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Stuttering

Stuttering (scientifically known as dysphemia and as stammering in the UK) is a speech disorder in which the normal flow of speech is frequently disrupted by repetitions (sounds, syllables, words, or phrases), pauses, and prolongations that differ both in frequency and severity from those of normally fluent individuals. The term stuttering is most commonly associated with the involuntary repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by stutterers as blocks, and the prolongation of certain sounds, usually vowels. Much of what constitutes “stuttering” cannot be observed by the listener; this includes such things as sound and word fears, situational fears, anxiety, tension, shame, and a feeling of "loss of control" during speech. The emotional state of the individual who stutters in response to the stuttering often constitutes the most difficult aspect the disorder.

About 1% of the total adult population and 5% of children in the world are afflicted with some form of the disorder, with slightly higher percentage of the total adult population amongst African (8-9%) and West Indies (3-4%) adults. Interestingly, men account for approximately 80% of all stutterers and women are much more likely to either outgrow or recover from the disorder. Stuttering is essentially neurogenic (neuropathological rather than mental) in origin, and is generally not a problem with the physical production of speech sounds (see Voice disorders) or putting thoughts into words (see Dyslexia, Cluttering). Stuttering does not affect intelligence and, apart from their speech problem, people who stutter are normal. Anxiety, low-confidence, nervousness, or stress therefore do not cause stuttering, but they do often worsen it. The disorder is also variable, meaning that in certain situations, such as speaking before a group of people or talking on the telephone, tend to exacerbate a stutter, while other situations, such as singing or speaking alone, often improve fluency. The exact etiology of stuttering is unknown, but genetics and neurophysiology are the two factors that stutters are most commonly attributed to today. A prevalent theory is that this inherited genetic factor may cause the speech pathways in the brain to be less efficient, contributing the development of a stutter. Although there are many treatments and speech therapy techniques available to help increase fluency, there is essentially no "cure" for stuttering.

Causes

There is no known cause for stuttering. What theories there are about the causes of stuttering, or about the factors that contribute to the development of a stutter, can be divided into three categories:

Genetics:

It is known that stuttering is strongly related to the genes, with 50% to 70% of all stutterers being related to another stutterer. While having a stutterer in the family does not automatically create a stutterer, it has been shown to create "stuttering potential" or a "stuttering predisposition." This inherited genetic factor may cause the speech pathways in the brain to be less efficient. The inefficiency of the pathways makes it difficult for the child to meet fluency demands by getting their words out quickly. Genetics may also influence the temperament of the child, which makes some children react negatively to their own early stuttering behavior. In a 1999 study conducted jointly between U.S. and Australian researchers, hundreds of twins who stuttered were examined, with significant differences in concordance rates for stuttering being found between identical and fraternal twin pairs. Also, scientists are working on identifying the "stuttering genes", conducted largely by Stuttering Research Project at the University of Illinois.

Childhood development:

In the past, the cause of stuttering was most often attributed to childhood development. Some theories argue that, in the crucial stages of a child's development, neurotic conflict or disturbed interpersonal relationships during childhood can create a stutter. Others argue that stuttering develops from the normal mistakes all children make when learning to speak (see Onset and development), and that some children get into a vicious cycle of putting a relatively large amount of effort into speaking, tensing their speech-production muscles too much, and worsening their speech. While such activity does worsen an already present stutter, it does not create one. Today, these theories are generally disregarded in favour of the genetic/neurophysical models. Although it is known that children with other speech and language problems or developmental delays are more likely to develop a stutter, it is popularly held that stuttering is one cannot "create a stutterer."

The "Monster" study:

In 1939, a controversial study on the possibility of "creating a stutterer" was conducted by University of Iowa speech pathologist Wendell Johnson and his graduate student, Mary Tudor. The study tried to create stutterers, using 22 unwitting orphans from the Soldiers and Sailors Orphans' Home in Davenport, Iowa over the course of 4 months. Ethically acceptable at the time, it was designed to induce stuttering in normally fluent children and to test out Johnson's "diagnosogenic theory" -- a theory suggesting that negative reactions to normal speech disfluencies cause stuttering in children. The study divided the orphans into 3 groups: 6 orphans who were normally fluent would be given negative evaluations and criticisms regarding their speech, another group of 5 orphans who allegedly already stuttered would also receive that treatment, with the remaining 11 being treated neutrally. The study concluded that the children given negative evaluative labeling went on to develop persistent, permanent stutters. The influence of the study was large at the time, with most speech pathologist and child health and educational professionals quickly accepting the theory. This also greatly influenced the general public, with parents using the "ignore it and it will go away" edict as a general cure for childhood speech disorders. In June 2001, the San Jose Mercury News revealed this study, dubbed the "monster study", to the public for the first time, creating widespread controversy and debate about scientific ethics. Soon after, University of Illinois professors Grinager Ambrose and Ehud Yairi wrote a paper discrediting the 1939 study, revealing flaws in data collection and method, as well as pointing out that none of the orphans actually did develop a permanent stutter. While such treatment during a child's development can certainly make a present stutter worse, it does not, and largely cannot, create a stutter.

