Understanding the Meaning of Stuttering - Essay Example

? Stuttering Introduction To understand the meaning of stuttering, it would be important to differentiate between medical stuttering and the normal stuttering that people occasionally encounter. There are many muscles that lengthen and contract synchronously to cause speech without error. According to Lavid (2003), stuttering refers to a generic term describing speech that fails to follow the normal conventional rhythm. In this sense, stuttering would occur when one speaks fast, with anger, nervousness, surprise or confusion or when one is lost for words. But of particular concern in this paper would be the medical aspect of stuttering. Termed as developmental stuttering in this context, it refers to a disorder exhibited through the disruption of normal speech mannerisms and fluency where words, syllables or sounds would last or be repeated longer than normal (Zieve, 2012). The British refer to it as stammering. The resultant break in flow of speech is referred to as disfluency. Prevalence and incidence In giving the prevalence and incidence of stuttering, Guitar (2006) differentiates the two noting that while prevalence indicates the spread of the disorder, incidence gives a position on the number of people that have had stuttered as some point in life. Statistics indicate that 5% of children at the ages of between 2 and 5 would develop stuttering in their childhood and could last from weeks up to years. The stuttering in 1% of these children would normally worsen with time. According to the National Institutes of Health, NIH (2012), 25% of childhood stammering persists in adulthood. The prevalence of stuttering among adults stands at 1%. In the UK, this represents about 500,000 adults with stuttering disorder and 3 million and 45 million in the US and globally respectively. The incidence rate has been estimated at between 4 and 5 percent by Iverach et al. (2009) with a 4:1 male to female ratio. But Dworzynski, Remington, Rijsdijk, Howell and Plomin (2007) observed that in childhood, the ratio stands at 2:1 for preschool boys to girls. Similarly, the researchers found out that recovery for girls would be higher than in boys, a phenomenon that points out at sex-modified transmission. The global incidence levels stand at 15% inclusive of those who have had temporary stuttering conditions. But when the period of focus exceeds six months of stuttering, this reduces to 5% which has been argued as being more accurate in reflection of the stuttering chronic disorder. Causes Though the causes of stuttering remain scanty, many researchers have cited genetic conditions as major risk factors (Craig & Tran, 2006; Iverach et al. 2009; Lavid, 2003). The onset of stuttering occurs at tender ages of between two and five and though majority of the children naturally recover later in life, it could become intractable and a persistent problem to a portion of the adult population. According to Guitar (2006), about two-thirds of the people who stutter have relatives, either of first or second degree, who stutter. Furthermore, it has been observed that monozygotic concordance rates would be much higher than dizygotic concordance rates. Pro-band families also exhibit higher tendencies of being infected as compared to the population rates. This implies that hereditary factors play a part in development of stuttering though the genetic transmission method and the specific genes accounting for these patterns and susceptibility remain unclear (Dworzynski et al., 2007). This has caused a rise in questions on whether differences exist between the genes where victims later recover from those where victims remain stuttering permanently. The observation of girls recovering more than boys also indicates that the genetic structure in boys could be different from that in girls with boys exhibiting higher heritability than girls. Lately, behavioural genetic analyses adopt approaches beyond the estimation of heritability alone to considering other issues like developmental change and continuity. Scholars have attributed stuttering to brain injuries including traumatic brain injuries and stroke. Congenital factors including physical trauma at birth, mental retardation and cerebral palsy have also been cited as possible causes of stuttering (NHI, 2012). This type of stuttering caused by progressive neurological disease, stroke or severe brain injury has been referred to as late-onset or acquired stammering by NHS (2012). In addition, deficits in auditory processing also cause stuttering disorder though it remains less prevalent among hard-of-hearing and deaf persons who would have their stuttering conditions improved through alteration of auditory feedback like delayed auditory feedback, frequency altered feedback or masking. Evidence has been documented of people who stutter having different auditory cortex. Difference in linguistic processing could also indicate the possibility of stuttering in an individual. Though considered a rare phenomenon, Zieve (2012) and Guitar (2006) cite emotional trauma as another possible cause of stuttering, referred to as psychogenic stuttering. Brain scans of people who stutter indicates that the right hemisphere of the brain, which is associated with emotions would be highly activated than the left hemisphere associated with speech. In addition, the