Talking Points – Understanding Stuttering and How It’s Treated and Managed

Imagine spending two years of your life unable to say to others what you were really thinking or needed at any given moment. Then, after spending that same time observing, practicing, and learning how to converse, the words finally come out, and just as one might think, you have a lot to say!

That’s the way it goes for many toddlers as they practice speaking at length, developing vocabulary alongside their speech and motor skills at around age 2. At this stage, it’s perfectly normal for a new speaker to slip up and experience dysfluency; it’s nothing out the ordinary for a child to repeat an entire word or phrase twice every so often, thinking so rapidly about what to say next that their mouth and current rate of speech can’t keep up.

However, by age 21Ž2 to 3, some children might not break away from the normal dysfluencies. The opposite may occur, whether it’s a child having difficulty sounding out a word, repeating one syllable multiple times (“I’d like a coo-coo-coo-cookie, please”), or even adding a totally different syllable to a word (“I’ve got soccer pr-ew-actice tomorrow”).

When signs like part-word repetition start to show and become more and more consistent, it is necessary to seek out a speech therapist, because such issues are common symptoms of what’s commonly known as stuttering, a disorder that interrupts the natural flow of speech and affects nearly 3 million people.

“Stuttering is a communication disorder that involves dysfluencies, or breakdowns in making sounds, and it usually starts developing between the ages of 2 and 5,” said Claudia Eitner, lead speech pathologist at Weldon Rehabilitation Center in Springfield.

A professional who sees a variety of stutterers come to the facility located at Mercy Medical Center’s campus, including both children and adults, Eitner told HCN that stuttering comes in many forms and is found to have a range of severity, with more severe cases often creating difficulty for those who have it.

“The anatomy of the stutter is something research is still trying to fully understand, but what we do know is that there’s a genetic component predisposing individuals to stuttering and that it originates in the brain, involving the pathways controlling movement of speech muscles, which become disrupted, resulting in the stutter.

“It affects both children and adults, making them extremely self-conscious about speaking,” he went on. “Family and social interactions can become much more difficult and stressful for everyone, especially in children. Because of the difficulty, they will actually speak less, and children need to be talking in order to develop those skills in their formative years. But children who stutter are less motivated to speak because it can be so frustrating for them.”

A condition that’s appeared in some of the earliest written recordings of man (in Exodus 4:10, Moses confesses he often tangles his words), stuttering, while not physically harmful, can have a tremendous impact on the lives of those who have it, especially at the young age when it commonly emerges.

“For a stutterer, all aspects of their life can be impacted,” said Jen Berneche-Stiles, a speech-language pathologist at Cooley Dickinson Hospital.

Like Eitner, Berneche-Stiles sees a number of cases involving mild to severe dysfluency, specifically in children ranging from toddlers to adolescents. While a number of them are relatively young and treated before entering kindergarten, some already have felt the negative impact of the impediment.

“Socially, children with the condition may find so much difficulty in speaking that they’re not willing to even approach friends,” she noted. “When interacting with kids their own age, they might experience kids walking away, not wanting to wait for them to sound out what they’re saying. I’ve worked with parents who describe situations in which their child will be trying to get the words out, only to witness the other children they’re talking to just leave.”

Though ranging in severity, with minor dysfluency sometimes going unnoticed or disregarded by those who hear it, severe stuttering can have a huge bearing on an already-crucial age at which, as mentioned by Eitner, some of the most key communication in a child’s life occurs.

With that in mind — and with research consistently confirming that, when it comes to treating stuttering, the sooner treatment begins, the better — it’s all a matter of watching for the right red flags.

For Berneche-Stiles and her team in Northampton, there are a great number of signs to search for and identify, especially when a child expresses visible stress when communicating, a very atypical behavior.

“We look for any sign of tension,” she explained. “Little kids are not tense when they talk. We look for any kind of tremor, any visible kind of tension in the neck or throat as the dysfluency stresses them out.

