Chapter 1 – How to recognise stuttering
In order to work with YPWS, youth workers should have the basic knowledge of what stuttering is. By definition, stuttering is characterized by an abnormally high frequency and/or duration of stoppages in the forward flow of speech (Guitar, 2014). These stoppages appear in repetitions, prolongations, and blocks and are usually accompanied by secondary behaviors which are behaviours or tricks a YPWS has learned during one’s lifetime and uses to avoid or end stuttering. A person who stutters (PWS) knows exactly what they want to say but is not always able to say it at the moment because of difficulties in speech or wanting to avoid stuttering. To understand the complexity of stuttering better, we use an iceberg metaphor, created by Joseph Sheehan in 1970, that we have modified (figure 1). All the aspects of stuttering that other people are able to see and hear, form the surface area of the iceberg above the water. All the aspects of stuttering that other people are not able to see and hear, form the area of the iceberg that is underwater. The proportion of the visible and hidden parts varies depending on the person. Also, it is important to distinguish the core behaviours that are involuntary and very difficult to control, from the secondary behaviours that a YPWS has learnt during their lifetime to avoid or escape stuttering. We will explain this in more detail below.
The core stuttering
The core stuttering is involuntary and very difficult to control. It emerges at a very early age when the child starts to stutter (Guitar, 2014). The core behaviours differ from person to person but usually take the form of:
People who stutter sometimes repeat the first letter or syllable of a word, for example: “My na-na-name is … “. It is important to recognise that it is not the same behaviour people without stuttering disorders do when they sometimes repeat words because they are searching for words. The difference is that a person who stutters knows exactly what they want to say but is unable to speak it fluently.
Prolongation of sounds
A YPWS might be prolonging a sound such as “My nnnnnname is … “. This usually happens when a person is not able to move from one sound to the next one. Again, they know what they want to say but they get stuck on a sound.
Speech muscles are blocking the sufficient airflow for speech production and thus making it impossible to make a sound. Usually there is also a lot of physical tension included in this behaviour.
The secondary stuttering
Secondary stuttering are behaviours or tricks a YPWS has learned during one’s lifetime and uses to avoid or end stuttering (Guitar, 2014). At the same time, these behaviours can perpetuate the stutter. For example, a YPWS learns that they can force the word out while in the block. Forcing the word out creates more tension, which consequently creates more stuttering, which again requires more forcing. Because of this the core stuttering becomes more severe over time, the secondary stuttering also increases, and speaking becomes more difficult. This might lead to avoiding speaking situations, avoiding certain words, and having negative thoughts and feelings related to stuttering. The main parts of secondary stuttering are the following:
A person is forcing the sound or word out and has noticeable physical tension in the face, neck or upper torso. The forcing can cause involuntary quivering of the lips or other facial structures, called tremors
Nonverbal behaviours are certain behaviors a person does because it might help him/her to start speaking or speaking more fluently. Examples of nonverbal behaviours are looking away when speaking, making face grimaces, fist pounding or clenching, stamping with feet, or jerking head.
Avoiding eye contact
Many people who stutter avoid eye contact, especially while they are blocking. Usually people avoid eye contact because they are embarrassed. Avoiding eye contact can also be a trick to ease social pressure and make speaking easier.
Changed way of speaking
People who stutter might change different aspects in their speech in order to avoid or end stuttering. They could use a faster talking speed, change the pitch and loudness of the voice, make deliberate pauses before the words, use a lot of filling words or odd phrases, say the word while inhaling, not exhaling. For example, someone might say: “Like … am … my … am …. Name … am … is …”.
Avoidance of speaking situations and certain words
Many people who stutter avoid social situations and words or sounds that may cause them to stutter. As a consequence, some sentences might sound unusual. For example, somebody might anticipate stuttering on “My name is Ken” and instead they say: “Ken, my name is” or “I’m Ken”. YPWS might also leave a situation in which they have to introduce themselves. This is the reason why you might not hear a lot of stuttering in real life situations. People who are at all costs avoiding speaking situations are called “covert” stutterers. It is very difficult to identify them, as they may look shy but are actually trying to hide their stutter. Covert stutterers might look ordinary from the outside but there can be a lot going on inside a person.
