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77-462: Before beginning therapy treatment, an assessment is needed, as diagnosing stuttering requires the a speech professional. In the USA, this is a speech–language pathologist (SLP). Some of the available treatments focus on repetitive practicing of strategies to suppress or hide stuttering through speed reduction, breathing regulation, and mouth motor contact. Alternatively, some stuttering therapies instead address

154-479: A 175 ms delay) has been shown to induce mental stress . It is a type of altered auditory feedback that—along with frequency-altered feedback and white noise masking—is used to treat stuttering ; it has also demonstrated interesting discoveries about the auditory feedback system when used with non-stuttering individuals. It is most effective when used in both ears. Delayed auditory feedback devices are used in speech perception experiments in order to demonstrate

231-510: A burning coal in his mouth had caused him to be "slow and hesitant of speech" (Exodus 4, v.10). Galen 's humoral theories were influential in Europe in the Middle Ages for centuries afterward. In this theory, stuttering was attributed to an imbalance of the four bodily humors —yellow bile, blood, black bile, and phlegm. Hieronymus Mercurialis , writing in the sixteenth century, proposed to redress

308-437: A controlled way. Some types of treatment for children younger than six years of age focus on the elimination of stuttering. Families are involved in the management of stuttering feedback in children: therapy is usually characterized providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech. Other types of speech therapy for children acknowledge that since there

385-494: A family history of stuttering. There is evidence that stuttering is more common in children who also have concurrent speech, language, learning or motor difficulties. For some people who stutter, congenital factors may play a role. In others, there could be added impact due to stressful situations. However there is not evidence to suggest this as a cause. Less common causes of stuttering include neurogenic stuttering (stuttering that occurs secondary to brain damage, such as after

462-555: A long period of time, but reports of long-term effects are inconsistent. This is because in some cases a continued but small benefit was obtained, while in others little benefit was found from the beginning and they did not continue using DAF. Clinical observations have determined that DAF may be less effective in people whose fluency failures are mostly blocks as opposed to people who present mostly repetitions and prolongations. In people who stutter with atypical auditory anatomy, DAF improves fluency, but not in those with typical anatomy. DAF

539-447: A negative self-concept and self-image. People who stutter may project their own attitudes onto others, believing that the others think them nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program. The impact of discrimination against stuttering can be severe. This may result in fears of stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being

616-416: A parent or a significant person in the child's life being trained in delivering feedback about stuttering in the child's everyday environment. In the program, family members praise their child for fluent speech in the child's daily speaking, and use negative correction of stuttering. Fluency shaping therapy focuses on changing all of the speech of the person who stutters. This type of therapy involves teaching

693-521: A possible target of bullying or discrimination, or feeling pressured to hide stuttering. In popular media, stuttering is sometimes seen as a symptom of anxiety, but there is no direct correlation in that direction. Alternatively, there are those who embrace stuttering pride and encourage other stutterers to take pride in their stutter and to find how it has been beneficial for them. Stuttering can co-occur with other disabilities. These associated disabilities include: The cause of developmental stuttering

770-696: A preliminary study, it was well tolerated in subjects, effectively reduced stuttering severity, and was even associated in a short-term study with improved quality of life in persons who stutter. Further research is still warranted, particularly for long-term impacts. Several treatment initiatives use diaphragmatic breathing (or costal breathing ) as a means by which stuttering can be controlled. Cognitive behavior therapy has been used to treat stuttering. Also sociological approaches has been explored regarding how social groups maintain stuttering through social norms. Stuttering support/community groups have gained prominence and visibility and can be an important part of

847-406: A reduction in the rate of speech, an increase in intensity, and an increase in fundamental frequency that occur to overcome the effects of the feedback. Direct effects include the repetition of syllables, mispronunciations, omissions, and omitted word endings. These direct effects are often referred to as "artificial stuttering". Delayed auditory feedback can be constructed using a speaker pointed at

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924-686: A shared forum within which they can access resources and support from others facing the same challenges of stuttering. Among ages 3–5, the prognosis for spontaneously recovery is about 65% to 87.5%. By 7 years of age or within the first two years of stuttering, and about 74% recover by their early teens. In particular, girls are shown to recover more often. Prognosis is guarded with later age of onset: children who start stuttering at age 3½ years or later, and/or duration of greater than 6–12 months since onset, that is, once stuttering has become established, about 18% of children who stutter after five years recover spontaneously. Stuttering that persists after

