What is Stuttering??
Every parent wants to know the answer to this question. But the answer is complicated and requires some understanding of how speech develops in the normal child. When children are about a year old, they typically say their first words. These are single words, which the child uses for a variety of purposes. By two years, the child has usually begun to put two or three words together, and is producing primitive sentences like "Mommy go?" "Want truck," or "See doggy." Usually, at this stage, the child's pronunciation of sounds is imperfect, the tempo of speech is slow, and each syllable is given equal stress. The sentences given above would be pronounced "Mama go," "Want twuck," "tee dawdaw," or something like that. Between two and three years of age, these primitive sentences become longer and more elaborate, pronunciation improves somewhat, and the children begin to talk more quickly and with a more grownup rhythm. Instead of saying "dawdaw" for doggy," a three year old would be more likely to say dawdy," still mispronouncing the "g" but producing the correct rhythm of the word, with the accent on the first syllable. It is during this stage of development, that children learn to produce unaccented syllables. This development, which goes unnoticed by most parents, enables the child to talk faster, and that is important because it is just at this same time that the child is beginning to use longer and more complex sentences, and it is also just at this time that the child is beginning to notice many complicated things about the world, which the child wants to talk about in those longer sentences. The drive to communicate at this age is very powerful, and the child will be frustrated by anything that gets in the way of the communication of ideas.
Quite a few children, at this stage of development, begin to repeat words or syllables, usually at the beginning of a clause or sentence. They say things like "I, I, I, I, I, saw a big, a big truck in the, in the street. And, and, and it, and it, it -- Mommy do trucks do wee wee?" In this sentence, you can see some of the things that make children hesitate -- a confusing thought, uncertainty about some event in the world, a complicated sentence to produce, perhaps a doubt about the politeness of the question. When children hesitate in their speech, they tend to repeat phrases, words, and syllables. Later, when they are older they have more sophisticated ways of hesitating -- saying "well," "like" and "um" for example. But at this age, they just repeat elements. Sometimes, if they are very unsure of themselves or of how to say something, or if they are very excited or nervous, they will continue to repeat for a very long time --- "Mommy Mommy, Mommy, Mommy, Mommy, Mommy I saw a birdy and he, and he, and he, he, he, he, he, he, he wash his bottom in the dirt." These repetitions of whole words or syllables, even the long ones, produced easily and without evident concern, are probably not very abnormal, unless they occur often. They are just the way the child talks who has more to say, or who wants to say more, of who wants to say it more quickly, than his speech mechanism or language skills can accommodate. But even though they are not too abnormal, these repeated elements, particularly when they are a common feature of the child's speech, mean that there is a risk that stuttering can develop. We believe that any child at risk should be dealt with. If the risk is small, it is easier to deal with, but stuttering is too awful a problem to just "wait and see."
The word fluency is used to refer to the ease with which speech is produced. The three year old who is highly fluent will say "But, but Daddy, if I, if I can have the candy now, I'll still eat my dinner." The less fluent child, less sure of which words to use, less sure of the grammar, and not so quick at moving his tongue, lips, jaw, and voice might say "But, but, but, but Da-daddy, if, if,, I have the ca-candy now, I, I, I, I'll still, still eat my dinner."
We like to think of two aspects of speech development that affect the child's fluency -- the demands for fluency, and the child's capacity for fluency. By capacities, we mean the skills and abilities that are required to talk -- the ability to move the speech mechanism to make sounds, the ability to choose the right words, the ability to compose the sentences so that others will understand, and the ability to know what is an appropriate thing to say under the circumstances. Naturally as children grow, these capacities for talking fluently are also maturing, and the child finds it easier and easier to say what he wants to say. We can tell that children find it easier to talk because they take less time to produce sounds, to find words, and to construct sentences. As a result they talk faster and with fewer hesitations and repetitions.
Demands for fluency come from the people the child talks to -- parents, brothers and sisters, friends -- and from the child too. As children grow, more is expected of them, and a child who is smart enough to think of the argument that he or she will eat dinner even if some candy is eaten now, is expected to be able to speak easily enough to utter the argument without too much hesitation and at a rate of speech that is age-appropriate. Not all of the demands for fluency come from the people the child is talking to. Some of them come from within the child. Just as parents expect a child to produce speech that is appropriately fluent for the child's age, intelligence, and linguistic sophistication, so too does the child have some sense of how easy it should be to talk. Some children have a lot to say but lack the capacity to say it easily, and they may become very frustrated because they expect more, demand more, of their speech mechanisms than it has the capacity to produce. As long as children's capacities for fluent speech are developing fast enough to meet the increasing demands that are made on them, including those they make on themselves, they will not hesitate, repeat sounds, stutter, or stumble in speaking very often. But when too much is asked of the mechanism, children will try to make it do what it lacks the capacity to do. And as a result, their speech will contain more than the usual amount of repetition of words, syllables, and phrases.