Neurophysiology:

Perhaps the most prominent view currently held is that stuttering is caused by neural synchronization problems in the brain. Recent research indicates that stuttering is correlated with disrupted fibers between the speech area and language planning area, both in the left hemisphere of the brain. This disruption could have been caused by early brain damage or a genetic link.

Structural brain imaging, where the anatomy of the brain can be visualized and analyzed has not shown an anatomical difference between the brains of those who stutter and those who do not. However, functional neuroimaging, where processes in the brain can be observed, has shown some differences in the state of stuttering. Differences in brain activity have been observed in other areas that are associated with speech motor function. For example, the area of the primary motor cortex that controls mouth movements, areas associated with perceiving and decoding sounds, and the areas involved with the formulation and expression of language.

Other causes:

Stutters can be acquired late in life, usually through a stroke or other brain trauma and sometimes resulting from neurosurgical procedures. Rarer still are stutters induced from specific medication. Medication such as antidepressants, antihistamines, tranquilizers and selective serotonin reuptake inhibitors have been known to sometimes affect speech in this way. While these afflictions create stutter-like conditions they do not create a stutter in the traditional sense.

Onset and development

Like most other speech disorders, stuttering begins in early childhood, when a child is first developing their speech and language skills. The vast majority of stutters develop between the ages of two and five, with many outgrowing it before adolescence. There have been cases of a stutter developing later, but those cases are extremely rare and the vast majority of stutters manifest before the age of 7. Almost all children go through a stage of disfluency in early speech, but when a child displays signs of a serious stutter, it is wise to seek professional help as stutters are much easier to prevent or lessen in their early stages. Stuttering can become a serious disability and an untreated stutter usually becomes worse with time. For a developing child, it can bring about lower self-esteem and can increase anxiety and stress; all of which only serve to worsen a stutter. Stutters can and often do hamper social development and limit educational and professional opportunities.

As speech and language are difficult and complex skills to learn, almost all children have some difficulty in developing these skills. This results in normal disfluencies that tend to be single syllable, whole word, or phrase repetitions, interjections, brief pauses, and revisions. In the early years, a child will not usually exhibit visible tension, frustration or anxiety when speaking disfluently and most will be unaware of the interruptions in their speech. Common with young stutterers is a that their disfluency tends to be episodic; periods of stuttering are followed by periods of relative fluency. This remains through all stages of a stutter's development, but to increasingly narrow degrees. As the stutter develops, the disfluencies present tend to develop more into repetitions and sound prolongations, often combined together (e.g., "Lllllets g-g-go there").

Usually by the age of 6, a stutterer begins to have their stutter exacerbated when excited or upset or when under some type of pressure. Also around this age, a child will start to become aware of problems in their speech. After this age, stuttering regularily includes repetitions, prolongations, and blocks. It also becomes more and more chronic, with long periods of disfluency, and secondary motor behaviors (eye blinking, lip movements, etc.) may be used during moments of stuttering or frustration. Also, fear and avoidance of sounds, words, people, or speaking situations usually start to ferment along with feelings of embarrassment and shame.

By age 14 on, the stutter is usually classified as an "Advance stutter" and is now characterized by frequent and noticeable interruptions, with the stutterer usually having poor eye contact and starting to use various tricks to disguise their stuttering. Along with a mature stutter comes advanced feelings of fear and increasingly frequent avoidance of unfavorable speaking situations. Around this time they are also become fully aware of their disorder and may identify themselves as a "stutterer." With this comes deeper frustration, embarrassment and shame. It is important to note that stuttering does not affect intelligence and that stutterers are sometimes wrongly perceived as being less intelligent than non-stutterers. This is mainly due to the fact that stutterers often resort to a practice called word substitution: where words that are difficult for a stutterer to speak are substituted for usually less-suitable (and sometimes completely unsuitable) words that are easier to pronounce. This usually leads to awkward or grammatically incorrect sentences that create the impression of feeble-mindedness. Stuttering is a communicative disorder that affects speech; it is not a language disorder -- although a persons use of language is often affected or limited by a stutter.

