speech impairment that causes shame and damages self-image, with the potential to sabotage social achievement. Clinically known as persistent developmental stuttering (PDS), it has been recorded in literature as old as the Bible, where it is attributed to Moses (Exodus 4, 10-13).

“Stuttering is a developmental speech disorder that usually appears between 3 and 8 years of age and often remits before puberty. When it persists past the close of the period of developmental plasticity, around puberty, it becomes a chronic adult speech disorder throughout the life span…” (Ludlow 2000)

John M. Williams, award-winning columnist and life-long stutterer, conveys a sense of frustration with PDS. “Stuttering is embarrassing, and physically and mentally exhausting. For people with severe stuttering patterns, 15 minutes of stuttering is like sparring three minutes with a professional fighter. You are whipped.” (2002, Ã?¶ 10)

Unfortunately there is no definitive cure for stuttering, because so little has been discovered about its causes over millennia of medicinal thought. Why do some “grow out of” PDS while others do not? Which social factors can cause the condition to worsen or improve? Is it hereditary? These are a few of the questions about PDS that have remained without definitive answers over the centuries.

“In ancient Greece, theories referred to dryness of the tongue. In the 19th century, abnormalities of the speech apparatus were thought to cause stuttering. Thus, treatment was based on extensive “plastic” surgery, often leading to mutilations and additional disabilities. Other treatment options were tongue-weights or mouth prostheses (Katz 1977). In the 20th century, stuttering was primarily thought to be a psychogenic disorder. Consequently, psychoanalytical approaches and behavioral therapy were applied to solve possible neurotic conflicts (Plankers 1999).” (BÃ?¼chel and Sommer 2004)

In 1997, PET and MRI scans monitoring the brain activity of 18 stutterers and 20 fluent speakers found that in stutterers, the brain’s right hemisphere seemed to be compensating for deficiency in the brain’s left hemisphere during periods of fluent speech (Braun et al. 1997). This explained the observed delay of sensory processing in the left hemisphere of the brains of stutterers, where speech function resides. Jancke, Hanggi and Steinmetz (2004) reported physical differences between the auditory cortices of stutterers and fluent speakers as well. During a study in 1998, dysfluency in stutterers was immediately reduced with the use of techniques that slowed speech and made it more predictable (Salmelin et al. 1998).

“Alterations of auditory feedback (e.g., delayed auditory feedback, frequency-altered feedback), various forms of other auditory stimulation (e.g., chorus reading), and alteration of speech rhythm (e.g., syllable-timed speech) yield a prompt and marked reduction of stuttering frequencyâÂ?¦” (BÃ?¼chel and Sommer 2004)

All of these techniques are commonly used in speech therapy, provided by speech-language pathologists (SLP). An SLP can also recommend the safest and most effective self-therapies for PDS. What’s more, some health insurance plans cover the cost of speech therapy.

It has been suggested since 1998 that stuttering may be pathologically related to Tourette’s syndrome, a neurological disorder that causes uncontrolled movements and vocal outbursts. Increased levels of the neurotransmitter dopamine have been observed in people who suffer from Tourette’s syndrome as well as in stutterers (Abwender et al. 1998). A recent breakthrough in psychopharmacology showed that stuttering improves with the use of an antidopaminergic drug called risperdone, which has also been successfully used to treat the symptoms Tourette’s syndrome (Maguire et al. 2000). This type of drug decreases dopamine levels, but it is still unclear why it reduces stuttering. Risperdone may raise the hopes of people with PDS, but so far the harmful side effects of risperdone outweigh its benefits to otherwise healthy stutterers. Further research and drug development may produce a safer alternative in the future.

In the meantime, developmental stuttering can be reduced and possibly eliminated with early intervention. A child whose stuttering lasts longer than a few months, or worsens over time, should be seen by an SLP for therapy, according to Erica Weir and Sonya Bianchet. “The SLP evaluates the child and then makes appropriate recommendations based on each child and their family according to factors such as severity of disorder, type and frequency of dysfluencies, parental commitment and concomitant developmental delays. For preschool fluency, the first therapeutic step usually involves training the parent to facilitate a more fluent speech environment in day-to-day interactions. The SLP may also provide a home program or monitor the child’s progress regularly. Therapy could occur in a parent education group or in a group with several children and families.” (Weir, Bianchet 2004)

By no means does PDS itself restrict the potential to achieve in any aspect of life. Anyone with PDS can meet the daily challenge of verbal communication with confidence, support, and determination. From famous actors, singers and sports stars to successful statesmen, scientists and corporate geniuses (“Famous People Who Stutter”), many people who stutter are capable of reaching beyond PDS to fulfill their dreams and live their lives without missing a beat.

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