What’s the worst sound ever? I know what you’re thinking…the sound of a record player stuck on repeat. That horrible noise of your favourite song stuck on one syllable, or perhaps one word, or even a singular phrase, on and on again. It’s the worst. If you were anything like me, or the community I resonate with, this horrible situation becomes your reality, your life, your everything. Part of a demographic of people who represent only 1% of the world’s population (I know cool right?), I’m someone who stutters. I was diagnosed with stuttering, meaning that my speech involves frequent disfluencies and I struggle maintaining a consistent flow of speech, at the age of 4, right when I began talking. I’ve been stuttering for almost 15 years now and its been an inhibitor in my daily routines, school, and my social life for the majority of this time. I was bullied, harrassed by my peers, teachers and sometimes even my own family as a result. And although I’ve lived with the ups and downs of stuttering for pretty much my entire life, I pretty much know nothing about it and neither does anyone else for that matter. The unfamiliarity regarding stuttering creates questions: Are stutterers missing something vocally? What is happening that makes him speak like that? Why does he stutter? Similarly, the little that we do know about stuttering entices us to think about how it can be treated, or perhaps cured. Since I was in the 1st grade I’ve been attending lessons, meetings, group sessions, etc., regarding speech pathology, and to this day I don’t know the most effective way to treat a stutter nor do I know of any way to cure my speech disorder. This unknowns excite me however; I’m intrigued by the possibilities and the new, but experimental research conducted by practitioners nationwide in describing and discussing the mechanisms of stuttering and the approaches to treatment options for the circle of people which I call “family”.
First things first – what is a stutter? According to the Mayo Clinic, a stutter a speech disorder that involves frequent and significant problems with normal fluency and flow of speech. Stuttering occurs in roughly 5-10% of children ages 2-6 and is more common in men than women (3:1). The precise synchronization of articulatory and auditory muscle groups within the body is severely compromised in developmental stuttering. Otherwise, there’s little to no information regarding the neuronal, or relationship to the nervous system, basis of persistent developmental stuttering. Several ideas regarding the pathophysiology of persistent developmental stuttering have been theorized: scientists claim that an incomplete or abnormal patterns of cerebral hemispheric dominance, impaired motor oral control or impaired auditory self-monitoring of speech, supported by temporal deactivation could be the reasoning.
In 2002, Professor Martin Sommer of Göttingen University aimed to weigh in on this discussion. He conducted an experiment in which he analyzed the speech of 15 people with persistent developmental stuttering and 15 closely matched controls for the percentage of syllables stuttered. Using a technique called Diffusion Tensor Imaging (DTI), which has been used to discover the abnormalities of another language disorder, dyslexia, Sommer’s team tested their hypothesis of a “disconnection between speech-related cortical areas as the structural basis of persistent developmental stuttering by characterising brain tissue structure”. In this experiment, a group of 15 stutterers (the study group) and a group of 15 non-stutterers (the control group) were asked to read a newsletter. Participants speech was recorded via audiotape and the percentage of syllables stuttered was assessed by two accounts of DTI and then averaged. Sommer’s team then compared the fractional anisotropy (FA), which measures the degree of diffusion in a reaction, of the fluent and stuttering groups using a method called Voxel-Based Morphometry, which involves spatially normalizing high-resolution images from all the subjects in the study into the same space.
The results showed that patients in the stuttering group stuttered significantly more syllables than the control group and as a result, Sommer’s team concluded that there is an innate cortical disconnection in people with persistent developmental stuttering immediately below the laryngeal and tongue representation in left sensorimotor cortex.
Now that the “sciency stuff” is out of the way, you may be wondering how stuttering is treated and is it a disorder that can be cured. Surprisingly, the first recorded case of stuttering treatment was found to have occured in the mid 300s BCE, although at first, treatment consisted of Greek men reading formal speeches while walking up and down mountains with pebbles in their mouths. More contemporary speech therapy was developed using the fluency-centric model which is used by speech pathologists to this day, in order to minimize, reduce and seek to eliminate stuttering all together. Techniques such as using increasingly slow speech or pausing for excessive periods of time between words characterizes this approach to speech therapy. Between the ages of 8 to 14, I thought of these techniques as the “talk less because the way you talk is weird” strategy.
