Stuttering

Stuttering (commonly known as stammering in the UK and scientifically known as dysphemia) 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 involuntary sound 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 of the disorder.

Characteristics

Fluency

Speech fluency consist 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.1 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. 1

Related Topics:
Fluency - English - 1

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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. The various behaviors that can disrupt the smooth flow of speech include reptition, prolongations, and pauses: 4

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• Repetition is by far the most common behavior exhibited by stutterers. In speech, repetition occurs when a unit of speech, such as a phrase, word, or syllable, is superfluously repeated. (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, repeat the unit once or twice as opposed to the 6 or so times common from stutterers.
• Prolongations are one of the least typical behavior exhibited by stutterers. Prolongations normally happen with child stutterers and with the sounds {{IPA|/?/}}, {{IPA|/?/}}, {{IPA|/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 common source of disfluency in both 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 may cause the larynx to close, restricting the flow of air necessary for speech. Stutterers refer to this as "blocking". (See Blocking.)

Related Topics:
Larynx - Blocking

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:*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 listeners know that he or she still has the floor and is 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 cannot speak fluently. Each stutterer has different sounds that he or she personally finds difficult to speak, usually plosive consonants or close vowels, and by using filled pauses the stutterer 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 pattern is quite common in teenagers and is also used heavily by some stutterers.

Related Topics:
Interjection - Plosive consonant - Avoidance behavior - Teenagers

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Blocking

Stuttering often 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 speech therapy techniques of "gentle onset" or "passive airflow", where the speaker controls his or her airflow to ease into words, aim to avoid abrupt increases in air pressure, and thereby reduce the likelihood of the Valsalva mechanism activating. Constant use of the Valsalva mechanism in speech can create nerve pathways linking speech to the Valsalva mechanism, making it more difficult to reduce blocking.

Related Topics:
Larynx - Valsalva maneuver - Scuba diver - Barotrauma - Mouth - Chest - Abdomen - Nerve pathway

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Avoidance behavior

When stuttering, stutterers will often use nonsense syllables or less-appropriate (but easier to say) words 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. Finger-tapping or head-scratching are two common examples of tricks, which are usually idiosyncratic and may look unusual to 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, stutterers 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 a person who stutters will do something at some point to avoid, postpone, or disguise a stutter and, by coincidence, will not stutter. The stutterer then makes a cause-effect connection between that new behavior and the release of the stuttering, and the behavior becomes a habit. 4

Related Topics:
Cause-effect - 4

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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 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 do not like on pizzas, or getting a style of haircut they do not 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 embarrassing situations.

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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 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 by 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.2 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 in many cultures may hamper the growth of personal or professional relationships.

Related Topics:
Positive conditions - 2 - Tic - Eye contact

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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:

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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. (See Treatments.) 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.

Related Topics:
Attitude - Metronome - Rhythm - Accent - Dialect - Treatments - Pets - Public speaking - Intoxicated

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Negative conditions

:All speech is more difficult when under 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, time pressure often exacerbates 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 stutterer is not there or the line has been disconnected. Other time pressures will also worsen a stutter, such as saying one's own name, which must be done without hesitation to avoid the appearance that one does not know his or her own name, repeating something just said, or speaking when somebody is waiting for a response.

Related Topics:
Telephone - Body language - Nonverbal communication

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