Stammering : FAQ

This is a work in progress. If you do not find here what you are looking for, send us an email (satksri@rediffmail.com, akash.acharya@gmail.com). Following info has been collected from diverse sources. In particular we wish to acknowledge the following sources:

• The Stuttering Homepage (Judith Kuster, Minnesota State University)

• www.stutteringhelp.org

• British Stammering Association

• Indiastammering.com

• wikipedia.org

1. What is Stammering or stuttering?

It is involuntary repetition of part of a word (syllable) while speaking. It is caused by a rare neuro-physiological disorder of the speech nerves in the brain. It is important to understand its ‘involuntary’ and ‘variable’ nature. It may not be present while singing, whispering, reading with others, talking to pets, friends and under a variety of other conditions. On the other hand, it may strike under quite common situations like saying our name, talking over the phone, speaking while being observed, etc. There is considerable variety in its symptoms and factors which lessen or make it worse.

It is one of the truly ubiquitous health disorders. PWS are found in every socio-economic group, culture and region.

2. How many people stammer in India?

Over all, about 1% adults are expected to be PWS. They can be found in any caste, community, ethnic group or region. Therefore their number in India would be at least one crore (i.e. ten million). Some Indian therapists claim that their number could even be more- almost 3%. But due to cultural stigma and social attitudes, they may neither seek help nor accept their problem openly. It is more common among men than women by 4 to 1. About half of PWS may have a close relative with the same disorder.

3. How many hildren suffer from stammering?

Between 5% and 15% of children stutter at some point in childhood. These are ‘normal dysfluencies’ of the growing child. Many children recover spontaneously. Some children may persist with this manner of speaking due to certain stress in the environment - birth of a sibling or other stresses of the early family life. This stress could also be due to demands made by “Grammar”, which a child is just beginning to learn at this stage. Genetics also play a role, since about half of such children may have a PWS as a close relative. The sex ratio among children who stammer is equal but gradually becomes 4 men to 1 woman in the adult age population.

4. Why do people stammer?

It is simplistic (wrong) to believe that it is just a ‘bad habit’. There is an actual ‘neurological’ disorder which makes uttering some sounds (often consonants) or transition from one sound (syllable) to another difficult. When the nerve impulse for the next syllable fails to come from the brain, the speech system repeats the last sound, until it arrives. Sometimes no sound or air may escape- a block. PWS often describe it as locking up of their jaw, tongue or mouth. This leads to considerable struggle behavior- as if we are trying to force the word out of our mouths. Eye blinking, grimace, head nodding or movements of other parts of body may be associated with this struggle. At one time, we may have used it to get out of this ‘block’, and then they become unconscious secondary behavior.

5. How does stammering affect PWS?

A common problem faced by young PWS is job interviews. Stress is well known to increase the speech difficulties. The interviewers may mistake this for lack of confidence, lack of knowledge, nervousness or a chronic communication disorder. They may not realize that the same person may speak normally on the job.

The other problem young PWS may face is the difficulty to communicate their feelings, inner thoughts and develop enduring relationships, particularly with opposite sex. Since strong emotions make stammering worse, PWS may find expressing anger verbally difficult. Often such emotions are buried deep and result in feelings of self loathing, unworthiness and deep dissatisfaction. Without our knowing, these feelings may affect our attitudes, our view of the world, our choices of pastimes, career, relationships etc.

On the other hand, some PWS grow into diverse directions: they may learn diverse languages, become writers, singers, actors, IT professionals, doctors, teachers etc. They may even attribute their success to their stammer and consider it as a blessing in disguise. But many PWS are not able to acquire higher education. This is because educational institutions have poor understanding of this neurological condition. Few schools have a speech therapist on their faculty.

As they grow older, PWS may develop better insights into their problems. They may even become more accepting of their issues and problems.

6. Why do people react to stammering as they do?

Studies show that people (both PWS and those who speak ‘normally’) experience stress (raised BP, heart rate etc.) when they hear someone stammering. Studies also show that PWS experience considerable stress when they feel they have to be ‘fluent’. This is a dilemma. Who should have the onus of coping with their stress?

Ideally, the audience should work on their attitudes by developing more acceptance to the diversity we may have in our speech. The PWS also need to work on their overall communication and not worry so much about ‘fluency’. Both need to be aware of their sub/unconscious reactions (like looking away, shifting uncomfortably, etc), in order to be able to deal with them successfully.

How do I know if my child will grow out of her or his stammering?

As mentioned earlier, normal dysfluencies are a part of a child’s speech learning process. But the old practice of ‘wait and watch’ is no longer recommended. The following considerations may call for an early consultation with a speech therapist.

• Does the child have a PWS as a close relative (uncle, cousin, father, etc)?

• The child repeats sounds more than twice, li-li-li-li-like this. Tension and struggle may be evident in the facial muscles, especially around the mouth.

• The pitch of the voice may rise with repetitions, and occasionally the child will experience a “block”—no airflow or voice for several seconds.

• Normal dysfluencies come and go; but in this case, these are frequent and persistent.