left cortex has been found out to have reduced activation. The understanding of these causes points out at various risk factors associated with stuttering. These include having relatives with stuttering disorder as it runs in families. Similarly, delays in childhood development or speech problems among children pose the risk of being a victim of stuttering. Since the prevalence of stuttering has been noted to be higher among the males than females, being male would also be a risk factor. Stress and various kinds of pressure could worsen the existing stuttering disorder. Age also poses the risk of developing stuttering with children aged between three and five. Symptoms The severity of stammering would be dependent on the surroundings and various symptoms and signs have been associated with this disorder. According to Lavid (2003), these symptoms would be more exaggerated when people with the disorder encounter stress. Social and psychological symptoms exhibited by people with stuttering disorder include emotional struggle while they stammer. Similarly, such persons tend to be shy and exhibit social avoidance tendencies because they fear to speak in particular social contexts. These persons also have high chronic anxiety levels, especially phobic or social anxiety (Craig & Tran, 2006). However, it is important to note that stuttering has high variability in that people who stutter would commonly report increased fluency when copying the speech of another person, talking in unison with someone else, singing, acting, whispering or when talking to themselves, children or pets. But in situations such as public speaking, greater fear would be recorded among people who stutter and indeed, greater stuttering would be observed. The most common behavioural symptoms include difficulty in initiating speech or flowing of syllables from one to the next – stammers vary in their sounding. As such, they use interjections such as ‘uhm’ before they attempt to utter some sounds. Their speech would be slurred and speech sounds prolonged. Words with specific sounds would be interchanged with others, referred to as circumlocution, another clear cut symptom to identify people with stuttering disorder. They would frequently repeat syllables, sounds or words and hesitate before uttering specific sounds. Similarly, they would experience problems in starting a word, phrase or sentence. Some of the people with stuttering disorder would appear to be breathless when talking with their face and upper body all tightened up. Others would have their jaws and lips trembling while some would be rapidly blinking and tapping their feet as they try to talk. These symptoms and signs of stuttering would prevail in both the children and adults and if left untreated, the disorder becomes permanent. This means that early diagnosis would be critical in increasing speech fluency and minimising the disorder. Lavid (2003) gives a critical review of when to see a doctor. According to the scholar, when stuttering lasts for more than six months, it would be critical to seek advice from qualified medical professional. Similarly, occurrence of stuttering with facial tightness and tension and other body and facial movements serve as critical indications for the need to see a doctor. It would be important for parents to consult a doctor in case the disorder affects the social interactions and schoolwork of their children. Whenever it would be determined that stuttering causes emotional complications like fear or avoiding situations that call for speech, then it becomes crucial to also see a doctor. Persistency of the condition beyond age 5 or its indication when a child reads aloud at the start of schooling would call for a similar action. Finally, for adults, if the stuttering causes stress and affects self-esteem, relationships or career, it would be important to seek medical advice from a speech-language pathologist or a doctor. Effects Effective and fluent speech and talking while interacting with other people have been considered as highly regarded skill. The ability to speak effectively and fluently would positively affect the life opportunities of a person while inarticulacy and dysfluency confers a myriad of disadvantages. Craig and Tran (2006) give the example of people with aphasia who lead a poor quality life. These negative social consequences set in from childhood for children with stuttering disorders. In primary school, such children would be perceived negatively by their normal peers and such pupils have been noted to be more susceptible to bullying. They experience difficulties in establishing friendships with their peers who do not stutter. Similarly, children with stuttering disorders exhibit higher rates of communication fears than their normal counterparts with these fears increasing with age. Because of the reduced fluency in speech, such children would have limited vocational prospects with those with this disorder perceiving it as a determent to effective communication which would be perceived as a negative life event. A reasonable reaction among people with problems of stuttering includes a feeling of anxiety because it elicits mockery, frustration, pity and embarrassment from the listeners. As these children grow into adolescence and adulthood and the chronic negative experiences precipitate social avoidance behaviour, development