Stuttering
is a disorder of fluency characterized by various behaviors that
interfere with the flow of normal speech. What differentiates
stutterers from non stutterers is the frequency of their disfluency
and/or the severity of their disfluency. Another factor that differentiates
stutterers from non stutterers is that almost invariably the disfluencies
that the stutterer regards as “stutters” are accompanied
by a feeling of loss of control. It is this loss of control, which
can’t be observed or experienced by the listener, that is
most problematic for the stutterer.
Primarily
characterized by repetitions (sounds, syllables, part-words,
whole words, phrases), pauses, and prolongations that differ
in number and severity from those of normally fluent individuals.
Other disorders are characterized by disfluent speech, but the
patterns of disfluency in these other disorders differ from
that seen in developmental stuttering.
People with significant speech difficulty often don't stutter
when singing, talking to animals, or reading to small children,
or when they are alone talking to themselves. Stuttering tends
to persist into adulthood more in males than females. The main
characteristics are:
Inappropriate for age, the patient lacks normal fluency and
time patterning of speech. This is characterized by frequent
occurrences of at least 1 of the following:
Repetitions
of sound and syllable.
Sound prolongations.
Interjections.
Broken words.
Blocking that is audible or silent.
Circumlocutions (substitutions to avoid words hard to pronounce).
Words spoken with excessive physical tension.
Repetitions of monosyllabic whole words (such as "a-a-a-a-a
dog bit me").
These problems interfere with educational or occupational achievement
or with social communication.
If the patient also
has a sensory or speech-motor deficit, the problems with language
are worse than you would expect with these problems.
Associated
Features:
Depression is most commonly seen in adults and adolescents who
stutter. However, this does not mean that all adults and adolescents
who stutter have psychiatric disorders.
Differential
Diagnosis:
Some
disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate
against the following disorders which need to be ruled out to
establish a precise diagnosis.
Developmental
stuttering should be distinguished from acquired stuttering.
Normal speech dysfluency occurs in young children and can be
difficult to distinguish from stuttering. Stuttering exhibits
more nonfluencies, part-word repetitions, sound prolongations
and disruptions in voice airflow. Nonfluent children are more
at ease than children with stuttering.
Cause:
Young
children often go through a short period of stuttering. For a
small percentage (less than 1%), the stuttering progresses from
simple repetition of consonants to repetition of words and phrases.
Later vocal spasms develop with a forced, almost explosive sound
to the speech. Stuttering also tends to run in families. There
is also some evidence that stuttering may be associated with some
neurological deficits but there is also a strong psychological
component.
Treatment:
There are
no absolute therapy or cure for stuttering.
Counseling
and Psychotherapy [ See
Therapy Section ]:
In persistent
stuttering cases, speech therapy may be helpful although stuttering
does tend to be very resistant to any therapies.
Clomipramine,
an SSRI, has been shown to be superior to desipramine, an antidepressant.
