Stuttering Is an Impaired Condition

Stuttering is an impaired condition affecting speech fluency. The definition given by WHO is "impairment of the rhythm of speech wherein the person is exactly aware what is required to be said but 'suffers' from a problem in spelling it out due to an involuntary repetition, prolongation and abrupt stoppage of sound." (Lawrence; Barclay, 1998) Stuttering may be classified into developmental dysfluency that a lot of children might experience and pathologic dysfluency. Stutterers are observed to manifest repetitions as well as prolongations which constitute primary symptoms. Besides, they are also observed to avoid speaking and suffer from frustration which manifest as secondary symptoms. However these basic signs of stuttering could be difficult to differentiate from the 'usual developmental dysfluency'. The secondary symptoms are sometimes a reaction towards the 'negative' types of 'feedback' which a child gets from peer groups and family. Nearly eighty percent of the children faced with stuttering problems are cured around the age of 16 years with speech therapy. (Lawrence; Barclay, 1998)

The incidence of stuttering differs with age. The impairment seem to happen in 3-5% of pre-school children and between 0.7-1.0 of the overall populace leaving aside pre-school aged children. The primary reason for the marked incidence of stuttering in children is ascribed to the increased degree of 'developmental dysfluency' in this populace. 'Developmental dysfluency' outcomes in small durations of stuttering which stop by the stage a child start going to school. Stuttering is found to occur 3-4 times more with regard to boys than compared to girls, the reasons of which are still unknown. The prevalence of shuttering affects all categories of population irrespective of race, language and historical periods. Legendary personalities like John Updike, Winston Churchill, James Earl Jones and King George VI were stutterers. but, the occurrence of stuttering definitely differs across various 'cultures' as well as 'socioeconomic groups'. (Lawrence; Barclay, 1998)

Discussion

(a) Etiology:

Converging theory suggests that the cause of shuttering is multi-factorial, inclusive of genetic, neuro-physiological and psychological causes that render a child to have poor speech fluency. Even though research evidence does not show that concern or conflicts constitute the reason behind stuttering or that person who suffer from stuttering have higher levels of psychological disturbances compared to those with other forms of speech and language disorders, stuttering can be aggravated by certain traumatic situations. The other theories regarding the cause of stuttering cover organic as well as learning models. Organic models cover those that concentrate on unfinished lateralization or abnormal cerebral dominance. A lot of studies using EEG revealed that stuttering males had a problem of right-hemispheric alpha suppression across stimulus words and assignments while non-stutterers had left-hemispheric suppression. Some studies of stutterers have observed an excessive representation of left-handedness as well as ambidexterity. (Sadock; Kaplan; Sadock, 2007)

Studies on twins and striking gender differences in stuttering reveal that stuttering has some genetic basis. Learning theories regarding the reason behind stuttering include the semantogenic theory that places shuttering fundamentally a learned response to normative initial childhood deficiencies. An additional learning model concentrates on classic conditioning, wherein shuttering comes to be accustomed to environmental factors. For example in the cybernetic model, speech is observed as a process which depends in the right feedback for regulation; stuttering is conjectured to happen due to a collapse in the feedback loop. The observation that stuttering is lowered by white noise and that delayed auditory feedback generates stuttering in normal speakers is supported by the feedback theory. It is observed that motor functioning of some children who stutter seems to be delayed or slightly abnormal. (Sadock; Kaplan; Sadock, 2007)

The study of struggling with speech planning demonstrated by some children who stutter indicates that higher-level cognitive dysfunction might be responsible for communication. In case of all children who stutter, mostly with mild cases, 50 to 80% of them recover spontaneously. Children in the school going age who suffer from chronic stuttering might be suffering from problematic peer relationships due to testing and social ostracism. These children might encounter academic problems in case they refrain from speaking out in the class. Subsequent major complications include an affected person's reduced potentialities in occupational choices and career advancement. (Sadock; Kaplan; Sadock, 2007)

(b) Effects on social and cognitive development:

Evidence is available that the environment plays an intervening role in stuttering to the level that frequency and acuteness of stuttering differs across listeners, situations as also the physical environments. Subjective corroboration reveal that children who stutter find it more difficult in the classroom while reading, answering and asking questions, delivering presentations and looking forward for help from the teacher. Children who stutter also said that their stuttering impacts their capability to concentrate in the classroom which is acknowledged to be one of the strongest effects on their social and behavioral development. It has also been recommended that the quality of peer interactions impacts the academic performance, socialization and the healthy development of children and the urgency of probing the consequences of stuttering on peer interactions have been identified since long. (Bothe; Shenkar, 2004)

Even though available research is required to establish the intensity to which children who stutter vary from non-stuttering children in educational and social development, children who stutter were said to have mild intensities of difficulties in adjusting themselves to the educational settings maybe as a consequence of stuttering in the school setting, with some securing one-half standard deviation less than non-stuttering children on intelligence tests and remaining 6 months behind their peers in achievement in school. Research conducted by Woods did not find any differences in social acceptance between boys who suffer from stuttering and their counterparts who are normally fluent, children who stutter and those with other disorders of articulation have overall been observed to possess lower social positions compared to children who are non-handicapped. Children having stuttering problems were also found to be more introvert compared to children who do not have the problem. Apart from that, children who stutter seem to be placed at a greater danger for experiencing adverse peer interactions because of being subjected to bullying and teasing more often compared to otherwise normally fluent children. (Bothe; Shenkar, 2004)