Development of a stutter

Phase 1# (age 2-6):

* Disfluencies tend to be single syllable, whole word, or phrase repetitions, interjections, pauses, and revisions.

* The child will not exhibit visible tension, frustration or anxiety when speaking disfluently.

* Normal disfluency will occur when the child is learning to walk or refining motor skills.

* There are periods (days or weeks) of fluency and disfluency

* Changes in the child's environment can cause normal disfluency.

Phase 2# (age 2-6):

* Disfluencies tend to be repetitions and sound prolongations

* More than two disfluencies put together (e.g., "Lllllets g-g-go there") and periods of fluency and disfluency come and go in cycles.

* The child demonstrates little awareness or concern about his/her disfluencies but may express frustration

Phase 3# (age 2-6):

* Disfluency most commonly occurs at the beginning of words or phrases.

* The child tends to be more disfluent when excited or upset

* Repetitions are usually part-word as opposed to whole-word

* The stuttering comes and goes in cycles, sometimes triggered by events and stressors

* The child may show awareness that speech is difficult in addition to the frustration

Phase 4# (age 6-13):

* Types of disfluencies include repetitions, prolongations, and blocks.

* Stuttering becomes chronic, without periods of fluency

* Secondary behaviors appear (eye blinking, limb movements, lip movements, etc.)

* Stuttering tends to increase when excited, upset or under some type of pressure.

* Fear and avoidance of sounds, words, people, or speaking situations may develop.

* The person may feel embarrassment or shame surrounding the stuttering

Phase 5# (age 14+):

* Speech is characterized by frequent and noticeable interruptions

* The person may have poor eye contact and use various tricks to disguise the stuttering

* Person anticipates stuttering, fears and avoids speaking

* The person identifies him/herself as a stutterer and experiences frustration, embarrassment and/or shame.

* The person may attempt to choose a lifestyle where speaking can often be avoided.

Characteristics

Fluency:

Speech fluency consists of three variables: continuity, rate, and ease of speaking. Continuity refers to speech that flows without hesitation or stoppage. Rate refers the speed in which the words are spoken. For English speaking adults, the mean overall speaking rate is 170 words per minute (w/m), substantially quicker than the approximately 120 w/m that stutterers produce. Ease of speaking refers to the amount of effort being expended to produce speech. Fluent speakers put very little muscular or physical effort into the act of speaking, while stutterers exert a relatively large amount of muscular effort to produce the same speech. In addition to the physical effort involved in producing speech, the mental effort is usually much greater in stutterers than non-stutterers.

Disfluency in speech, including repetitions and prolongations, is normal for all speakers, but stuttering is distinct from normal disfluency in that it occurs with greater frequency and severity -- the disfluencies occur much more often and tend to last longer with more strain. The types of disfluencies are also markedly different: normal disfluencies tend to be a repetition of whole words or the interjection of syllables like "um" and "er," while stuttering tends to be repetition and prolongation of sounds and syllables. Of the various different behaviors that can disrupt the smooth flow of speech, 3 categories can be produced:

* Repetition is by far the most common behavior exhibited by stutterers. In speech, repetition is when a unit of speech - a phrase , word, or syllable - is repeated superfluously. Examples of repetition for a phrase would be, "I want.. I want.. to go.. I want to go to the store," or, "I want to go to the - I want to go to the store." A word repetition would often resemble, "I want to-to-to go to the store," and a syllable or sound repetition being, "I wa-wa-want to go to the store," or, "I w-w-want to g-go to the store." Repetition occurs in the speech of both stutterers and non-stutterers, but non-stutterers are less likely to repeat shorter units of speech, mainly repeating phrases and sometimes words but rarely syllables. Non-stutterers will also, in the majority of cases, iterate the unit once or twice as opposed to 6 or so times common from stutterers.

* Prolongations are one of the least typical behavior exhibited by stutterers. Prolongations normally happens with child stutterers and with the sounds /th/, /sh/, /v/, or any other fricative consonant or vowel. With stutterers, prolonging a sound sometimes leads to a pitch and volume increase.

