Stuttering

Stuttering Classification Characteristics Sub-types Causes of developmental stuttering Treatment Prognosis Epidemiology History and cultural aspects

Characteristics

Primary behaviors

Primary stuttering behaviors are the overt, observable signs of speech fluency breakdown, including repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. These differ in from the normal disfluencies found in all speakers in that stuttering disfluencies may last longer, occur more frequently, and are produced with more effort and strain. Stuttering disfluencies also vary in quality: normal disfluencies tend to be a repetition of words, phrases or parts of phrases, while stuttering is characterized by prolongations, blocks and part-word repetitions.

* Repetition occurs when a unit of speech, such as a sound, syllable, word, or phrase is repeated and are typical in children who are beginning to stutter. For example, "to-to-to-tomorrow".
* Prolongations are the unnatural lengthening of continuant sounds, for example,"mmmmmmmmmilk". Prolongations are also common in children beginning to stutter.
* Blocks are inappropriate cessation of sound and air, often associated with freezing of the movement of the tongue, lips and/or vocal folds. Blocks often develop later, and can be associated with muscle tension and effort.

Secondary behaviors

Secondary stuttering behaviors are unrelated to speech production and are learned behaviors which become linked to the primary behaviors.

Secondary behaviors include escape behaviors, in which a stutterer attempts to terminate a moment of stuttering. Examples might be physical movements such as sudden loss of eye contact, eye-blinking, head jerks, hand tapping, interjected "starter" sounds and words, such as "um," "ah," "you know". In many cases, these devices work at first, and are therefore reinforced, becoming a habit that is subsequently difficult to break.

Secondary behaviors also refer to the use of avoidance strategies such as avoiding specific words, people or situations that the person finds difficult. Some stutterers successfully use extensive avoidance of situations and words to maintain fluency and may have little or no evidence of primary stuttering behaviors. Such covert stutterers may have high levels of anxiety, and extreme fear of even the most mild disfluency.

Variability

The severity of a stutter is often not constant even for severe stutterers. Stutterers commonly report dramatically increased fluency when talking in unison with another speaker, copying another's speech, whispering, singing, and acting or when talking to pets, young children, or themselves. Other situations, such as public speaking and speaking on the telephone are often greatly feared by stutterers, and increased stuttering is reported.

Feelings and attitudes

Stuttering may have a significant negative cognitive and affective impact on the stutterer. In a famous analogy, Joseph Sheehan, a prominent researcher in the field, compared stuttering to an iceberg, with the overt aspects of stuttering above the waterline, and the larger mass of negative emotions invisible below the surface. Feelings of embarrassment, shame, frustration, fear, anger, and guilt are frequent in stutterers, and may actually increase tension and effort, leading to increased stuttering. With time, continued exposure to difficult speaking experiences may crystallize into a negative self-concept and self-image. A stutterer may project his or her attitudes onto others, believing that they think he is nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program.