Contemporary research undertaken by Franke, Ebben, van de Poel and Embrechts on Children Who Stutter -- CWS in the year 2000 analyzed the effect on cognitive development by assessing the temperamental aspect using parental reports on the Children's Behavior Questionnaire and revealed that parents ranked their children who stutter as showing lowered 'attention span' as well as reduced success in adjusting to the new situations. The most recent studies undertaken in 2003 by Anderson, Pellowski, Conture and Kelly observed using the Children behavior Questionnaire that CWS were markedly less prone to adjust to changes, 'less distractible' and manifested increased 'irregularity' pertaining to 'biological operations'. Nevertheless, inconsistencies are seen in findings as regards of what aspects CWS vary from 'CWNS -- Children Who Do Not Stutter'. First of all CWS were observed to be considerably less adaptable to their controls. Another difference that was noticed was as regards the terms of distractibility. CWS were markedly more active, but more negative in their temperament and less unrelenting compared to their CWNS. Variables relating to temperament such as the power of the nervous system may result in problems in production of speech, especially under stressful situations. (Furnham; Davis, 2004)

(c) Treatment:

Two individual types of intervention have been used in the treatment of stuttering. Direct speech therapy normally targets modification of the stuttering response to fluent-sounding speech through systematic steps as also rules of speech mechanics that the person is able to practice. An additional form of treatment for stuttering aims at lowering tension and anxiety at the time of delivering speech. These treatments use breathing exercises as well as relaxation techniques, to facilitate children deliver speech at a slower rate and also modulate speech volume. Till the last part of 19th century, the most usual treatment for stuttering constituted distraction, suggestions, and relaxation. Latest strategies using distraction cover teaching stutterers to deliver speech in time to rhythmic movements of the hand, arm or the fingers. Stutterers are also given advice not to speak very fast preferably in a sing-song or monotonous manner. However these strategies tend to eliminate stuttering only for a temporary phase. (Sadock; Kaplan; Sadock, 2007)

Relaxation techniques indicate that it is almost not possible to be relaxed and stutter in the normal manner concurrently. Contemporary interventions for stuttering use personalized combination of behavioral distractions, relaxation methods and directed speech modification. Stutterers having a poor self-image comorbid anxiety disorders or depressive disorders have increased chances of additional treatments. Majority of the modern treatments of stuttering cover components which target stuttering as, in part, a learned behavior which can be adapted by means of behavioral techniques irrespective of the intricacy of the manner in which they started. These strategies function directly with speech problems in order to minimize responses of stuttering, to transform or decrease the acuteness of stuttering through removing the secondary symptoms, and to urge upon the stutterers to speak in the midst of stuttering, in a comparatively simple and easy fashion which aims to remove trepidations and mental blocks. One instance of this strategy is the self-therapy suggested by the Speech Foundation of America which is focused on the assumption that stuttering is not a symptom, rather a behavior which can be corrected. (Sadock; Kaplan; Sadock, 2007)

Stutterers have been advised that they can learn to control their problems in part by correcting their feelings regarding stuttering and mindset towards it and in part by correcting the abnormal behaviors linked with the blocks that come to the forefront during stuttering. The strategy covers desensitizing i.e. lowering the emotional reaction to and uncertainties revolving stuttering and substituting positive action to control the moment of stuttering. The latest mature strategies concentrate on the aspect of restructuring fluency. The complete speech production pattern is remolded with emphasis on a series of target behaviors, covering reduction of rate, simple or gentle starting of voicing, and even shift between sounds, syllables as also words. These strategies have come with considerable success in determining. (Sadock; Kaplan; Sadock, 2007)

Speech therapies that are used for the treatment of stuttering included (i) the metronome method (ii) negative practice (iii) voluntary stuttering (iv) hypnosis (v) syllable-timed speech (vi) ventriloquism (vii) pantomime (viii) fake stuttering (ix) shadowing (x) the chewing method etc. The metronome method involves the stutterer to speak in time to rhythmic movements. Under the negative practice the stutterer is made to learn to control a habit that one would prefer to discard, in this case stuttering, by practicing willfully and with purpose of the very habit. By means of this technique of self-imitation, the stutterer is assisted to undo through conscious method what he fancies not doing. Voluntary stuttering can use two techniques. (Pedrini; Pedrini, n. d.)

Under the first technique, the stutterer is asked to voluntary repeat the initial sound or the first syllable of each word as many a times he thinks it to be necessary prior to completing the remaining part of the word. Hypnosis is also observed to lower the severity of stuttering either as a supplementary procedure of a therapy or the direct reticence of stuttering through post-hypnotic suggestion. On the other hand syllable-timed speech involves speaking in smoothly chest-pulses involving uttering the words syllable by syllable, stressing on every syllable in a smooth manner and uttering it very time to a regular smooth rhythm. Ventriloquizing involves a method that is used to permit the subject so to engage him in a talk without closing his mouth and without moving his lips or tongue. (Pedrini; Pedrini, n. d.)

Pantomime is essentially performing the articulatory practice in the absence of uttering the words in a loud manner. This constitutes an endeavor to educate the stutterer. Fake stuttering is a group method in which the stutterer imitates speech features of another stutterer. A sense of control can be obtained in case the stutterer is proficient at imitating the behavior of other stutterers. In the shadowing method which is also known as echo talk or echo speech, the shutterer is oriented to repeat the things that he is hearing instantly, following nearly immediately the utterance of another person. The chewing method entails having the victim occupied in chewing motions as well as speech concurrently at the point when he is about to stutter. It is believed that this procedure concentrates on the attention of the patient on the process of chewing. (Pedrini; Pedrini, n. d.)