As of more recently, as Dr. Kong Voon Poon discusses in his composition “Stuttering Therapy when the Problem Isn’t Stuttering: Using Narrative Practices in a Fluency-Centric Society”, practitioners have developed beneficial ways of using narrative practices and externalising conversations to work with adults and young people who stutter. Narrative practices invite speech pathologists to join with young stutterers in questioning social discourses and helping them work towards their own hopes, values and goals, whether or not these include reduction of stuttering. This method uses the externalising conversations technique, which is a way of speaking in which space between the person and the problem is created. The goal of this technique is to make young stutterers understand that “they are not the problem, stuttering is the problem”. Another feature of the narrative practice method is the use of re-Mkoňng conversations. In the early stages of speech therapy, a young stutter like myself may say “I get nervous speaking on the phone with distant relatives because of my stutter” or “I can never speak fluently around friends but around family I always can”. Re-Mkoňnging or re-authoring these conversations “provide a pathway to move from these responses to exploring the steps an individual has taken to counteract the problem.”
When I was about 15 years old, as a sophomore in high school, my family and I made the decision to switch my speech therapist and explore other options regarding my speech. I spent the last two years petrified by the idea of public speaking, reading aloud in class and talking to my friends and family. My mother got in touch with a Manhattan-based program called SAY, The Stuttering Association for the Young, a national nonprofit whose mission is to empower, educate, and support young people who stutter and the world that surrounds them. At SAY, I was introduced to a new level of speech therapy, one which correlates to Dr. Poon’s narrative practice techniques. I was welcomed in this environment and worked with the faculty and peers to accept my stutter rather than shy away from it. Through a series of exercises, like calling random stores and talking until I was hung up on, to walking around in Central Park starting conversations with strangers about their outfits, I became more content with my stuttering and it increased my overall quality of life. With this new acceptance and content, came more fluency. The narrative approach to speech therapy which I experienced at SAY played a large role in innately reducing the amount of disfluencies I’d say in a phrase, in a few sentences, in paragraphs, in formal speeches.
Our understanding of the mechanisms of stuttering, in terms of the relationships between cortical disconnection and vocal output, have transformed throughout the years. Similarly, our recognition of treatment techniques and approaches to speech pathology have vastly evolved since the “age of hiking and pebble-eating” with newer, more narrative methods which utilize externalising and re-Mkoňng conversations in order to promote acceptance and content in regards to stuttering, therefore increasing the quality of life and subsequently reducing disfluency. Given the fact that stuttering is an under the radar subject, there’s still much to learn regarding its mechanisms and treatment options. Researchers will continue to uncover information about stuttering and perhaps new speech pathology techniques will be developed but we must remember that we owe it to the young people of the world who struggle to accept their identities with stuttering to aim to create an environment characterized by empowerment, education and support.
By: S. Williamson
Coleman, Craig E. “Comprehensive Stuttering Treatment for Adolescents: A Case Study.” Language, Speech & Hearing Services in Schools (Online), vol. 49, no. 1, 2018, pp. 33-41. ProQuest, http://libproxy.lib.unc.edu/login?url=https://search.proquest.com/docview/2003275465?accountid=14244, doi:http://dx.doi.org/10.1044/2017_LSHSS-17-0019.
Pang, Voon. “Stuttering Therapy when the Problem Isn’t Stuttering: Using Narrative Practices in a Fluency-Centric Society.” The International Journal of Narrative Therapy and Community Work, no. 2, 2017, pp. 45-54. ProQuest, http://libproxy.lib.unc.edu/login?url=https://search.proquest.com/docview/2101264405?accountid=14244.
Sommer, Martin, et al. “Disconnection of Speech-Relevant Brain Areas in Persistent Developmental Stuttering.” The Lancet, vol. 360, no. 9330, 2002, pp. 380-383.
Yaruss, J. S. “Assessing Quality of Life in Stuttering Treatment Outcomes Research.” Journal of Fluency Disorders, vol. 35, no. 3, 2010, pp. 190-202.
“Can ‘Demosthenes Pebbles’ Make You a Great Orator?” Sciencevibe.com, 11 May 2015, sciencevibe.com/2015/05/11/communication-breakdown-r-u-suffering-from-rhotacism/.
“Children Should Be Screened for Stuttering, Researchers Say.” The Telegraph, www.telegraph.co.uk/health/healthnews/9633039/Children-should-be-screened-for-stuttering-researchers-say.html.
“Cover Picture for The Stuttering Association for the Young.” Www.say.org, 2017, www.say.org/wp-content/uploads/2014/04/SAY_opengraph-e1410213547589.jpg.