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Stammering is a disorder of fluency, meaning that the flow of speech is disrupted, resulting in disjointed words and sentences. Stammering affects many people in the UK today and it is estimated that some 3% of the adults in the UK have a stammer, and that up to 8% of children in the UK experience a stammer, though many children lose their stammer after some time. Stammering affects people all across the world, and is more prevalent in men than women, at a ratio of 4:5.
What is stammering?
A stammer causes repetition of sounds and/or syllables in a word, which differs from the usual fluency of an individual’s speech. A person with a stammer will repeat words multiple times (“I’m I’m I’m I’m I’m hungry”), lengthen a particular syllable within a word (“I’m huuuuuuuuungry”), repeat a syllable (“I’m hu-hu-hu-hu-hungry”) or be delayed in moving past a particular point in the sentence (“I’m hu-ngry”). They may present any or all of these occurrences.
Additionally, someone with a stammer might experience outward bodily effects such as screwing up parts of their face to push words out, using parts of their body, or making bodily signals when they are trying to get their words out. This might include moving their neck and shoulders, changing position, stamping or hitting something, tapping and blinking.
Despite being described as a ‘disfluency of speech’, stammering is not a speech disorder, but a communication disorder, known to often affect the individual’s self-perception, their relationships and their opportunities in life. Whilst many people may struggle with their fluency in speech to a certain extent, someone with a stammer experiences disfluency more frequently and more extremely. People living with a stammer also experience internal feelings that cannot be observed outwardly, such as a sense of poor control over their communication.
What is the difference between stuttering and stammering?
When researching a stammer, it is common to come across a stammer being referred to as a stutter. Stuttering is the American-English term given to the same set of symptoms as a stammer, and there is no real difference between the two. Generally, the term ‘stuttering’ will be used in America and Australia, whilst ‘stammer’ is used in the UK.
What is the root cause of stammering?
There is no singular known root of stammering, though there are many factors which may contribute to developing a stammer, including genetics, brain development and environmental factors. One, some, or all of these can affect the onset of a stammer.
Brain injury or stroke
For some people, their stammer may be caused by a serious brain injury, or a stroke. Sometimes stammers can be caused by a growth or lesion on the left cortical or bilateral cortical. It may also be caused by a neurological condition such as Alzheimer’s disease. For developmental stammers, which develop in early childhood, it is thought that one cause may be an issue with the development of parts of the brain which are responsible for speech motor control and coordination.
Genetics can be the cause of stammers in some individuals, as 66% of people with a stammer have a family history of stammering. Studies observing the presence of stammers in twins have shown that one twin may develop a stammer, and one may not, but the rate of stammers are higher in identical twins than in non-identical same-sex twins, suggesting that there is a genetic link. Although an individual is more likely to stammer if there is a history within the family, the stammer is not any more likely to be more severe.
Whilst stammers are not known to be onset by environmental factors, traumatic events, extreme stress and anxiety can cause a stammer.
Furthermore, environmental factors can cause a stammer to be significantly more prevalent. These include:
- Pressured environments, e.g. interviews, exams, or competitive events.
- Speaking to people in positions of power, e.g. managers, teachers.
What are the different types of stammering?
There are three different known types of stammer: developmental stammer, neurogenic stammer and psychogenic stammer. Each type of stammer has a different cause, though the symptoms for each remain consistent with each other.
Developmental stammering or stuttering refers to a stammer that develops in children when they are still acquiring the skills of speech, language and communication. Speech is normally produced by muscle movements which include inhalation, exhalation, throat movement, tongue movement, lip movement and use of the voice box. However, though not fully understood, developmental stammering occurs when children aren’t able to use these mechanisms to articulate their thoughts, feelings and needs.
Brain scan methods, such as PET and MRI, have shown that there are clear structural discrepancies between children with stutters and those without, which makes it clear that the issue is deeper than how it can often appear at a surface level, which is a child who is unable to speak properly because they haven’t yet learnt to. It is thought that developmental stammers are closely linked to genetics.
The National Institute on Deafness and Other Communication Disorders have found elements in genes that can be attributed to stuttering, which appear to be inherited.
Neurogenic stammering or stuttering is when an individual is prone to elongated sounds, pauses or repetition due to an injury affecting the brain. This might be due to a stroke, a physical brain injury or operation, lack of blood flow to the brain, conditions such encephalitis, or any brain disorder. Neurogenic stammers have been known to affect up to 5.3% of individuals who have had a stroke.
Neurogenic stammers can also affect people with Parkinson’s disease, Alzheimer’s and multiple sclerosis (MS). In very rare cases, it can be onset by medication. The cause of neurogenic stammers can usually be identified, and may be more treatable in some cases than stammers that develop in childhood with the absence of a brain disorder.
