The Curse of Stuttering

My heart went out to the guy on the phone. I was interviewing a local business owner, and as soon as he started talking I recognized all the signs and coping mechanisms of someone who stuttered. There was the slow, studied cadence, the deliberate, practiced manner of pronunciation, the insertion of multiple "um's" in his sentences, and his tendency to stretch out the first syllable of a certain word as he struggled to make his mind and mouth work in unison.

I could sympathize with every verbal stumble, false start and compensatory trick because it closely resembled the way I used to talk. Between the ages of 10 and 16 I struggled with what most people take for granted -- just open your mouth and the words come out, right? For about three million Americans it's not nearly that simple. As an already awkward, gangly teenager with pimples, it didn't exactly help that I had trouble putting words together.

I'm lucky, though; for the most part I've outgrown the problem, at least to where it's now manageable. But to this day I can still be in mid-sentence, rolling along just fine, and suddenly I know there's no way the next word my brain is sending down to my mouth is going to make it out in one piece. I'm forced to instantaneously come up with an alternate word my mouth is more willing to cooperate with, or, like my interviewee, interject multiple "um's" until my mouth decides to kick into gear again. As a reporter, where word economy and fluency is an integral part of the job -- particularly during interviews -- having to rely on these kinds of verbal gymnastics can be a real pain -- and an embarrassment.

For many, stuttering is much more than just an adolescent inconvenience. It's a lifelong ordeal and an impediment, both socially and professionally, that can be devastating. While most people are afraid to speak in front of a large crowd, think about having that same fear as it relates to every day, normal conversations. Imagine being someone who stutters during a job interview; when you're out on a date; when you're called on in class; or just during a simple exchange with a stranger while waiting in line at the bank -- all normal, everyday situations, yet all potentially humiliating to someone who stutters.

You always hear about how much we communicate through body language, but our vocal skills are the real thing -- an integral part of who we are, how we express ourselves, and how we're perceived. Because speech is such a fundamental form of communication, being unable to do it fluidly can be extremely disabling, which of course is made worse by the many stigmas and prejudices associated with stuttering. People who stutter are often perceived as slow or socially inept, and characters like Howard Stern's Stuttering John and cartoon character Porky Pig only perpetuate the buffoonish, comical stereotypes.

While there's no miracle cure for stuttering, research has yielded a great deal of new information, and therapy has come a long way in the past few decades in helping remedy what is still a largely misunderstood problem.

Some Kind of Freak

"Jamie" is 30, married, and the proud new father of a baby girl. He works as a computer technician for a local investment firm, and he's a good example of just how big an impact stuttering can have on an individual.

Jamie is a little unusual in that he didn't begin stuttering until the age of 11. While everyone just assumed it was a stage he would soon outgrow, by the time he entered high school he was still stuttering, and by then had developed the unfortunate habit of not speaking as a way of dealing with it. Conversations were simply too frustrating and embarrassing.

"Most of the time, especially in social gatherings, I would just keep quiet, so I didn't have a lot of friends," Jamie said. "And dating was especially tough."

Some of his most painful memories from high school involve the dreaded first-day -of-class introduction ritual, something that makes nearly everyone squirm. To Jamie, though, it was nearly unbearable.

"It was the absolute worst," he said. "But I would always make myself do it because it would have looked weird if I had just refused to stand up and speak."

While remaining silent through high school and college may have stifled his social life, as an adult in the workaday world, it's now become a roadblock to him professionally.

"In school I could just keep quiet; so it really didn't bother me a whole lot," Jamie said. "But it bothers me at work. At work you have to talk. Meetings and conference calls are always a problem. I've been offered management positions in the past and I've had to refuse them. In management you have to run meetings and talk to your team, and communicate to lots of people, and I just couldn't do it. I want to just stay in my cube and do my work."

It's All In Your Head

Perhaps the most widely recognized authority on stuttering and stuttering therapy is the Stuttering Foundation of America, based in Memphis, TN. Malcolm Fraser, who struggled with the disability all his life, founded the organization in 1947 with the goal of providing information about the prevention of stuttering in young children and the treatments available for teenagers and adults.

Since then a great deal of research has been conducted, most recently exploring brain waves and genetics as possible causes, which have resulted in many progressive new therapy techniques. Despite decades of research, the causes of stuttering are still largely unknown. It is known, however, that over three million Americans stutter, and that it affects four times as many males as females.

While there are some clinics that claim they can "cure" anyone of stuttering, their techniques usually involve spending an extended period of time in a controlled environment where intensive therapy takes place. The therapists interviewed for this story agree that such methods are usually ineffective because the therapy is taking place in a clinical environment, and eventually the patient has to return home to his or her regular routine, where the same problems inevitably reoccur.

