What is stuttering?

by Michael, Speech Pathologist.

We may all think we have at least a rough idea of what stuttering is, but arriving at a precise definition of stuttering that differentiates those who stutter from those who do not is a deceptively complex endeavor. Why should this be? Let us look at the definition offered by the World Health Organization in 1977:

Disorders in the rhythm of speech, in which the individual knows precisely what he wishes to say, but at the time is unable to say it because of an involuntary, repetitive prolongation or cessation of a sound.

There are two glaring problems in this definition. The first is that the definition relies on behaviours that are not exclusive to people who stutter. Whether or you are someone who stutters, I am sure that you can recall many occasions when you were temporarily unable to say what you wanted to say due to “involuntary, repetitive prolongation or cessation of a sound.” So this definition in no way distinguishes between those two do and do not stutter, it merely describes interruptions to fluent speech, which are a universal phenomena.

But this definition suffers from an even more fatal flaw. It fails to acknowledge two hidden, but extremely important, facets of stuttering: covert stuttering behaviours, and the psycho-emotional concomitants of stuttering. If we use the visual metaphor of an iceberg, the stuttering behaviours captured in the World Health Organization’s definition represent only the visible ‘tip,’ of the iceberg, while the two facets just mentioned represent the vast bulk submerged beneath the water.

Covert stuttering behaviours are, as the name implies, behaviours which are an attempt on the part of the person who stutters to conceal, avoid, and prevent ‘stuttering moments’—or times when the repetitions and prolongations already mentioned occur. Behaviours of this sort range from substituting words or phrases associated with stuttering moments, to the avoidance of speech altogether. Some people who stutter may be so practiced in the utilisation of these behaviours that they may not be recognised by those who associate with them as someone who stutters.

It should not be underestimated, however, the toll that covert stuttering behaviours may take on the one who regularly employs them. Avoidance of speech, in particular, may have devastating consequences in the realms of professional and personal life. Anxiety (particularly social anxiety), depression, and other impacts on mental and social wellbeing may all ensue when stuttering functions to negatively alter one’s self-image and/or ability to function in social life without excessive levels of discomfort.

It might even be said, that it is the impact that stuttering has on the life of someone who stutters, rather than the subset of behaviours that might be said to comprise stuttering, which is the true grounds for differentiating someone who stutters from someone who does not. At the very least, this should be the primary consideration when evaluating the need for treatment.

Treatment

There are a large number of treatments available for both children and adolescents or adults who stutter. For children, the treatments supported by the most robust research evidence are:

• The Lidcombe Program
• The Westmead Program (also known as syllable-timed speech)

For adults, the approach demonstrated to most effectively reduce stuttering behaviours is the Camperdown Program. This approach is what is known as a “speak more fluently” approach, while there are other treatments which emphasise a “stutter more fluently” approach, in that they place a greater level of importance on the ‘submerged’ aspects of stuttering that we have already touched on, rather than on only reducing the incidence of overt stuttering behaviours.

The reason that different programs exists for children and adult or adolescent populations is that effective treatment in the early years can often result in a complete remission of stuttering behaviours (though of course not the elimination of typical dysfluencies). Past a certain stage of maturation, however, stuttering behaviours—covert and overt—become well enough entrenched that management, rather than remission, is what might reasonably be expected as an outcome of current treatment modalities.

No matter the age of the person seeking treatment, or what treatment he or she ends up selecting, it is vital that to the success of these treatments that they enjoy the support of their loved ones: both on an emotional level, but also as active participants in the intervention itself.