Psychogenic stammering or stuttering is stammering that is onset by a wide range of psychological issues. A psychogenic stammer is not typically attributed to genetic factors. Psychogenic stammering is the least common form of stammer, and is usually a result of emotional factors, such as extreme trauma and stress or depression and anxiety. It can be developed at any age, and is thus hard to identify the root of its cause; however, the individual may experience a partial or complete loss of control over their speech and fluency.
A change in someone’s speech and fluency in conjunction with a psychological factor, such as trauma, does not always mean that their disfluency is definitely attributable to the trauma. The individual may be experiencing issues with their muscles or their brain, so medical advice should always be sought immediately if there is a sudden onset of speech disfluency.
Signs and symptoms of stammering
In children, stammering can be more difficult to identify, as many children under the age five experience some kind of hesitancy when they speak, as they are learning how to form sentences. Usually, children will stop in their sentences at some point. Other children will display lengthened sounds and syllables, or become visibly uncomfortable or flustered when trying to form a sentence.
Stammering is more common in individuals whose families have a history of stammers, and though not confirmed, it is believed that there is a gene malfunction involved, which could be inherited.
Signs of stammers include:
- Issues with beginning a sentence.
- Elongated sounds or syllables in a word.
- Repetition of syllables or words.
- Using additional words where there is a pause in the sentence, such as ‘uh’ or ‘er’.
- Facial tension when trying to pronounce a sound, or movement of facial features, and facial tics.
- Eye blinks.
- Shaking of the lips or jaw.
- Broken sentences or words, where a syllable is skipped.
When someone first notices that they have a stammer, particularly a child, they may deliberately try to conceal it, though this can worsen the stammer. Children often find that their stammer decreases when participating in singing in a group, when the attention is not solely on them, or when they play by themselves.
How is a stammer diagnosed?
Stammers are usually diagnosed between the ages of 2 to 5 years old, when signs of a communication impairment become more apparent. A diagnosis of a stammer does not mean that the stammer will stay with the individual their whole lives. Many stammers disappear without any help.
A diagnosis will be made by a healthcare professional, after an assessment with a speech and language pathologist. The pathologist will assess how the individual’s speech occurs in different environments. Either the parent or the individual will be asked questions about the onset of the stammer and will investigate whether they are suffering from any other condition. They will try to understand what measures have already been taken to treat the stammer and how it has impacted their lives.
How is a stammer treated?
There is no cure for stammering. A stammer can last a lifetime, or disappear in a few years, and there are no medications available that have an effect on stammering. After a diagnosis, a treatment plan of one or more methods will be put in place to try and reduce some of the symptoms of a stammer and relieve the impact on the individual’s daily life. The aims of any treatment method will be to decrease disfluency.
Treatments may include the following:
Speech therapy, provided by a trained speech and language therapist, is used as a treatment to help the individual gain control over the speed of their speech, and recognise where they tend to pause or repeat words, sounds and syllables. Most people find that by reducing the speed of their speech, they are able to become more fluent.
For children, the earlier the intervention of speech therapy is introduced, the better the results will be. Speech therapists will offer different techniques, and work with the individual to see the stammer as a part of their life, rather than negatively. They will work with the individual to create strategies to manage the stammer and its impact.
Breathing and relaxation
Breathing techniques have no direct impact on the speech itself, but are used to help the individual to relax, as stress can often worsen the frequency of pauses, repetition and elongated sounds. Many people with a stammer share complaints of chest tightness and holding their breath, and using breathing techniques brings attention to using the breath in order to increase lung capacity.
Again, Cognitive Behavioural Therapy (CBT) has no direct effect on the stammer itself, but it does lead to decreased anxiety and how the individual feels when their disfluency is prevalent. It provides a range of skills and techniques which can decrease anxiety level, which may decrease the stammer in stressful environments.
Some devices have been developed to support those living with a stammer. These devices can change the sound or play a noise which helps to make the individual less aware of their stammer, which can then reduce the frequency of the stammer. These do not change the stammer itself, but allow the individual to be less anxious and more confident. These are not always limited to devices, as a number of apps have been developed too.
What support is available?
People with stammers may be severely affected by their stammer, depending on the severity of the stammer. It can damage self-esteem, which can have a long-lasting impact on the individual’s life. Furthermore, it can cause difficulty in communication within relationships, which may impact families. There are many charities and organisations that support individuals and their families who are living with stammers.
- Action for Stammering Children is a charity dedicated to ensuring that young people with stammers are still able to access the same opportunities as those without. They provide a service where a full assessment can take place, in order to work out the best forms of therapy and treatment for the child.
- The Michael Palin Centre for Stammering provides individualised specialist therapy for people of all ages with a stammer, and offers workshops and accredited courses for speech and language.
- The Stuttering Foundation gives free online resources to individuals who stutter and their families, teachers, employers and therapists.