“When we start looking at more borderline or mild cases of dysfluency, we start to see tension just as we see emphasis on repetitions change,” she continued. “Whole-word repetitions are typical because, when kids are young, they’re highly dysfluent, and that is normal; children are just developing language, and automaticity isn’t there yet, so if you ask them a question, sometimes they will rephrase or back up their words when giving a response.

“What we’re concerned about is when a child starts repeating a sound or part of a word instead,” she went on. “For instance, we look for sound repetition, as if the child were to say ‘boo-ooo-oook’ instead of ‘book.’ When a child begins reaching the age of 3 and they’re constantly repeating the sound, that’s not typical, though it may happen to anyone once in a while.”

Other commonly accepted signs of stuttering include the speaker prolonging certain sounds of a word (“ssssoup”), holding their breath and avoiding words altogether, and, most telling of all, inserting a ‘schwa’ or ‘uh’ sound into a word that doesn’t call for it.

“If they add sounds rather than just the sound of the word, sometimes there will be a ‘schwa’ sound right after the consonants, and that’s one of the biggest indicators,” said Laura Roberts.

A speech language pathologist at Learning Solutions for Learning Success, LLC, a diverse group of clinicians in Florence, including psychologists, learning strategists, and speech therapists, Roberts and all other experts interviewed for this piece agree that the dull ‘uh’ sound that comes with an inserted ‘schwa’ is one of the most definitive signs of a stutter.

“What happens is a stutterer will add in the sound right after the consonant instead of going right into the next vowel. Like if they’re saying ‘pan’ and say ‘p-uh, p-uh, pan,’” she explained. “It’s a key indication, and what happens if they start to develop secondary features that aren’t just easy repetition or pauses — if they start to blink their eyes, or shake their head to get it out. There are a number of secondary characteristics a stutterer can have, and since they can help get the word out, it’s positively reinforced. And this becomes an issue of learned behaviors on top of the stuttering.”

A dysfluency, a stammer, an impediment — stuttering is a case-by-case condition that for some can go untreated and carry into adulthood. For a select few others, a stutter can simply be grown out of as the speaker grows to speak more and more and simply leave it behind. But what’s most important to understand about the condition that affects 1{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the population is that it’s very much treatable.

For David Landry of Baystate Rehabilitation Outpatient Care, along with all other experts interviewed, slowing and breaking down a stutter are key for the child or adult to better comprehend and manage their dysfluencies.

“For younger kids, say around preschool age, we’ll have a play-center-type of therapy rather than strictly saying ‘let’s work on this sound,’ encouraging the child to think about speech in terms of  turtle vs. rabbit talk,” Landry said.

‘Turtle talk’ is a commonly used tool in speech therapy that encourages children to take on a more controlled, reduced rate of speech by having them speak at the pace of a turtle (with rabbit talk being a more fluid, normal tone). For almost all speech pathologists, slowing down the rate of speech is imperative to working on a stutter and is just as important as having parents work one-on-one with their child to avoid tense communication and encourage better speech.

“When the patient is older, I like to use a cognitive approach they can understand more, asking, ‘what do you consider stuttering?’ and have them tell me what they think it is and how it comes to be. Then, we can talk about strategies to help with breathing and the natural flow of sounds and words.

“And with adults, we really work with them because they’re coming from a longer period of time of having their stutter and having people react to them,” he continued. “We work to identify it and make it smoother — not necessarily cure it, because I don’t think you can use the term ‘cure’ for stuttering. It’s more along the lines of management and control.”

Those are essential strategies when it comes to approaching a stutter. And with the amount of literature and research available, speech pathologists are well-equipped to take on each individual case, whether it’s easy-to-follow sheets encouraging fluent speech as used by Berneche-Stiles or engaging in ongoing collaborations between family members with Roberts.

And most importantly, as agreed upon by everyone interviewed and emphasized best by Landry — give them time.

“If anything, I want people to understand that stutterers want to talk just like everyone else,” he said. “They have ideas, thoughts, and feelings, and they want to share those things. We need to build awareness on the public side that this is something they’re dealing with, that they’re not doing this on purpose and are trying to work through their dysfluencies.”

In short, “I think the best people can do is give them time,” he said. “Don’t rush them.”