* Pauses are also a very common source of disfluency in stutterers and non-stutterers. Most pauses can be divided into two categories: filled pauses and unfilled pauses.

* Unfilled pauses are extraneous portions of silence in the ongoing stream of speech. These pauses differ from the pauses that punctuate normal speech, where they reflect common sentence structure or are used to add a particular rhythm or cadence to speech. Unfilled pauses by stutterers are usually unintentional and causes the larynx to close, restricting the travel of air necessary for speech. Stutterers refer to this as "blocking."

* Filled pauses are interjections typical in normal speech like "um", "uh", "er", and so on. In speech these serve as a kind of place-holder -- a way a speaker lets their listener know that they still have the floor and are not finished speaking. In addition to being used as a way of preempting interruption, they are also used by stutterers as a way of easing into fluency or deflecting embarrassment when they can not speak fluently. Each stutterer has different sounds that they personally find difficult to speak, usually plosive consonant or close vowels, and by using filled pauses they can ease into continuous speech that otherwise would be more difficult to begin. This is a form of avoidance behavior. Another element of speech that is similar to filled pauses are parenthetical interjections -- interjections like "so anyways", "like", or "you know." This is especially common in teenagers and also used heavily by some stutterers.

Blocking:

Stuttering almost always develops into blocking, where the first letter or syllable becomes very difficult to pronounce and is in effect "blocked" from being spoken. When this happens the larynx closes, halting the flow of air. This closure is very similar to the closure of the larynx during the Valsalva maneuver - a maneuver commonly used as pressure equalization technique by scuba divers and airplane passengers to avoid barotrauma. The Valsalva maneuver intentionally exploits the Valsalva mechanism, which is a natural mechanism involving a group of neurologically coordinated muscles in the mouth, larynx, chest, and abdomen. The mechanism is used to help force things out of the body, for example during defecation, urination, or childbirth, and is also present during unusual physical exertion, like weightlifting. In extreme cases, attempts to force air against this for too long or with to much strength will induce dizziness and light-headedness upon cessation. The speech therapy techniques of "gentle onset" or "passive airflow", where the speaker controls their airflow to ease into words, aim to avoid abrupt increases in air pressure and thereby reduce the likelihood of the Valsalva mechanism activating. Left unchecked, the constant use of the Valsalva mechanism in speech could cause the development of strong nerve pathways linking speech to the Valsalva mechanism, thereby making it more difficult to reduce blocking.

Avoidance behavior:

When stuttering, stutterers will often use nonsensical syllables or other, frequently less appropriate, words that they do not stutter upon to ease into the flow of speech. Stutterers also may use various personal "tricks" to overcome stuttering or blocks at the beginning of a sentence, after which their fluency can resume. These tricks, finger-tapping or head-scratching are just two common examples, are usually idiosyncratic and unusual for the listener. In addition to word substitution or the use of filled pauses, stutterers may also use starter devices to help them ease into fluency. A common practice is the timing of words with a rhythmic movement or other event. For instance, a stutterer might snap their fingers as a starter device at the beginning of speech. These devices usually do work, but only for a short amount of time. Often times a person who stutters will do something at some point to avoid, postpone, or disguise a stutter and, by coincidence, not stutter. The stutterer then makes a cause-effect connection between that new behavior and the release of the stuttering behavior and it becomes a habit.

As stutterers often resort to word substitution in order to avoid stuttering, some develop an entire vocabulary of easy to pronounce words in order to maintain fluent speech -- sometimes so well that no one, not even their spouses or friends, know that they have a stutter. Stutterers who successfully use this method are called "covert stutterers" or "closet stutterers". While they do not actually stutter in speech they nevertheless suffer greatly from their speech disorder. The extra effort it takes to scan ahead for feared words or sounds is stressful and the replacement word is usually not as adequate of a choice as the stutterer originally intended. Famously, some stutterers drastically limit their options when dealing with employees at given establishments; only eating cheeseburgers at fast-food restaurants, ordering toppings they don't like on a pizzas, or getting haircuts they don't want as a by-product of their inability to pronounce certain words. Some stutterers have even changed their own given name because it contains a difficult to pronounce sound and frequently leads to very embarrassing situations.