1001-1079: A shorter delay time, while slower speakers are maximally disrupted under longer delay times. Studies using computational modeling and functional magnetic resonance imaging (fMRI) have shown that the temporo-parietal regions function as a conscious self-monitoring system to support an automatic speech production system and that projections from auditory error cells in the posterior superior temporal cortex that go to motor correction cells in right frontal cortex mediate auditory feedback control of speech. Juvenile songbirds learn to sing through sensory learning. They memorize songs and then engage in sensorimotor learning through vocal practice. Songs produced during sensorimotor learning are more variable and dependent on auditory feedback unlike adult songs. Adult zebra finches and Bengal finches, for example, need feedback to keep their songs stable, and deafening in these species leads to song impairment. Continuous delayed auditory feedback in zebra finch songbirds caused them to change their song syllable timing, indicating that DAF can change

1078-543: A significant negative cognitive and affective impact on the person who stutters. Joseph Sheehan described this in terms of an analogy to an iceberg, with the immediately visible and audible symptoms of stuttering above the waterline and a broader set of symptoms such as negative emotions hidden below the surface. Feelings of embarrassment , shame , frustration , fear , anger , and guilt are frequent in people who stutter, and may increase tension and effort. With time, continued negative experiences may crystallize into

1155-904: A speech disfluency exists, and (2) assess if its severity warrants concern for further treatment. During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech ( Riley's Stuttering Severity Instrument Fourth Edition (SSI-4) ). They might also employ

1232-463: A speech instructor himself. Stammering awareness activist Adam Black, also a graduate of the course, received a British Empire Medal in the 2019 New Year Honours list where his work raising awareness of stammering was recognised. Cognitive behavioral therapy (CBT) may be used to help people who stutter. CBT may be partially effective in helping clients reduce their secondary behaviors, anxiety, and cognitive distortion . Cognitive behavioral therapy

1309-491: A stroke) and psychogenic stuttering (stuttering related to a psychological condition). Auditory processing deficits were proposed as a cause of stuttering due to differences in stuttering for deaf or Hard of Hearing individuals, as well as the impact of auditory feedback machines on some stuttering cases. Some possibilities of linguistic processing between people who stutter and people who do not has been proposed. Brain scans of adult stutterers have found greater activation of

1386-535: A stutter can lead people who stutter to react in different ways including behavioral and cognitive reactions. Some behavioral reactions can manifest outwardly and be observed as physical tension or struggle anywhere in the body. Almost 80 million people worldwide stutter, about 1% of the world's population. Stuttering is not connected to the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress do not cause stuttering, but they may trigger increased stuttering in people who have

1463-425: A test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future. Stuttering is a multifaceted, complex disorder that can impact an individual's life in

1540-472: A variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of

1617-413: Is a speech disorder characterized externally by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses called blocks in which the person who stutters is unable to produce sounds. According to adults who stutter, however, stuttering is defined as a "constellation of experiences" expanding beyond the external disfluencies that are apparent to

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1694-853: Is a collaborative process that requires the client and the therapist working together to explore the buried feelings of frustration, avoidance, anger, and self-doubt. Younger children who stutter are more benefited by CBT as compared to adults who stutter. Research at the Michael Palin Center has shown that CBT is a powerful tool for children who stutter. Several pharmacologic , i.e. drug-based, methods to control or alleviate stuttering events have been studied, but each has either proved ineffective or have had adverse effects. A comprehensive review of pharmacologic interventions for stuttering showed that no agent leads to valid improvement in stuttering or in secondary social and emotional consequences. Stuttering Stuttering , also known as stammering ,

1771-418: Is a normal part of speech development and temporarily present in preschool-aged children who are learning to speak. "Developmental stuttering" is stuttering that has on onset in early childhood, i.e. when a child is learning to speak. About 5-7% of children are said to stutter during this period. Despite its name, the onset itself is often sudden. This type of stutter may persists after the age of seven, which

1848-468: Is a stammering or stuttering treatment programme/course run for people who stammer or stutter (ages 14+) by people who stammer. There are no licensed speech therapists involved. It was founded in 1994 by American Dave McGuire in Holland . Scottish international rugby union captain, Kelly Brown , is a graduate of the course. Singer Gareth Gates attended the programme's workshops and subsequently qualified as

1925-436: Is a type of altered auditory feedback that consists of extending the time between speech and auditory perception. It can consist of a device that enables a user to speak into a microphone and then hear their voice in headphones a fraction of a second later. Some DAF devices are hardware; DAF computer software is also available. Most delays that produce a noticeable effect are between 50–200 milliseconds (ms). DAF usage (with