Stuttering related negative thoughts and feelings
For many YPWS there can be many stuttering related negative thoughts and emotions. For example, a YPWS can think: “If I stutter, people won’t accept me, thus stuttering has to be avoided”. With these negative thoughts it is easy for negative feelings like shame, fear, anger and disappointment to follow. One reason why this thought has emerged is due to feedback from others when a person has stuttered. For example, other people have made confused faces, have made fun of stuttering, or been impatient with YPWS.
Development of stuttering
The cause of stuttering is not known yet, but research shows it is a combination of genetic and environmental factors (Guitar, 2014). Although primary stuttering is genetic, secondary stuttering is a learnt behaviour. Stuttering typically begins in early childhood and it develops throughout a person’s life. In rare cases, people start to stutter in older age or suddenly as a consequence of a brain trauma. About 5% of children between the ages of 2 – 5 years old stutter at some point (Guitar, 2014). There are neurological differences in the brains of children who have disfluencies in speech and those who don’t. Due to the plasticity of the brain, 75% of children who start to stutter grow out of it naturally by the age of five. For those children who continue to stutter, the stuttering changes throughout their life and therefore all people stutter differently. Also, the same person can stutter differently depending on time of the day, social situation, level of tiredness, anxiety, complexity of the text, etc. For example, a person can be totally fluent at one point when talking to a friend and have severe blocks when having a spontaneous conversation with a stranger.
What goes into speech therapy?
What it is important to know for YW-s is that speech therapy is not a miracle cure. When a person has been stuttering for more than three years, they will probably continue to stutter for the rest of their life. Which does not mean we do not recommend speech therapy. When a speech therapy program promises a fast and 100% fix, it is probably a scam. When you hear of a YPWS who plans to attend a “scam” therapy, please talk to a YPWS similar to the way described at “how to establish and maintain safe relationship” section.
Usually speech therapy is carried out by a speech language pathologist, but some YPWS see psychologists, life coaches or counselors, or combine different forms of therapy. In speech therapy YPWS learn to speak easier and reduce the fear of speaking situations. A good speech therapist analyses the condition in a systematic way – they look at what elements in what relation are needed to achieve the results. Some YPWS want more speech techniques to learn to speak more fluently, but a lot of good speech therapy also focuses on developing healthy attitudes toward stuttering and on self-esteem. Many YPWS who have been to speech therapy for years still continue to stutter, but they have learned to deal with their condition..
When a YPWS is attending speech therapy, a YW can provide opportunities to practice, as usually speech therapy requires long term implementation of techniques learned in daily practice. To find out which speech therapy is recommended, you can look at the website of the International Stuttering Association (http://www.isastutter.org/wp-content/uploads/2013/06/Declaration-for-Stuttering-Treatment.pdf) or contact a national stuttering association or their local branch. Usually there is a specialised stuttering therapist in your area.
Are YPWS different from their peers?
On average YPWS have the same intelligence, academic capability, emotionality and nervousness level as other young people. Also, YPWS are not more anxious, rather it is other people’s reaction to their stuttering that creates this problem (Rind & Rind, 2003). If the people in a YPWS’s life accepts them as they are, there is more of a chance that a YPWS will accept their stuttering as well.
| In conclusion about how to recognize stuttering:
Stuttering is in general characterized by an abnormally high frequency and/or duration of stoppages in the forward flow of speech. Within stuttering we can distinguish core behaviors (repetitions, prolongation, blocks) that are involuntary and very difficult to control, and secondary behaviors (forcing, nonverbal behaviors, avoiding eye contact, changed way of speaking, avoidance of speaking situations and certain words) that a YPWS has learned during their lifetime to end or avoid stuttering. In addition, for many people who stutter, there can be stuttering related negative thoughts and feelings.