of shyness which would in turn limit the opportunities for educational and psychological development sets in. According to Iverach et al. (2009), if the condition goes untreated in the long run, the persons with stuttering disorder face the risk of developing anxiety disorder later in life. A longitudinal research by Craig and Tran (2006) on stuttering children indicates that in early adulthood, such persons exhibit high anxiety disorder rates, especially social phobia as compared to other psychiatric conditions such as eating disorder or schizophrenia. The development of concerns and negative perceptions towards stuttering sets in at 10 years of age such that by the time such persons attain adulthood, they exhibit persuasive negative stereotypes. For example, people with stuttering disorder would develop negative self perceptions whereas most of those who do not stutter would consider those adults that stutter as self-conscious, shy, anxious and lack confidence. This indicates that as one continues to age, the negative effect of chronic stuttering could be debilitating not only socially but also psychologically. Treatment There are various methods of treating stuttering. The fluency shaping therapy, also referred to as connected speech, prolonged speech or speak more fluently aims to train people who stutter on speaking fluently by practicing control on their breathe, articulation of tongue, jaw and lips and phonation. This operates under the basis of operant conditioning where people with this disability would be trained to reduce their rate of speaking through stretching consonants and vowels and application of various fluency techniques such as soft speech contacts and continuous airflow. This results in slow and monotonic but also fluent speech which would only be used in speech clinic. As the stuttering person masters the fluency skills, the doctor would gradually increase the intonation and speaking rates. The resultant more normal sounding and fluent speech would then be applied outside the speech clinic setting. These fluency shaping techniques have been taught through intensive group therapy programs, lasting between two and three weeks. This approach has however been criticised for its inability to impart speech naturalness on the person being treated (Guitar, 2006). Another form of therapy used to treat stuttering is referred to as stuttering modification therapy. The objective of this approach, unlike the fluency shaping therapy would not be elimination of stuttering but rather modification so as to make stuttering less effortful and easier (Guitar, 2006). This rides on the postulate that anxiety and fear enhances stuttering and therefore, employment of easier stuttering with less avoidance and fear would decrease stuttering. The most widespread approach in this form of therapy has been the block modification therapy. Altered auditory feedback has also been used for over five decades where the stuttering persons hear their voices differently. The effect of altered auditory feedback would be achieved by speaking in chorus with other persons, by blocking out the voice of persons who stutter referred to as masking; through delay of the voice of the person who stutters referred to as delayed auditory feedback and modifying the feedback frequency, referred to as frequency altered feedback. However, this approach has received a lot of criticism for its failure to yield reliable results. While some subjects would exhibit substantial reduction in stuttering, others would show minimal or no effect at all. An associated treatment approach referred to as diaphragmatic breathing has been found to control stuttering. An observation by NHS (2012) indicates that performing vocal artists with strengthened diaphragms would stutter only when speaking but not when singing because when singing, the diaphragm would be involuntarily involved as opposed to speaking where the involvement of the diaphragm would be involuntary. Therefore, other scholars have supported use of anti-stuttering medications. Research studies have evaluated the effectiveness of some pharmacological agents like anti-convulsants, anti-depressants, benzodiazepines, antihypertensive medications and antipsychotic medications in treating stuttering among adults and children. In their study, Craig and Tran (2006) found out that few of these drugs pass the methodological soundness test. In addition, these drugs pose serious side effects with their usage including potential rise in blood pressure and weight gain. But a drug named pagoclone has been found out to be well-tolerated and has minor side effects like fatigue and headache. Various self help approaches and support groups approaches have been supported by Guitar (2006). According to the scholar, whereas medicinal, behavioural and prosthetic measures provide limited solutions for to stuttering symptoms, self-help movements and support groups have gained popularity in the professional circles for people with stuttering problems. Among the principles of this approach connotes that since there has been no cure for the disorder yet, the quality of life could be improved by being less involved in the thoughts of stuttering. Indeed, psychoanalysis has been cited as an effective treatment to stuttering (NHS, 2012). The focus of the support groups has been on stuttering as a psychological more