About Stammering

What is Stammering / Stuttering ?
Stammering or Stuttering is a speech problem which occurs when the speaker is not able to maintain a smooth forward flow of speech and experiences recurrent blocks in the production of speech sounds in conversational speech, particularly when excited or under psychological stress. A person who stammers often has difficulty in smoothly coordinating breathing exhalations during speech caused by lack of synchrony between his thoughts and his speaking machine. Most persons who stammer attempt to avoid or substitute particular words and situations. The problem has both physical and psychological overtones. Stammering is not a disease but an undesirable speech habit with causes havoc with the sufferer’s self-confidence.

Is Stammering different from Stuttering ?
Stammering and Stuttering mean exactly the same condition. It is called ‘Stammering’ in England while Americans call it Stuttering. No difference

What is the incidence of stammering?
Stammering is said to affect approximately 1% of the global population and occurs uniformly regardless of race, culture, education or socio-economic status.

Does it affect only males?
Stammering is predominantly a ‘male’ condition and 80% of all persons who stammer are male. It is usually known to affect the first-born male child.

Is stammering inherited?
A significant majority of persons who stammer (65%) have a family history of the disorder; usually the father who stammers or speaks at a rapid rate. Nearly always, stammering starts before the child is 5 years of age. If left untreated, it peaks in severity around the age of 10 to 18 years.

What is the real cause for stammering?
A person who stammers knows precisely what he wants to say but cannot, for the moment, say it because of an involuntary repetition, prolongation or cessation of the speech sound.

Research suggests that the disorder might be caused due to a ‘neurological mistiming’ during the act of speech which leaves the person who stammers confused about when exactly to say the word he wants to say.

Speaking is not merely the movement of the tongue but involves a fine coordination of both mental and physical processes. Like all other physical actions, the act of speech is the result of neuro-muscular coordination which involves the transmitting of electro-chemical messages from the brain to the appropriate muscle groups. For everyone of us, this neuro-muscular system sometimes trips and fails especially during moments of inadequate emotional control. Haven’t we all found the quality of our speech delivery changing with our feelings as we experience thrill, anger, fear, joy or other such strong emotions?

For the person who stammers, this ‘tripping’ occurs much more frequently than it does for normal speakers. Whenever he faces what he perceives as a ‘feared’ situation, the person who stammers adopts a mind-set which triggers off spasms of speech-blocks. Such fears can also center around certain speech sounds or even certain people.

Dr. Edward Conture, Professor of Speech Pathology at Syracuse University, New York, talks about what causes stammering :
“Things that cause stammering may be, and probably are, quite different from the things that keep it going, aggravate or worsen it. For example, if you mishandle a knife, you may cut your finger. The knife causes the cut and initial pain. Salt rubbed into the cut makes the pain continue or even worsen it but the salt does not cause the cut”. Dr. Conture says, scientists “…still haven’t found the ‘knife’ that causes stammering. However, we do know something about the ‘salt’ that keeps it going, makes it worse or aggravates it”.

These are aspects which can be changed through self-therapy to help the person overcome his speaking difficulty.

Why can persons who stammer sing without difficulty?
One more of the unusual facts about stammering is that even the person with the severest stammer can sing fluently without any speech blocks. This is because when we sing a song, we know exactly when to say the words and there is no ambiguity in our minds about this timing. In conversational speech however, we cannot bank on any such cues but as normally fluent speakers, most of us do not need these cues. However, without these cues, the speech of a person who stammers becomes disoriented, because of his ‘wrongly tuned’ neurological speech-timing system. He experiences difficulty in maintaining a smooth forward flow of words in feared situations.

What are these ‘feared situations’?
Actually, all persons who stammer have periods of fluency when they are emotionally relaxed but revert back to dysfluent speech under stress. Answering the roll call in class, speaking on the telephone, talking to someone in authority, speaking in a group, attending a job interview, etc. are some such pressure situations which might cause an increase in stammering behaviour.

So is stammering a psychological condition?
Frequently repeated, experiences of stammering arouse fear in the mind of the child who stammers. With growing years, these fears keep snowballing until the person who stammers begins to experience tremendous frustration, anxiety, shame, embarrassment, even guilt every time he opens his mouth to speak. He begins to recoil from speaking. The smirks on the faces of his listeners which his speech sometimes elicits, do nothing to help his self confidence. In every other respect, except speaking ability, the person who stammers is a completely normal human being, as good or bad as the rest of us. In fact most persons who stammer are sensitive and intelligent people.
So the psychological repercussions of his stammering can very well keep the problem alive by catching him in a vicious circle. The more he is afraid, the more he stammers and that in turn increases his fear of speech. Any treatment-plan must consider this aspect carefully.