Most seem to agree that therapy is more about controlling and improving -- not curing -- fluency problems. Of course, a key to finding the best method to reach that goal is to have a more definitive answer about the causes. While most therapists think researchers are narrowing the causes down, there are still a multitude of theories, as well as the age-old debate of whether it's nature or nurture.

"I believe it's some of both," said Bates. "Stuttering, while it doesn't have a totally physiological ideology, does have components of breathing, environment, stress, and anxiety."

"In the 70s it was the parents' fault," said Sally Pidge, a speech and language pathologist at the Achieve Speech and Language Clinic. "Now researchers have linked one gene to stuttering, Tourettes Syndrome and ADD. So I think they're going to find out that it's more genetic that anything else. In cases where children have a stuttering disorder that continues to be a problem through adulthood, they can generally trace it back through the family history. Most of the theories today are based on the idea that if a child is predisposed to stutter, oftentimes it's environmental factors that may trigger it.

Treatment And Therapy

Most folks probably associate Porky Pig's "th-th-th-that's all folks" trademark line with typical stuttering. Not to get too technical, but in speech pathology that's known as "blocking," where the air flow gets blocked and there's a repetition of the sound.

Another common form of stuttering is knows as "closis." This involves the speaker getting stuck on sounds like "p, b, m" which are spoken with the lips closed and teeth open.

Actually, unless the case is particularly severe, what most people hear when talking to someone who stutters are the techniques they've developed so they won't make those repetitive or blocked sounds.

When a stuttering problem persists past adolescence and into adulthood it usually becomes far more difficult to control. Therapists say this has to do with both learned behavior, and people's general attitude about stuttering and therapy.

"People just don't know where to turn," said Bates. "They're humiliated and very self-conscious and they just kind of give up. They've had it. There are a lot of people out there in their mid-30s and 40s who sort of got lost. They should be at the height of their profession, but they're really struggling. They're unable to get a high-profile position or not likely to get promoted because of their fluency problem, and they need to know help is available."

There are numerous therapy approaches practiced today, many of them focusing on the patient slowing down his or her rate of speech, decreasing the tension, and speaking in a more continuos phonation. There's even a new therapy technique based on biofeedback. Resembling a hearing aid, a device worn in the ear changes how the speaker perceives his/her own voice, and the user can usually tell within a matter of hours if it will be effective.

Perhaps the most common therapy is having the patient develop what is knows as "secondary compensatory techniques." Usually individuals who stutter develop these verbal or physical techniques naturally, such as the "um, um, um" you may hear some people say while they're speaking. These individuals don't necessarily have a limited vocabulary or a word retrieval problem; it's simply their way of buying themselves some time so they can effectively manage their stutter.

Other methods involve repetitive, physical movements, like the one displayed by a patient of one of the therapists interviewed. This patient was a bank executive whose job demanded lots of verbal interaction. Her method of controlling her stutter was to constantly fiddle and shake a pen when talking, a method she developed naturally. But the real trick is finding a secondary technique that works for the long term.

"People often create secondary behaviors like tapping their toe," Bates said. "And that works great for awhile. But then they realize they have to tap their foot. And before long they have to shake their whole leg and jump up and down to make that continue as an effective secondary measure. Eventually you're almost unrecognizable as the person you could be. You practice compensatory techniques and avoidance behavior so much that you're not really your true self. And there's so much that can be done. People have to be really careful and seek the guidance of a professional to come up with a secondary characteristic that works for them."

It's important to note that a certain amount of stuttering, or "disfluency," as it's known in the industry, is normal for kids between the ages of 2 and 4. For most children it's simply the stage of development when their language and vocabulary are advancing more than their articulation. It's estimated that about 25 percent of all children go through a stage of development during which they encounter disfluencies severe enough to concern their parents. Speech therapists stress that how parents react during this stage is critical, and can have a great influence on how the situation turns out.

Bates warns parents not to overreact or fixate on the problem. "What can happen is if you have a particularly anxious parent, they obsess over it. And the child is the first person to pick up on that. It then becomes a self-fulfilling prophecy. The child becomes anxious, stressed, self-conscious, and you can get a stutterer for life."

Pidge stresses that while it's important not to overreact, parents shouldn't assume that the problem will just go away, either. "All children go through stages of stuttering, but there are certain types of stuttering that aren't considered normal or developmental," Pidge said. "But what happens is that general doctors don't know the difference, and they just tell the parents they'll outgrow it. If I get a kid before the age of 4 there's about a 97 percent recovery rate. However, if I see them after the age of 4, the chances for recovery drop dramatically. So the important message to parents is don't wait; at least have them screened and the therapist should be able to tell you if it's developmental or not."

For information about stuttering and different kinds of therapy, call the Stuttering Foundation of America at 1-800-992-9392, or visit their web site.

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