than a physical impediment. Other forms of therapy as cited by NHS (2012) include direct therapy and the demands and capacities model. The Demands and Capacities Model postulates that speech fluency would be broken down in a child who exhibits stuttering tendencies when the demand on their speech exceeds their production ability. These demands would arise when the child pressures oneself to communicate in a manner above the scope. Therefore, this model promotes an environment where the child would be more confident and relaxed in using languages. This would involve the development of interaction between the child and parent, avoiding criticism and according the stuttering child attention and speaking to the child slowly. On the other hand, direct therapy would be mostly used by speech and language therapists, SLTs in cases of moderate to severe stuttering that persist over time. The most commonly used therapy in this category has been referred to as Lidcombe Programme by NIH (2012). The basis of this lies on parents providing the child with consistent feedback on their speech in a manner deemed to be friendly, supportive and non-judgemental. According to Zieve (2012), stuttering persisting beyond the age of six could prove challenging to resolve. Implications for treatment As noted, a considerable portion of stuttering people develops social anxiety which would be compared to the people who have been primarily diagnosed with social anxiety disorder. Documented evidence indicates that such persons could benefit from treatment meant for people with social anxiety disorder. Since this paper indicates a correlation between anxiety and stuttering, it would be important to consider anxiety as a feature of stuttering disorder. This suggests that researchers need to conduct further studies to determine the type of anxiety suffered by people with this disorder. It would also be needful to clarify the observation of social anxiety being disproportionate to the stuttering levels since Iverach et al. (2009) observed that 40% of the people who suffer from stuttering would exhibit abnormal chronic social anxiety levels. In addition, it should be differentiated between stuttering people who develop social anxiety and those who fail to do so. Including anxiety symptoms in features of stuttering would play a critical role in its management. Currently, not giving medication for anxiety could be widespread because anxiety is yet to be perceived as an important component of stuttering although evidence supporting the positive effect of anti-anxiety treatment on stuttering persons exists. Therefore, wholly relying on treatment meant for stuttering could be detrimental to offering appropriate management of stuttering especially for individuals exhibiting high chronic social anxiety levels. Therefore, both stuttering and anti-anxiety treatments should be offered to people suffering from stuttering disorder. Conclusion Stuttering or stammering refers to a condition where one exhibits disrupted speech mannerisms and fluency, usually repeating words, syllables or sounds longer than normal. Developmental stuttering, a medical condition, affects a majority of men than women with its major cause attributed to hereditary factors, though it remains unclear how this occurs. Similarly, head injuries have been cited as the other causes of the disorder. Though there are cases of natural recovery, stuttering could persist into adulthood causing negative social interactions which could deny the victims opportunities in life. As such, diagnosis should be done at a tender age so as to device appropriate measures to contain the disorder before it exhibits its severe consequences. Treatment is available for stuttering through use of appropriate medicine though the various forms of therapies have been widely adopted as they are considered to be more effective than the pharmacological methods. In addition, a combination of stuttering treatment and anti-anxiety treatment would be crucial in curbing social anxiety resulting from stuttering and thus offer appropriate management of the disorder. References Craig, A. & Tran, Y. (2006). Fear of speaking: chronic anxiety and stammering. Advances in Psychiatric Treatment, 12, 63 – 68. Dworzynski, K., Remington, A., Rijksdijk, F., Howell, P. & Plomin, R. (2007). Genetic etiology in cases of recovered and persistent stuttering in an unselected longitudinal sample of young twins. American Journal of Speech-Language Pathology, 16, 169 - 178 Guitar, B. (2006). Stuttering: an integrated approach to its nature and treatment. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins. Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M. Harrison, E.,... Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking therapy for stuttering. Journal of Anxiety Disorders, 23, 928 – 934. Lavid, N. (2003). Understanding Stuttering. Mississippi: University Press of Mississippi. National Institutes of Health. (2012). Stuttering. US National Library of Medicine. Retrieved 28 November 2012 from http://www.nlm.nih.gov/medlineplus/stuttering.html NHS (2012). Stammering. Retrieved 28 November 2012 from http://www.nhs.uk/conditions/stammering/Pages/Introduction.aspx Zieve, D. (2012, December 6). Stuttering. US National Library of Medicine. Retrieved 28 November 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002400/ Read More