2002-438: Is also used with people who clutter . Its effects are slowing of speech which can result in increased fluency for people who clutter and also syllable awareness. Studies that are more recent have looked at the effects of DAF in people who do not stutter to see what it can prove about the structure of the auditory and verbal pathways in the brain. Indirect effects of delayed auditory feedback in people who do not stutter include

2079-441: Is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback are not effective with the acquired type. Finally, "psychogenic stuttering", which is less than 1% of all stuttering conditions, may also arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous:

2156-415: Is classified as "persistent stuttering". "Neurogenic stuttering" (stuttering that occurs secondary to brain damage, such as after a stroke) and "psychogenic stuttering" (stuttering related to a psychological condition) are less common and classified separately from developmental. "Neurogenic stuttering" typically appears following some sort of injury or disease to the central nervous system. Injuries to

2233-539: Is complex. It is thought to be neurological with a genetic factor. Various hypotheses suggest multiple factors contributing to stuttering. There is strong evidence that stuttering has a genetic basis. Children who have first-degree relatives who stutter are three times as likely to develop a stutter. In a 2010 article, three genes were found by Dennis Drayna and team to correlate with stuttering: GNPTAB , GNPTG , and NAGPA . Researchers estimated that alterations in these three genes were present in 9% of those who have

2310-607: Is designed to be a computer-aided, bio-feedback program that requires appropriate software (MPI smartphone app) and hardware (a throat microphone headset) which records the phonation intervals, or PIs, from the surface of the speaker's throat. The app records all PIs as well as speaker-rated speech performance measures. The MPI Stuttering Treatment Program is based on a series of experimental studies by Roger Ingham and colleagues (Gow & Ingham, 1992; Ingham, Kilgo, Ingham, Moglia, Belknap, & Sanchez, 2001; Ingham, Montgomery, & Ulliana, 1983). The MPI Stuttering Treatment Schedule

2387-423: Is divided into four phases: Pre-Treatment, Establishment, Transfer, and Maintenance. Each phase is designed to be managed jointly by the speaker (person who stutters) and the clinician. The Pre-Treatment phase is directed by the clinician, but the other phases are largely self-managed while also requiring regular validation by a clinician. Stuttering modification therapy, also known as traditional stuttering therapy,

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2464-506: Is no cure for stuttering, elimination as a goal may cause negative impacts. As such, a speech therapist will work on educating parents and family members about how to listen to their child and how to advocate for them. The goal for this type of therapy is to ensure a child continues to speaks, whether they spontaneously stop stuttering or not. One option for an elimination model is Lidcombe Programe, popular in Australia. Lidcombe therapy requires

2541-493: Is no cure for stuttering, several treatment options exist and the best option is dependent on the individual. Therapy should be individualized and tailored to the specific and unique needs of the client. The speech–language pathologist and the client typically work together to create achievable and realistic goals that target communication confidence, autonomy, managing emotions and stress related to their stutter, and working on disclosure. Self-help groups provide people who stutter

2618-430: Is present in every culture and in every race, although the attitude towards the actual prevalence differs. Some believe stuttering occurs in all cultures and races at similar rates, about 1% of general population (and is about 5% among young children) all around the world. A US-based study indicated that there were no racial or ethnic differences in the incidence of stuttering in preschool children. Different regions of

2695-407: Is the ability to speak two languages. Many bilingual people have been exposed to more than one language since birth and throughout childhood. Since language and culture are relatively fluid factors in a person's understanding and production of language, bilingualism may be a feature that impacts speech fluency. There are several ways during which stuttering may be noticed in bilingual children including

2772-423: Is to reduce the speed of speech in such a way that the longer the delay time, the greater the reduction is made. It has been proposed that it is in fact the reduction in speaking rate that produces fluency when using DAF however, it has been evidenced in other studies that a slow speaking rate is not a prerequisite for improving fluency under DAF. Furthermore, DAF is believed to continue to cause increased fluency over

2849-465: Is unique from other dopamine antagonists in that it acts on D1 receptors instead of D2, owing little, if any risk, of movement disorders. A 2019 open label study of ecopipam in adults demonstrated significantly improved stuttering symptoms with no reports of parkinsonian-like movement disorders or tardive dyskinesia which can be seen with D2 antagonists. In addition, ecopipam had no reported weight gain, but instead has been reported to lead to weight loss. In

