Stuttering
is a disorder of fluency characterized by various behaviors that interfere
with the flow of normal speech. What differentiates stutterers from
non stutterers is the frequency of their disfluency and/or the severity
of their disfluency. Another factor that differentiates stutterers from
non stutterers is that almost invariably the disfluencies that the stutterer
regards as “stutters” are accompanied by a feeling of loss
of control. It is this loss of control, which can’t be observed
or experienced by the listener, that is most problematic for the stutterer.
Primarily characterized
by repetitions (sounds, syllables, part-words, whole words, phrases),
pauses, and prolongations that differ in number and severity from
those of normally fluent individuals. Other disorders are characterized
by disfluent speech, but the patterns of disfluency in these other
disorders differ from that seen in developmental stuttering.
People with significant speech difficulty often don't stutter when
singing, talking to animals, or reading to small children, or when
they are alone talking to themselves. Stuttering tends to persist
into adulthood more in males than females. The main characteristics
are:
Inappropriate for age, the patient lacks normal fluency and time patterning
of speech. This is characterized by frequent occurrences of at
least 1 of the following:
Repetitions
of sound and syllable.
Sound prolongations.
Interjections.
Broken words.
Blocking that is audible or silent.
Circumlocutions (substitutions to avoid words hard to pronounce).
Words spoken with excessive physical tension.
Repetitions of monosyllabic whole words (such as "a-a-a-a-a
dog bit me").
These problems interfere with educational or occupational achievement
or with social communication.
If the patient
also has a sensory or speech-motor deficit, the problems with language
are worse than you would expect with these problems.
Associated
Features:
Depression is most commonly seen in adults and adolescents who stutter.
However, this does not mean that all adults and adolescents who stutter
have psychiatric disorders.
Differential
Diagnosis:
Some
disorders have similar or even the same symptoms. The clinician, therefore,
in his/her diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Developmental
stuttering should be distinguished from acquired stuttering. Normal
speech dysfluency occurs in young children and can be difficult to
distinguish from stuttering. Stuttering exhibits more nonfluencies,
part-word repetitions, sound prolongations and disruptions in voice
airflow. Nonfluent children are more at ease than children with stuttering.
Cause:
Young
children often go through a short period of stuttering. For a small
percentage (less than 1%), the stuttering progresses from simple repetition
of consonants to repetition of words and phrases. Later vocal spasms
develop with a forced, almost explosive sound to the speech. Stuttering
also tends to run in families. There is also some evidence that stuttering
may be associated with some neurological deficits but there is also
a strong psychological component.
Treatment:
There are no absolute
therapy or cure for stuttering.
Counseling
and Psychotherapy [ See
Therapy Section ]:
In persistent
stuttering cases, speech therapy may be helpful although stuttering
does tend to be very resistant to any therapies.
Clomipramine,
an SSRI, has been shown to be superior to desipramine, an antidepressant.
