Overview
Fluency is the ability to be able to produce smooth fluent speech, and dysfluency, stammering and stuttering all mean the same thing and are pretty much interchangeable. They describe an inability to speak smoothly and pronounce words with out breaks in them or adding additional sounds or syllables to them.
Stuttering can often get worse if a person feels anxious, under pressure or are in a stressful situation. Symptoms can also get worse if they are feeling tired, excited or self-conscious. Strangely when people who stutter sing or talk to themselves they can do so without stuttering. Whilst dysfluency can cause people to feel anxious it is not actually a form of anxiety.
People who stutter know what it is they want to say but struggle saying it. This can cause then to feel anxious and frustrated and affect their school, work and social life. There are three main types of dysfluency which are:
Developmental stammering
Generally starts around the ages of two to seven years and is believed to affect around eight percent of children. It is sometimes referred to as childhood onset fluency disorder. It is a neurodevelopmental disorder and it occurs when a person’s brain develops differently than you would expect it to. For this reason it only affects children, but almost ninety percent of these children are likely to recover on their own by the age of eighteen. It is unlikely to return unless they develop acquired stuttering.
Persistent stuttering
Occurs when developmental stammering continues in to a person’s adulthood so only affects adults, it is rare but the condition is usually lifelong.
Acquired stuttering
Is a type of dysfluency that occurs when a person has had a stroke, illness or brain injury and can affect children and adults. It can be a temporary or permanent condition in both children and adults.
Causes of developmental stammering
There is no single reason for a child to develop a stutter it can be caused by a variety of factors which can include:
Environmental factors
It’s believed that certain environmental factors may contribute to someone developing a stutter. If a child has been raised in a home where their family argued or there was aggressive behaviour it can cause them both stress and anxiety, which can lead to them developing a stammer. Having parents that had high expectations of their child can also be a contributory factor.
Family history and genetics
Genetics can play a large part in the likelihood of someone developing a stutter so if they have a family member with a stutter then they are more likely to develop one as well. It’s believed that sixty percent of people who stammer have a family member that also has a stammer.
Neurological Problems
It’s believed that the way a person’s brain works can also be a cause for them stuttering. Certain conditions can increase this risk as they are associated with problems in the way the brain is able to process information, which can affect speech and language development, such as:
ADHD (attention deficit hyperactivity disorder)
Autism spectrum disorders
Tourette Syndrome
Causes of non-developmental dysfluency
Other than developmental stuttering in children that continues into adulthood, adults can also develop speech dysfluency in certain instances, including the following:
Emotional distress
During times of emotional distress some people can find that their normal speech patterns are affected by dysfluency. Those who already stammer can find that their symptoms worsen.
Neurogenic stuttering
If a person has had a traumatic brain injury or suffers from other brain disorders or has had a stroke it can affect their speech. They can struggle to pronounce words; their speech may be slower or they pause in their speech or repeat sounds.
Psychogenic Stuttering
This can happen when a person has suffered extreme emotional trauma but is rare.
Symptoms of stuttering
Symptoms of dysfluency can vary in length and severity amongst individuals, the most common of these include:
Speech Symptoms
· Repeating sounds syllables or words
· Struggling to start a word phrase or sentence
· Feeling anxious at the thought of speaking
· Struggling to communicate with other people effectively
· Have tightness or tension in the face or upper body when they are trying to say certain words
· Breaking the sound of a word with a pause
· Having brief silences when saying certain syllables in words
· Extending or prolonging the sound of a word
· When they think they are going to have difficulty saying their next word they add on extra sounds to the current one
Physical Symptoms
Physical symptoms can include things like:
· Trembling of the lips or jaw
· Clenching their fists
· Becoming out of breath or changes to their breathing pattern
· Looking away or closing their eyes
· Nodding or jerking the head
· Facial tics or unusual movements of the face
· Blinking the eyes rapidly
Associated risks of stammering
People who have a stammer or develop some form of speech dysfluency can often develop associated conditions such as:
· Anxiety
· Become a target for bullies or be teased because of their speech
· Depression
· Issues with low self-esteem
· Lack confidence
· Not take part in school or work activities which can affect their academic or career success
· Struggle to communicate with other people
· Will avoid any situation that involves speaking in public
It’s believed that around forty percent of children who stutter between the ages of twelve and seventeen also struggle with anxiety and depression. Adults with dysfluency are twice as likely to develop anxiety and depression and it’s believed they are three times as likely to also develop a personality disorder.
How you can help yourself manage your dysfluency
There are a variety of different ways you can try and manage your symptoms such as:
Support groups
Support groups can be helpful as they allow people to socialise with other people who have challenges with their speech, in a place where they won’t feel judged, or the need to try and hide their stammer. They can also share techniques that they have found useful, share their successes and provide support and encouragement. It can be a relief to realise that you are not alone in having dysfluency.
Breathing Techniques
Breathing techniques can help you to slow down your speech and form your words better, as well as reducing the effort it takes. You can do this by practising breathing from the stomach rather than the chest. You can then practice talking with someone you feel comfortable with so that you feel less anxious when you have to talk to people you don’t know.
Mindfulness
Practicing mindfulness can be useful to help reduce stress levels and anxiety. It can also be helpful to record yourself speaking, so that you can study this afterwards to see if you can recognise if there is anything that triggers your stammer.
Diagnosis and treatment
Whilst some children can grow out of stuttering as part of their natural speech development, if it continues and causes them problems then you should seek help from a healthcare professional especially if:
· It occurs alongside other speech or language difficulties
· Results in anxiety or emotional issues
· Symptoms have lasted for a period in excess of six months
· They are physically struggling to speak or shown signs of muscle tightening or facial tics or twitching
· Symptoms occurred in adulthood
If your dysfluency has occurred in adulthood or alongside any other pre existing speech problems your doctor may need to run other tests to rule out any underlying medical issues. They may run tests such as:
· CT scans
· MRI scans
· PET scans
These are all used to rule out conditions such as:
· Aphasia
· Traumatic brain injuries
· Strokes
· Brain tumours
Once they have ruled out any undiagnosed health conditions they can work out a treatment plan. There are a variety of treatments available and different treatment options work better for some people than others. These can include:
Speech Therapy
Is the most common type of therapy used for all types of stuttering, it can teach you to slow down your speech so that you notice when you stutter. You may find that when you start the therapy your speech pattern is slow but this will improve to a more natural speech pattern over time.
Electronic Devices
There are a variety of devices available and you can talk to your speech therapist to see which one they think might be most beneficial.
Psychotherapy
CBT (cognitive behavioural therapy) and psychotherapy can help you to manage any anxiety, stress or depression that you’re your dysfluency may have caused. It can also help you to identify any negative thoughts or behaviours that may be making it worse. As well as helping with poor confidence or low self-esteem.
Medication
Whilst there are no specific medications for dysfluency your doctor can prescribe antianxiety or antidepressant medication if you are suffering with either anxiety or depression as a result of your speech problems.
Coping and support
As the parent of a child who stutters you should ensure that you always listen to them and maintain eye contact. Never finish their sentences for them and speak slowly so that your child will follow your example. Offer praise and encouragement and don’t draw attention to their stuttering. Try and keep situations calm, rather than rushed or hurried, and never scold or criticise them in public as this could result in them feeling insecure or embarrassed. Written by Jan, Jeana and Wendy at Barnsley Hypnosis and Counselling (UK). For more free Information click above link.