2926-574: Is very slow, monotonic, but fluent speech, used only in the speech clinic. After the person who stutters masters these skills, the speaking rate and intonation are increased gradually. This more normal-sounding, fluent speech is then transferred to daily life outside the speech clinic, though lack of speech naturalness at the end of treatment remains a frequent criticism. Fluency shaping approaches are often taught in intensive group therapy programs, which may take two to three weeks to complete. The Modifying Phonation Intervals (MPI) Stuttering Treatment Program

3003-435: The age of seven is classified as persistent stuttering, and is associated with a much lower chance of recovery. The lifetime prevalence , or the proportion of individuals expected to stutter at one time in their lives, is about 5–6%, and overall males are affected two to five times more often than females. As seen in children who have just begun stuttering, there is an equivalent number of boys and girls who stutter. Still,

3080-483: The anxiety or fear that is may be caused by living with a stutter. This method of treatment is referred to as a comprehensive approach, in which the main emphasis of treatment is directed toward improving the speaker's attitudes toward communication and minimizing the negative impact stuttering may have on the speaker's life. When treating stuttering in children, some researchers recommend that an evaluation be conducted every three months in order to determine whether or not

3157-485: The body. These could range anywhere from tension in the head and neck, behaviors such as snapping or tapping, or facial grimacing. These behavioral reactions are those that might not be apparent to listeners and only be perceptible to people who stutter. Some people who stutter exhibit covert behaviors such as avoiding speaking situations, substituting words or phrases when they know they are going to stutter, or use other methods to hide their stutter. Stuttering could have

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3234-420: The brain and spinal cord, including cortex, subcortex, cerebellum, and even the neural pathway regions. It may also be called "acquired stuttering" and it may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and

3311-595: The danger of bleeding to death and their failure to stop stuttering. Less drastically, Jean Marc Gaspard Itard placed a small forked golden plate under the tongue in order to support "weak" muscles. Italian pathologist Giovanni Morgagni attributed stuttering to deviations in the hyoid bone , a conclusion he came to via autopsy . Blessed Notker of St. Gall ( c.  840 – 912), called Balbulus ("The Stutterer") and described by his biographer as being "delicate of body but not of mind, stuttering of tongue but not of intellect, pushing boldly forward in things Divine,"

3388-597: The data collected from these studies indicate, the delay required for maximum disruption decreases with age. However, it increases again for older adults, to 400 ms. Sex differences in DAF show no difference or indicate that men are generally more affected than women, indicating that the feedback subsystems in the vocal monitor process could be different between the sexes. In general, more rapid, fluent speakers are less affected by DAF than slower, less fluent speakers. Also, more rapid fluent speakers are maximally disrupted by

3465-435: The fear and avoidance of stuttering. Devices used to reduce stuttering alters the frequency of the speaker's voice to mimic the "choral effect", a phenomenon in which person's stutter decreases or ceases completely when she is speaking with a group of others, or slows the rate of speech through delayed auditory feedback. Delayed auditory feedback devices, such as Speech Easy, encourage the slowing down of speech by replaying

3542-415: The following. It was once believed that being bilingual would 'confuse' a child and cause stuttering, but research has debunked this myth. Stuttering may present differently depending on the languages the individual uses. For example, morphological and other linguistic differences between languages may make presentation of disfluency appear to be more or less depending on the individual case. Because of

3619-548: The goal of helping others who stutter in the group has been linked to better psychological well-being. Studies in the United States involving members of support groups of the National Stuttering Association have found that 57.1% of survey respondents said that the support group had affected their self-image "very positively", with no respondents indicating that it had a negative impact. The McGuire Programme

3696-462: The imbalance by changes in diet, reduced libido (in men only), and purging . Believing that fear aggravated stuttering, he suggested techniques to overcome this. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century. Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman emperor Claudius was initially shunned from

3773-650: The importance of auditory feedback in speech perception as well as in speech production . There are now also different mobile apps available that use DAF in phone calls. Electronic fluency devices use delayed auditory feedback and have been used as a technique to aid with stuttering . Stuttering is a speech disorder that interferes with the fluent production of speech. Some of the symptoms that characterize stuttering disfluencies are repetitions, prolongations and blocks. Early investigators suggested and have continually been proven correct in assuming that those who stutter had an abnormal speech–auditory feedback loop that

3850-410: The individual and information about the individual's background, through a case history. The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents. The overall goal of assessment for the SLP will be (1) to determine whether

3927-426: The influence of the works of Wendell Johnson , who claimed that the onset of stuttering was connected to the cultural expectations and the pressure put on young children by anxious parents, which has since been debunked. Later studies found that this claim was not supported by the facts, so the influence of cultural factors in stuttering research declined. It is generally accepted by contemporary scholars that stuttering