• If the child stutters on more than 10% of his speech, stutters with considerable effort and tension, or avoids stuttering by changing words and using extra sounds to get started, she or he will profit from having therapy with a specialist in stuttering. Complete blocks of speech are more common than repetitions or prolongations. Dysfluencies tend to be present in most speaking situations in such cases.

7. What can I do if my child stammers?

While direct therapy with the child will be conducted by the therapist, the family has a vital role in helping the child gain the new skills, habits and attitudes:

• Talk about it openly, so that your child feels comfortable about this issue. Try not to be upset or annoyed when stuttering increases. Your child is doing her best as she copes with learning many new skills all at the same time. Your patient, accepting attitude will help her.

• When you and others talk to her, talk in a slow, relaxed fashion.
  - Use small, simple sentences. Speak slowly and clearly.
  - Give a gap of a few seconds before you answer her questions
  - Let there be small silent gaps between your sentences when you talk to her
  - Never interrupt her when she is saying something; let her finish, wait for 2 seconds and then ask your question. Don’t ask too many questions.
  - Never force her to say or talk when she does not want to: never force her to recite poems for a guest; if she does it on her own, welcome it; praise her. But never force her.
  - Never interrupt her to say: Slow down; First think what you want to say; Take a deep breath, etc. These suggestions don’t help. These only make a child feel bad and ashamed.
  - If you don’t understand what she says, say- ‘Sorry, what did you say?’ But don’t react negatively, either in words or through facial expression and body language
  - Encourage her to talk in a louder voice.
  - Slow and relaxed speech can be the most effective when combined with some time each day for the child to have one parent’s undivided attention. Set aside a few minutes at a regular time when you are doing nothing else but listening to your child talk about whatever is on her mind.
  - Increase the situations in which your child is most fluent. If your child is more fluent during bedtime stories, extend this time by reading one more book at bedtime or provide other reading opportunities throughout the day. Success in one situation builds confidence and leads to success in more situations.
  - Do not encourage your child to use ‘tricks’, such as substituting words or tapping a foot, to help her or him get through a moment of stuttering. These tricks do not really help and eventually become part of the stuttering pattern. In the long run, they can make the stuttering more conspicuous.
  - Do not let teasing from siblings or friends go unrecognized. Take siblings/friends out of sight and sound of the dysfluent child and talk to them.

• Every child excels at something or the other; Find out and praise her or his achievements in those fields. Help him to develop a strong and positive self image, but remember to keep the praise realistic and objective.

• To help the child gain confidence, encourage her to excel at some hobby: painting, sketching, singing, playing some musical instrument, outdoor games, drama, etc.

• An intelligent mind helps a PWS greatly by helping him to understand what is happening inside and outside; it helps him to acquire and master those small psychological / language skills which facilitate communication in spite of stammering. So, pay attention to his intellectual development.

• Talk to his teachers (or principal) and explain to them that they must not give any negative comments to the child. That they must ensure that she is not bullied / harassed in the class room by other children. If some children do that, explain to them that the child is doing her best not to stammer, and that their mocking only makes the situation worse.

• In the home, try to create an open atmosphere where the child can freely talk about his difficulty with talking. If you or other family members show your distress, pain or irritation when he stammers, the child will develop feelings of shame which might affect his personality.

8. What shall I do when I am talking to a PWS?

• Listen to the content of the message rather than to how the message is coming out.

• Keep natural eye contact with the person to show that you are listening and are interested in their message. "Natural" does not mean staring at the person; nor does it mean avoiding looking at the person. Pay attention to how often and for how long you usually look at another speaker and then try that with the person who stutters. Try not to look embarrassed or alarmed. Just wait patiently and naturally until the person is finished.

• Let your posture, your facial expressions, your manner, and your voice show that you are listening and are interested and that you are not embarrassed.

• You might be tempted to finish sentences or fill in words for the person. Unless you know the person well and have his or her permission, please do not do this. Your action could be taken as demeaning. And, of course, if you guess the wrong word, the difficulties multiply.

• The person's stuttering sometimes makes it harder to understand what he or she is saying. If you do not understand what is said to you, do not be afraid to say, "I'm sorry, I didn't understand what you just said." No matter how much of a struggle it was for them to say it, this is preferable to your pretending you understood, or guessing what his or her communication was.

• Refrain from making remarks like: "Slow down," "Take a deep breath," or "Relax." Such simplistic advice can be felt as patronizing and is not constructive.

• Instead of telling the person to slow down, try using a slower, more relaxed speaking rate yourself. This may help relieve the feeling of time pressure and it will show them that you have time to talk.

• Treat the person who stutters with the same level of dignity and respect as you treat other people.

• Be aware that people who stutter usually have more trouble controlling their speech on the telephone. Saying "Hello," in particular, often presents a special problem for us. Please be extra patient in this situation.

• People sometimes ask if they should ask the person questions about his or her stuttering. This is something we must leave to your judgment. But surely, stuttering should not be a taboo subject. If you have a question about it, the person will probably appreciate your interest. It is to your mutual benefit that it be talked about openly. You should be prepared that some people who stutter will be sensitive about it, but if you follow the rules of common courtesy, you should be fine.