Severity:

When the behaviors of a stutter are infrequent, brief, and are not accompanied by substantial avoidance behavior, the stutter is usually classified as a mild or a non-chronic stutter. Non-chronic stuttering is often called "situational stuttering" because the afflicted person generally has difficulty speaking only in isolated situations -- usually during public speaking or other stressful activities -- and outside of these situations the person generally does not stutter. When the behaviors are frequent, long in duration, or when there are visible signs of struggle and avoidance behavior the stutter is classified as a severe or chronic stutter. Unlike mild or situational stuttering, chronic stuttering is iteratively present in most situations, but can be either exacerbated or eased depending on different conditions (see Positive conditions). Severe stutters often, but not always, are accompanied by strong feelings and emotions in reaction to the problem such as anxiety, shame, fear, self-hatred, etc. This is usually less present in mild stutterers and serves as another criteria in which to define stutters as mild or severe. Another way of discerning between the two severities is by percentage of disfluency per 100 words. When a speaker experiences disfluencies at a rate around 10%, they usually have a mild stutter, while 15% or more is usually indicative of a severe stutter. In addition to the disfluency, many people who stutter display secondary motor behaviors. Observers often notice muscles tensing up, facial and neck tics, excessive eye blinking, and lip and tongue tremors. In extreme cases entire body movements may accompany stuttering. Most common with stutterers is the inability to maintain eye contact with the listener, which may in turn hamper the growth of personal or professional relationships.

It is worth noting that the severity of a stutter is not constant and that stutterers often go through weeks or months of substantially increased or decreased fluency. Stutterers universally report having "good days" and "bad days" and report dramatically increased or decreased fluency in specific situations. Below is an overview of the circumstances that harm and help the fluency of most stutterers:

Positive conditions:

Subtle changes in mood or attitude often greatly increase or decrease fluency, with many stutterers developing tricks or methods to achieve temporary fluency. Stutterers commonly report dramatically increased fluency when singing, whispering or starting speech from a whisper, speaking extremely slowly, speaking in chorus, speaking without hearing their own voice (e.g. speaking over loud music), speaking with a metronome or other rhythm, speaking with an artificial accent or voice, speaking in a foreign dialect, or when speaking while hearing their own voice with a minuscule delay or pitch change. Stutterers also display increased fluency when speaking to non-judgmental listeners, such as pets, children, or speech pathologists. It is perhaps most interesting to note that most stutterers experience extraordinary levels of fluency when talking to themselves. A rare few even experience increased fluency when they exclusively "have the floor" (public speaking or teaching), when they are intoxicated, or when they are explicitly trying to stutter. There is no universally accepted explanation for these phenomena.

Negative conditions:

As there are certain situations that make speaking easier, there are also circumstances that make speaking more difficult. As a general principle, stuttering, and all speech in general, is made more difficult when under any form of pressure. Commonly, social pressures, like speaking to a group, speaking to strangers, speaking on the telephone, or speaking to authority figures, will irritate and make worse a stutter. Also, almost any form of time pressure will immediately exacerbate a stutter. Pressure to speak quickly when answering or conversing is usually very difficult for a stutterer, particularly on the telephone where stutterers do not have body language to aid themselves. This usually leaves dead silence in the place of nonverbal communication, which will indicate to the listener that the stutter is not there or the line has been disconnected. Other time pressures will also worsen a stutter, such as saying ones own name, which must be said without hesitation to avoid the appearance that one does not know their name, repeating something just said, or speaking when somebody is expressly waiting for or needs a response.

Treatments

There are many treatments for stuttering; none of which are 100% effective. Traditional speech therapy mainly serves to reduce the frequency and severity of a stutter and to teach stutterers to use effective communications skills, such as making eye contact. While not a cure, therapy can, and often does, offer positive results and more fluent speech patterns and is especially effective when used in early childhood. The duration or type of stuttering therapy needed varies among stutterers but usually involves both speech training (articulation, intonation, rate, intensity) and language training (phonology, morphology, syntax, semantics). Depending on the nature and severity of the disorder, common treatments may range from physical strengthening exercises and repetitive practice to the use of medication, electronic devices, and neurosurgery.