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4004-420: The listener. Much of the experience of stuttering is internal and encompasses experiences beyond the external speech disfluencies, which are not observable by the listener. The moment of stuttering often begins before the disfluency is produced, described as a moment of "anticipation" - where the person who stutters knows which word they are going to stutter on. The sensation of losing control and anticipation of

4081-522: The mesolimbic pathway, and works similarly on serotonin 5HT2A receptors in the frontal cortex. At doses between 2.5 and 5 mg, olanzapine has been shown to be more effective than placebo at reducing stuttering symptoms, and may serve as a first-line pharmacological treatment for stuttering based on the preponderance of its efficacy data. However, other medications are generally better tolerated with less weight gain and less risk of metabolic effects than olanzapine. The investigational compound, ecopipam ,

4158-425: The motor program of syllable timing generation during short periods of time in zebra finches, similar to the effects observed in humans. Moreover, in experiments, DAF is used to selectively interrupt auditory feedback in such a way that when adult zebra finches are exposed, their songs degrade and when discontinued they recover. As DAF is reversible and precise it can be applied and directed to specific syllables within

4235-476: The neurotransmitter dopamine . It was once thought that forcing a left-handed student to write with their right-hand caused stuttering due to bias against left-handed people , but this myth died out. Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a licensed speech–language pathologist (SLP). Diagnosis of stuttering employs information both from direct observation of

4312-473: The person by the speaking situation. Demands may be increased by internal factors or inadequate language skills or external factors. In stuttering, severity often increases when demands placed on the person's speech and language system increase. However, the precise nature of the capacity or incapacity has not been delineated. Stress, or demands, can impact many disorders without being a cause. Another theory has been that adults who stutter have elevated levels of

4389-552: The person speaking, yielding a "speechjammer". With an individual who does not stutter, auditory feedback speech sounds are directed to the inner ear with a 0.001 second delay. In delayed auditory feedback, the delay is artificially disrupted. Studies have found that in children ages 4–6 there is less disturbance of speech than in children ages 7–9 under a delay of 200 ms. Younger children are maximally disrupted around 500 ms while older children around 400 ms. A 200 ms delay produces maximum disruption for adults. As

4466-402: The presence of control groups. There are specialized mobile applications and PC programs for stutter treatment.The following methods are typically used: No medication is FDA-approved for stuttering. The most studied medication in stuttering is olanzapine , whose effectiveness as of 2004 had been established in replicated trials. Olanzapine acts as a dopamine antagonist to D2 receptors in

4543-611: The process for stutterers, A growing number of speech–language pathologists encourage their clients to participate in support groups. Research shows that participating in support groups and self-help sessions with others who stutter may reduce the negative attitudes associated with stuttering. Becoming part of stuttering groups may help reduce the feelings of loneliness, fear, shame and embarrassment that comes with years of stuttering. Participants of group sessions show lower internalization of stigma regarding stuttering. They have lower levels of negative feelings about themselves. Moreover,

4620-401: The public eye and excluded from public office. In and around eighteenth and nineteenth century Europe, surgical interventions for stuttering were recommended, including cutting the tongue with scissors, removing a triangular wedge from the posterior tongue, and cutting nerves, or neck and lip muscles. Others recommended shortening the uvula or removing the tonsils . All were abandoned due to

4697-405: The right hemisphere, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed. The 'capacities and demands model' has been proposed to account for the heterogeneity of the disorder. Speech performance varies depending on the 'capacity' that the individual has for producing fluent speech, and the 'demands' placed upon

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4774-403: The selected treatment option is positively impacting the child. "Follow-up" or "maintenance" sessions may be implemented after completion of formal intervention to notice any changes. There are different approaches to stuttering therapy. There is no cure for the condition. Depending the child or adult, therapy is generally a management of speech comfort, and/or teaching techniques to speak in

4851-485: The sex ratio appears to widen as children grow: among preschoolers, boys who stutter outnumber girls who stutter by about a two to one ratio, or less. This ratio widens to three to one during first grade, and five to one during fifth grade, as girls have higher recovery rates. the overall prevalence of stuttering is generally considered to be approximately 1%. Cross-cultural studies of stuttering prevalence were very active in early and mid-20th century, particularly under

4928-471: The speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)). Clinical psychologists with adequate expertise can also diagnose stuttering per the DSM-5 diagnostic codes. The DSM-5 describes "Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However,