9. I am a teacher. What can I do to help?

1. Meet with the child's parents before school begins to learn about their concerns and expectations.

2. Encourage positive communication skills in the classroom: do not interrupt someone when they are talking, talk for, or finish thoughts and statements for anyone else.

3. Avoid, as much as possible, treating the child with dysfluencies differently from others in the classroom. It is important that the child does not feel any differently than the other children by receiving "special treatment." The child who stutters should be held to the same academic and social standards as the other children in the classroom.

4. Commend the child when he or she participates in classroom discussions. Praise what they say, not how they say it.

5. If the child is teased by classmates, make sure to talk to the child first before confronting the teasers. Listen to what the child has to say, how he or she is feeling. If the child agrees that you speak to the teasers, pull them aside, away from the child, and tell them why their behavior is inappropriate.

6. If appropriate, it may benefit the child if you talk to the class about stuttering. It is important to get permission from the child. You may even help the child present a science project on stammering or how a DAF device helps PWS. (Read on for explanation of DAF under question no. 12)

7. Do not call on students in a specific order. People who stutter build up tension and anxiety when they know their turn is coming because they anticipate that they will stutter. It is best to call on the child early on in the process.

8. For oral presentations, encourage the child to practice the oral presentation requirements at home. It may even be helpful for the child to practice in the classroom to relieve some anxiety. Be sure to ask the child about how they feel about doing an oral presentation and what could be done to make it a little less frightening.

9. Most children who stutter are fluent when reading in unison with someone else. Rather than not calling on the child who stutters, let him have his turn with one of the other children. Let the whole class read in pairs sometimes so that the child who stutters doesn’t feel “special.” Gradually he may become more confident and be able to manage reading out loud on his own.

10. I am a PWS. What can I do?

Speech therapy is not affordable for everyone, nor is it available everywhere in India. But it does help. So if you can, go for professional help. But many PWS may not be able to do so. Here is what they can do on their own and with some help from family and friends:

1. Start talking about the problem with close friends or family members; this reduces the emotional isolation we develop over years. You may even start an interactive blog on the web. Here are two examples:

http://thestutteringbrain.blogspot.com/

http://closetstutterer.blogspot.com/

2. Prepare well for formal presentations - use PowerPoint if appropriate (or other AV aids).

3. Consciously plan and place thoughtful silences in your speech; use these silences to breathe deeply. It relieves stress and tension in speech muscles. Make your presentation or discussion participatory: ask questions and listen to others when they talk.

4. Smile whenever appropriate, while talking. Smile reduces your tension and the chances of stumbling over words also goes down.

5. Practice deep abdominal breathing and other relaxation exercises at frequent intervals during the day. While talking, remind yourself to switch into this kind of breathing instead of holding the breath unconsciously.

6. Volunteer to serve someone needing help in the neighborhood for example, a person with paraplegia. This takes your mind away from your own problem and generates good vibrations.

7. When sub/unconsciously, you talk to yourself- what kind of things do you say to yourself? PWS often acquire critical attitudes of the world around them and judge themselves harshly for every little failure or setback. The use of positive affirmations, religion, yoga, meditation, etc can help us change our self perception and attitude towards life.

8. Join a self help group. Start one if there are none in your neighborhood. A self help group can start with even two PWS. For ideas about how to run a self help group, return to this blog or get in touch with us;

You may even join a web based support group. Here are two:

http://uk.groups.yahoo.com/group/stutteringselfhelp/

http://health.groups.yahoo.com/group/IndianPWS/

There are many specific skills (like eye contact, slow onsets etc) to be acquired by constant practice and by developing greater insight into and awareness about what we do when we stammer. Which muscles tense up? Do we hold our breath or try to force it out against a closed throat? What happens before and after? This awareness helps us to deal with these, one at a time and over a long period.

Above all, do you have the will to change yourself? It is a long process with many ups and downs, but finally a very rewarding journey.

11. Is there a cure for stammering?

Drugs (like Pogoclone) have shown some promise but it is too early to recommend its general use. Among the electronic aids, Delayed Auditory Feedback (DAF) and Frequency shifted auditory Feedback (FAF) machines have been shown to help. These machines look like a hearing aid and play back the sound of our own voice in the ear with a delay of 40-100 microseconds. This is based on ‘choral effect’: PWS stammer less when speaking in unison with others. It also slows down the speech. Similar software can be used with some cellphones; it works even when we are not talking on the phone. But these technological interventions do not offer a ‘cure’ and beneficial effect tends to wear off after some months in some cases. As a part of wider exploration, it should be given a try. It could also be used as an adjunct to speech therapy. The software is available for free trial on a regular computer or palmtop:

http://www.speechgym.com/

There have been some claims of cures but there have been no objective studies to confirm this. To many PWS, to be able to talk about their stammering without a sense of fear or shame is ‘cure’ enough. Yet they should continue to work on their ‘communication’ skills and strategies- as opposed to ‘perfect fluency’, which in any case is a myth.