Isn’t there any medicine for stammering?
Speech is one of our body’s strongest habits and stammered speech is also a habit. Stammering is not a disease and therefore, it cannot be treated through medicines. The stammering child or adult has to be helped to develop a new, more fluent manner of speech through an intensive re-orientation program which focuses on modifying his physical manner of talking as well as changing his mental attitude towards the problem. With the greater sense of emotional and intellectual balance that he gains, the person who stammers finds his attempts to develop speech getting successful results.

In their desperate search for fluency, many in India subject themselves to a myriad of so-called treatments ranging from swallowing vile concoctions to allowing themselves to be pierced with needles and cut with knives. Actually, such treatments hold no relevance to the problem of stammering and are only placebos which cause greater frustration in the long run by corroding the sufferer’s faith in a real and long-lasting cure.

Do tranquilizers help?
Some psychiatrists might prescribe tranquilizers in the belief that relieving stress would help speech fluency. Such drugs usually complicate, rather than resolve the issue and are strongly de-recommended for the treatment of stammering by most speech pathologists.

Dr. Peter Rosenberger, M.D., Director, Learning Disorders Unit at Harvard Medical School, Boston says “Since the increase in stammering during anxiety is a common experience, it might be assumed that drugs that relieve anxiety would be beneficial. However, minor tranquilizers have been tried many times without success”.

What about hypnosis?
Hypnosis has also shown unpromising results in the treatment of stammering. A few persons who stammer who might become fluent while under a trance invariably return to stammering when out of the hypnotic state.

So what is the treatment that works?
In the final analysis, stammering can be overcome if the sufferer seeks scientific, professional guidance and is ready to work towards achieving speech fluency through regular practice of therapeutic techniques. It certainly cannot disappear by ingesting some magic potent!

Children who Stammer:

When their 3 to 5 year old child begins to hesitate/stammer or stutter, parents naturally become worried about this and may unknowingly handle the problem incorrectly resulting in increasing rather than decreasing the stammering. Here is a typical case-history:

“Mu..mmm..mum..mummy! We wa.wa.wa..won the mmm..mmmatch!” Mrs. Sharma’s body tenses up whenever she hears her 10-year old son stammering. She becomes desperate herself, when Amit gets stuck on a word and struggles so hard to speak it out. His young-er brother speaks absolutely normally which makes it even more difficult for Amit. Mrs. Sharma : “Sometimes, a class-mate might tease him and that makes Amit feel as if he is abnormal. Last year he used to come home crying. He speaks quite well with everyone at home or with some of his friends. He has no difficulty when he sings or recites from memory. But when the teacher asks him to read in class, he breaks down into severe stammering. The problem is especially noticeable when he is excited or angry. Talking on the telephone is also difficult for Amit. From the time he was 4 years old and had started stammering, we had mentioned it to our pediatrician but he advised us not to worry because it would disappear when Amit reached 6 years of age. Now, 4 years later, the problem is in fact increasing. I feel helpless.” – Mrs. Sharma, New Delhi.”.

Children who have a case background history similar to Amit’s need to be handled with special gentleness and support from parents. Feeling increasingly concerned about their child’s speech problem, parents employ a variety of corrective methods ranging from scolding or even beating the child (in extreme cases) to frequently correcting him or promising him rewards if he is fluent to getting angry or upset with him. All these techniques only indicate the degree of the parent’s worry and need to be changed. Continued parental counselling is provided. This forms half of the therapy plan. Alongside, the child is given certain simple therapy practices to help him time his speech better and to develop habits of easier breathing patterns.

How do you treat children/adults with unclear speech? If a child cannot pronounce the Ka or Ga sounds or when someone cannot say the R sound correctly?
The tongue is a pure muscle and speech clarity depends upon the placement of the tongue as it contacts the teeth or lips to form most speech sounds. Sometimes a small surgical procedure is needed to release a tied tongue. This 15-minute surgery is done by a qualified plastic surgeon in Pune. Dr. S.G.Pandit, M.S., M.Ch.
So our goal is to first identify sounds which come out unclear in spontaneous speech, then grade them according to complexity and start practicing the sound repeatedly once it is learnt.

How should non-stammerers (i.e. normally fluent speakers) react when they encounter a person who stammers?

In India where even today, stammering is considered funny; where the comedian in our films still stammers in search of cheap laughs, one of the primary goals of The Speech Foundation is to disseminate correct information about this baffling speech condition and suggest ways to overcome it.