Adult Male Stutterer an Analysis

Adult Male Stutterer

An Analysis of the Incidence, Treatment and Implications of Stuttering for the Adult Male

Stuttering is virtually universal in all societies, but it remains fairly rare with only about one percent of the world's population suffering from this condition. The growing body of evidence on the causes and incidence of stuttering has pointed to various genetic, cultural and familial factors, but all of these factors would appear to play a role to varying degrees in every case. To determine the incidence, treatment and implications of stuttering for the typical adult male American, this paper provides a review of the relevant scholarly and peer-reviewed literature concerning stuttering in general and adult male stutterers in particular, followed by a summary of the research in the conclusion.

Review and Discussion

Causes and Incidence of Stuttering.

Stuttering, or dysphemia (the term is seldom used) (Wingate, 1997), is a speech defect that affects both the fluency and rhythm of speech; the condition is characterized by involuntary repetition of sounds or syllables and the intermittent blocking or prolongation of sounds, syllables, and words (Gibbons & Sims, 2006). There appears to be some type of anticipatory element involved in stuttering, with adult stutterers being able to accurately predict 95% of the words over which they will stutter in reading aloud a given passage before doing so; this factor has led some researchers to believe that when adult stutterers anticipate having problems with certain words, it acts like a self-fulfilling prophecy that actually produces the stuttering (Gibbons & Sims, 2006). According to these authors, "Stutterers consistently have difficulty with certain types of words: those beginning with consonants, initial words in sentences, content words (nouns, verbs, adjectives, opposed to function words like pronouns and prepositions), and words of several syllables. Since these are also the types of words that produce hesitation in normal speakers, there seems to be some link between stuttering and normal disfluency (pauses, repetition)" (Gibbins & Sims, 2006, p. 87). While the anticipatory element usually begins during childhood when parents or caregivers overreact to natural pauses and hesitations, this factor seems to linger well into adulthood for those stutterers that are unable to resolve this issue. For instance, one-40-year-old stutterer reported that, "Anticipatory fear is 80% of the problem" (Goff, 2000). There is also some indication of a genetic component among stutterers, but the findings of the studies to date suggest that this is attributable more to a neurological predisposition or to environmental factors than to a specific genetic trait for stuttering (Gibbons & Sims, 2006). Nevertheless, research is underway at the National Institutes of Health in an attempt to gain an understanding of the genetic link to stuttering because a number of stutterers have a parent that also stuttered (Goff, 2000).

While stutterers do not usually suffer from a specific organic defect that causes their condition (Gibbons & Sims, 2006), there are some physiological and emotional components involved in most cases that must be taken into account (Fitzgerald & Greiner, 1992). For instance, cultural attitudes concerning fluency can also contribute to an increased incidence of stuttering: "The Igbo (Ibo) people of West Africa, who prize public-speaking ability, have a rate of stuttering almost three times the world average (about one percent of most populations stutter). The fact that five times as many boys as girls stutter in Western culture may be linked to greater performance pressure put on males" (emphasis added) (Gibbons & Sims, 2006, p. 87). Performance demands were also identified by Attanasio and Packman (2004) as contributing to a higher incidence of stuttering among adult male in the West.

Although the precise causes of stuttering remain under investigation and studies have not identified any universal organic deficient, abnormal brainstem functioning has previously been reported in a few moderate and severe adult stutterers that suggests an organic cause rather than a behavioral one (Boberg, 1993). According to Boberg (1993), unlike childhood stuttering, adult stuttering behavior may represent a breakdown in the initiation of expiration that is associated with speech appears to be under control of the brainstem and midbrain/thalamic regions of the left hemisphere: "The evidence, based on brainstem evoked potentials, is of importance because of its robust nature in terms of validity and near invariant reliability, compared to the variance associated with behavioral techniques" (Boberg, 1993, p. 159). Likewise, researchers have also shown that adult stutterers may experience difficulties in the motor, spatial, and temporal regulation of the right hemisphere that tend to interfere with the balance between right- and left-hemisphere activation and inhibition. "In other words, these results may reflect the effects of disorganization in interhemispheric processing of information, as well as intrahemispheric competition" (Fitzgerald & Greiner, 1992, p. 396). In fact, because every individual is unique, formulating across-the-board generalizations about adult stutterers can be misleading, but there have been some valuable insights gained from the treatment of adult stutterers and these issues are discussed further below.

Treatment of Adult Stuttering.

Research has shown that approximately 80% of stutterers manage to completely recover from the condition without any clinical intervention, a process that typically takes place during early adulthood or adolescence; such recovery from childhood stuttering is thought to be attributable to increased self-esteem, acceptance of the problem and the resulting relaxation (Gibbons & Sims, 2006). In fact, according to Boberg (1993), "Adult stutterers consist of less than half of all those who ever stutter and should, therefore, be considered a functionally distinct subgroup of stutterers. The possibility that findings obtained from adults whose stuttering problems have persisted may not be pertinent to either the onset of stuttering or to its remission" (1993, p. 159). According to Hood and his colleagues (1996), for those adults that were unable to recover from their stuttering condition during early childhood, successful resolution of the problem was most likely to take place during their mid-20s. Therefore, Healey and Ratner (1999) emphasize that, "For patients, clinicians, and researchers, understanding probable windows of opportunity, as well as probable stages of life when maximal progress in therapy is less likely to be achieved is as important as which treatment approach is followed" (p. 7). Today, adult stutterers therefore represent about 20% of those people that have been unable to make the requisite mental accommodations that will allow them to overcome the problem earlier in life have two primary options for dealing with their condition:

Obtain intensive therapy to correct the stutter. Therapy for adult stuttering, or so-called "fluency shaping," is comparable to the mechanics-based speech therapy that a child would receive and focuses on the mechanics of breathing and the movements of the vocal cords, tongue, lips and jaw -- some fluency-shaping programs are intensive inpatient programs that last about three weeks; or,