Behavioral and cognitive therapy:

Behavioral and cognitive therapy is the most common approach to stutter treatment. Speech therapy usually involves the development of new speaking habits and attitudes towards speech, often including exercises in manipulating rate of speech, establishing new breathing patterns, practicing relaxation, and targeting troublesome sounds. Breathing control is often paid some of the most attention, notably with the del Ferro method, which focuses on proper control of the diaphragm. Proponents of the method hold uncoordinated movements of the diaphragm as the core cause of stuttering. Also, efforts are made to increase confidence in the individual through repetition and positive feedback to help alleviate the anxiety and fear associated with speaking. While individual or group therapy with a licensed speech pathologist is common, self-therapy is also a very popular practice, mainly due to its cost, convenience, and low pressure. The stutterer invests in the necessary books or tapes and spends varying amounts of time per day doing exercises similar to the exercises in professional speech therapy. Therapy usually will offer some improvements to most individuals within a few weeks or months. But, like most therapy for other disorders or afflictions, it often requires constant attention and practice to maintain success. Other, less-accepted methods include everything from hypnosis to laughter or art therapy.

Medication:

The use of medication that affects brain functions has also had some limited success in increasing fluency, although it is usually taken in conjunction with behavioral and cognitive therapy and has side effects that sometimes make it difficult or impossible to take the medication for extended periods of time. To date only two have medications, haloperidol and risperidone, have proven to be effective in a rigorous double-blind, placebo-controlled trial. Unfortunately, both drugs are associated with side effects that limit their compliance, with haloperidol having far more severe side effects than risperidone. The largest study of risperidone for stuttering was completed by the University of California Stuttering Research Group. In the study, the medication induced fluency and was well tolerated by the participants and the side effects observed with haloperidol were not present. However, other side effects associated with the hormone prolactin developed and the medication was discontinued. Another drug, olanzapine, is similar to risperidone and haloperidol, but has a different side effect profile and has not yet been tested under a comparable double-blind, placebo-controlled trial. While the medicinal treatments for stuttering have vastly improved over recent years, there is still no medication that can “cure” stuttering. Like traditional speech therapy, the best ones only decreasing the frequency and severity of a stutter.

Electronic fluency aids:

One of the most recent trends in speech therapy is the use of electronic fluency aids. The devices are mostly based on altering the pitch with which the speaker hears his or her own speech (frequency altered feedback, altered auditory feedback), playing back speech slightly delayed (delayed auditory feedback), playing white noise (to disallow the individual from hearing his own voice), and the playing of slow and steady clicks, much like a metronomes. These approaches have either been found to offer great success or to have no effect whatsoever. It is still largely unclear why these devices works in alleviating stutters. Recent advances in digital technology has made the commercial application of these devices possible and products are already available, although they have yet to be widely adopted due to their high cost. The most popular form of electronic fluency aids are devices that are placed inside the ear, resembling hearing aids.

Reactions to stuttering

Stuttering has often featured prominently in popular culture and in society at large for centuries. Because of the unusual sounding speech that is produced, and the behaviors and attitudes accompanying a stutter, stuttering has frequently been a subject of scientific interest, curiosity, discrimination, or ridicule. Stuttering was, and essentially still is, a riddle with a long history of speculation and interest into its causes and cures and is by no means a recent phenomena. Stutterers can be traced back centuries through the likes of Demosthenes, Aesop, and Aristotle -- and with some interpreting a passage of the bible to indicate Moses to have been a stutterer. Misinformation and superstition did, and to a lesser extent still do, influence society's perceptions of the causes and remedies of a stutter, as well as the intelligence and perceived disposition of people afflicted with the disorder.

The well-known author of , hoped to become a priest but was not allowed to because of his stuttering. In response, he later wrote a poem which mentions stuttering: Learn well your grammar, And never stammer, Write well and neatly, And sing soft sweetly, Drink tea, not coffee; Never eat toffy. Eat bread with butter. Once more don't stutter. Enlarge The well-known author of Alice in Wonderland, Lewis Carroll hoped to become a priest but was not allowed to because of his stuttering. In response, he later wrote a poem which mentions stuttering: Learn well your grammar, And never stammer, Write well and neatly, And sing soft sweetly, Drink tea, not coffee; Never eat toffy. Eat bread with butter. Once more don't stutter. Partly due to the lack of intelligence he was perceived to have because of his stutter, Roman Emperor Claudius was initially shunned from the public eye and excluded him from public office. This exclusion from public life suited his inclination towards the academic and gave him time for study. His infirmity is also thought to have saved him from the fate of many other Roman nobles during the purges of Tiberius and Caligula's reigns. With his study of history, Claudius became very knowledgeable about governmental institutions which aided him when emperor. Balbus Blaesiuse is another Roman who stuttered severely, so much that he became an 'exhibit' in a freak show, which displayed him locked in a cage. His last name, Blaesius, is now the Italian word for stuttering. Isaac Newton, the famous English scientist who developed the Law of gravity, also had a stutter. Another famous Englishman who had a stutter was Winston Churchill, a British politician best known as Prime Minister of the United Kingdom during World War II, who even thought that his mild stutter added an interesting element to his voice: "Sometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience. . ."