5005-410: The speaker's words into their ears. The stutterer is then forced to slow their rate of speech to prevent distortions in the speech that is heard through the device. This is not effective for all people who stutter, and is shown to wear off over time. In a 2006 review of the efficacy of stuttering treatments, none of the studies on altered auditory feedback met the criteria for experimental quality, such as

5082-560: The specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms fluency and disfluency . Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies"). This type of disfluency

5159-802: The speech disorder, and living with a stigmatized disability can result in anxiety and high allostatic stress load . Neither acute nor chronic stress, however, itself creates any predisposition to stuttering. The disorder is variable , which means that in certain situations the stuttering might be more or less noticeable, such as speaking on the phone or in large groups. People who stutter often find that their stuttering fluctuates, sometimes at random. Common stuttering behaviors are observable signs of speech disfluencies, for example: repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. People who stutter may have reactions, avoidance behaviors, or secondary behaviors related to their stuttering that may look like struggle and tension in

5236-558: The stutterer to use a speaking style that requires careful and prominent self-monitoring; examples of such therapy include one in which the stutterer slows his speech down or speaks in a controlled tone. This type of approach can reduce stuttering, although in children its effectiveness decreases if stuttering persists after eight years of age. People who stutter are trained to reduce their speaking rate by stretching vowels and consonants, and using other disfluency-reducing techniques such as continuous airflow and soft speech contacts. The result

5313-453: The stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker. Other disorders with symptoms resembling stuttering, or associated disorders include autism , cluttering , Parkinson's disease , essential tremor , palilalia , spasmodic dysphonia , selective mutism , and apraxia of speech . While there

5390-454: The throat and his face turned purple" and that "born with a stutter and a lisp , both caused in large measure by a defect in his palate, Churchill was at first seriously hampered in his public speaking. It is characteristic of the man's perseverance that, despite his staggering handicap, he made himself one of the greatest orators of our time." Delayed auditory feedback Delayed Auditory Feedback ( DAF ), also called delayed sidetone ,

5467-449: The unusual-sounding speech that is produced and the behaviors and attitudes that accompany a stutter, it has long been a subject of scientific interest and speculation as well as discrimination and ridicule. People who stutter can be traced back centuries to Demosthenes , who tried to control his disfluency by speaking with pebbles in his mouth. The Talmud interprets Bible passages to indicate that Moses also stuttered, and that placing

5544-631: The world are researched unevenly. The largest number of studies has been conducted in European countries and in North America, where the experts agree on the mean estimate to be about 1% of the general population. African populations, particularly from West Africa, might have the highest stuttering prevalence in the world—reaching in some populations 5%, 6% and even over 9%. Many regions of the world are not researched sufficiently, and for some major regions there are no prevalence studies at all. Bilingualism

5621-459: Was born and grew up with a stutter" in her 1941 book I was Winston Churchill's Private Secretary . She related one example, "'It's s-s-simply s-s-splendid,' he stuttered—as he always did when excited." Louis J. Alber, who helped to arrange a lecture tour of the United States, wrote in Volume 55 of The American Mercury (1942) that "Churchill struggled to express his feelings but his stutter caught him in

5698-493: Was corrected or bypassed while speaking under DAF. More specifically, neuroimaging studies of people with stuttering have revealed abnormalities in several fronto-paretotemporal pathways and are thought to affect connectivity between speech (pre)motor regions and auditory regions. The above is consistent with behavioral studies that demonstrate that stutterers present reduced compensatory motor responses to unexpected perturbations of auditory feedback. The mechanism of action of DAF

5775-463: Was developed by Charles Van Riper between 1936 and 1958. It focuses on reducing the severity of stuttering by changing only the portions of speech in which a person stutters, to make them smoother, shorter, less tense and hard, and less penalizing. This approach attempts to reduce the severity and fear of stuttering, and strives to teach stutterers to stutter with control, and not to make the stutterer fluent. Therapy using this approach tends to recognize

5852-496: Was invoked against stammering. A royal Briton who stammered was King George VI . He went through years of speech therapy, most successfully under Australian speech therapist Lionel Logue , for his stammer. The Academy Award-winning film The King's Speech (2010) in which Colin Firth plays George VI, tells his story. The film is based on an original screenplay by David Seidler , who also stuttered until age 16. Another British case

5929-447: Was that of Prime Minister Winston Churchill . Churchill claimed, perhaps not directly discussing himself, that "[s]ometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience ..." However, those who knew Churchill and commented on his stutter believed that it was or had been a significant problem for him. His secretary Phyllis Moir commented that "Winston Churchill

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