For centuries "cures" such as speaking with a pebble in the mouth, consistently drinking water from a snail shell for the rest of one's life, "hitting a stutterer in their face when the weather is cloudy", strengthening the tongue as a muscle, and various herbal remedies were often used; clearly to little effect. Similarly, in the past people have subscribed to various theories about the cause of stuttering which, with todays new scientific understanding of stutters, one might consider odd. Problems such as tickling an infant too much, a mother eating improperly during breastfeeding, allowing an infant to look in the mirror, cutting the child's hair before they say their first words, the child having a small tongue, or the "work of the devil" were all prevalent myths about the cause of stuttering. Roman physicians attributed stuttering to an imbalance of the Four bodily humors; yellow bile, blood, black bile, and phlegm. Humoral manipulation continued to be the dominant treatment until the eighteenth century. Italian pathologist Giovanni Morgani attributed stuttering to deviations in the hyoid bone, a conclusion he came to via autopsy. Later in the century, surgical intervention, via esection of a triangular wedge from the posterior tongue to prevent spasms of the tongue, was tried.

More recently, films like A Fish Called Wanda and A Family Thing deal more with the contemporary reactions to and portrayals of stuttering. In A Fish Called Wanda, a lead character, played by Michael Palin, has a severe stutter and low self-esteem. His character -- who is socially awkward, nervous, an animal-lover, and reclusive -- accurately captures the stereotypical image of stutterers that is most prevalent today. The three other characters generally make up the spectrum of reactions to stuttering: Jamie Lee Curtis's character is sympathetic and sees past it, John Cleese's character is polite but indifferent, and Kevin Kline's is malicious and sadistic. Upon release the film caused controversy amongst some stutterers who disliked the film for its portrayal of Palin's character as a pushover and the bullying his character receives, and received favour from others who valued the film for showing the difficulties stutterers commonly face. It is worth noting that Palin, whose father was a stutterer, stated his intention in playing the role as being to show how difficult and painful stuttering can be. He also donated to various stuttering-related causes and later founded the Michael Palin Centre for Stammering Children in London.

In addition to personal feelings of shame or anxiety, outside discrimination is still a significant problem for stutterers. The vast majority of stutterers experience or have experienced bullying, harassment, or ridicule to some degree during their school years, and with this trend usually carrying over into the workplace. Stuttering is legally classified as a disability in many parts of the world, affording stutterers the same protection from wrongful discrimination as for people with other disabilities. The UK Disability Discrimination Act 1995 and the Americans with Disabilities Act of 1990 both specifically protect stutterers, and many cases have been brought up with regards to wrongful dismissal or discrimination. Along with disability legislation, many stutterer rights groups have formed to address these issues. One interesting example being the Turkish Association of Disabled Persons, which successfully appealed to the major Turkish telephone company Telsim, resulting in reduced rates for people with stutters or other speech disabilities because of the additional time it takes them to converse on the telephone. Also, the U.S. Congress passed resolution in May 1988 designating the second week of May as Stuttering Awareness Week, in addition to International Stuttering Awareness Day, which is held internationally on October 22.

Even though public awareness of stuttering has improved markedly over the years, misconceptions are still very common, usually reinforced by media portrayals of stuttering and various folk myths. A 2002 study conducted by University of Minnesota Duluth set out to query into what the general public knows and thinks about stuttering. Focusing on college-age students, the study found that a large majority viewed the cause of stuttering as simply nervousness or as a result of low-confidence, and "slowing down" as the most reported course of action for recovery. Also, many parents of children who have or are suspected to have a stutter still erroneously subscribe to the belief that ignoring the speech problem is the surest way toward rehabilitation. While these misconceptions are damaging, groups and organizations are making significant progress towards a greater public awareness.


The information above is not intended for and should not be used as a substitute for the diagnosis and/or treatment by a licensed, qualified, health-care professional. This article is licensed under the GNU Free Documentation License. It incorporates material originating from the Wikipedia article "Stuttering".

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