If, in addition, they find the presence of those repeated elements too time-consuming, or if they come to believe that these repetitions are bad, that they shouldn't talk that way, they will try to force the repeated words out, they will try to repeat the words and syllables faster so as to get to the rest of the sentence, and they will start to struggle when they talk. This struggle to talk, manifested by an unusual amount of repetition, by the repetition of smaller elements of speech such as syllables and sounds, by the presence of vocal strain and tension, and by the presence of muscular tension in the speech mechanisms, is stuttering
Unfortunately, we don't know very much about why stuttering develops in some children but not in others. There is clearly a tendency for stuttering to run in families, and some of this tendency seems to result from inheritance. Genes do make a difference, but it is also clear that they do not make the entire difference, since there are many children whose parents stutter but who develop normal speech, and there are many children who stutter despite having no one in the family who stutters. Besides, the way in which stuttering develops is clearly a result of the child's interaction with his or her immediate environment.
We do know that stuttering is not caused by tickling the child, nor is it acquired by imitation of some other child who stutters. We also know that the child who stutters is not developmentally delayed or mentally ill, and that he or she does not have a personality disorder. Sometimes children who stutter are socially withdrawn, shy, or nervous, but these are probably reactions to the disorder. Nevertheless, these reactions probably do make the problem worse.
Some children do not follow the gradual path of development described above. Instead, they begin to stutter suddenly, usually under circumstances that involve emotional distress, either sudden or prolonged -- absence of one or both parents, moving to a new location, starting a new school, death or serious illness in the family, hospitalization of the child or of a sibling. Typically also, the emotional distress is somehow related to speaking, and there is sometimes a period of not talking at all (mutism) before the child begins to stutter. Stuttering can also develop suddenly following a head injury, but this is quite rare in children.
Quite a few children, at this stage of development, begin to repeat words or syllables, usually at the beginning of a clause or sentence. They say things like "I, I, I, I, I, saw a big, a big truck in the, in the street. And, and, and it, and it, it -- Mommy do trucks do wee wee?" In this sentence, you can see some of the things that make children hesitate -- a confusing thought, uncertainty about some event in the world, a complicated sentence to produce, perhaps a doubt about the politeness of the question. When children hesitate in their speech, they tend to repeat phrases, words, and syllables. Later, when they are older they have more sophisticated ways of hesitating -- saying "well," "like" and "um" for example. But at this age, they just repeat elements. Sometimes, if they are very unsure of themselves or of how to say something, or if they are very excited or nervous, they will continue to repeat for a very long time --- "Mommy Mommy, Mommy, Mommy, Mommy, Mommy I saw a birdy and he, and he, and he, he, he, he, he, he, he wash his bottom in the dirt." These repetitions of whole words or syllables, even the long ones, produced easily and without evident concern, are probably not very abnormal, unless they occur often. They are just the way the child talks who has more to say, or who wants to say more, of who wants to say it more quickly, than his speech mechanism or language skills can accommodate. But even though they are not too abnormal, these repeated elements, particularly when they are a common feature of the child's speech, mean that there is a risk that stuttering can develop. We believe that any child at risk should be dealt with. If the risk is small, it is easier to deal with, but stuttering is too awful a problem to just "wait and see."
The word fluency is used to refer to the ease with which speech is produced. The three year old who is highly fluent will say "But, but Daddy, if I, if I can have the candy now, I'll still eat my dinner." The less fluent child, less sure of which words to use, less sure of the grammar, and not so quick at moving his tongue, lips, jaw, and voice might say "But, but, but, but Da-daddy, if, if,, I have the ca-candy now, I, I, I, I'll still, still eat my dinner."
We like to think of two aspects of speech development that affect the child's fluency -- the demands for fluency, and the child's capacity for fluency. By capacities, we mean the skills and abilities that are required to talk -- the ability to move the speech mechanism to make sounds, the ability to choose the right words, the ability to compose the sentences so that others will understand, and the ability to know what is an appropriate thing to say under the circumstances. Naturally as children grow, these capacities for talking fluently are also maturing, and the child finds it easier and easier to say what he wants to say. We can tell that children find it easier to talk because they take less time to produce sounds, to find words, and to construct sentences. As a result they talk faster and with fewer hesitations and repetitions.
Demands for fluency come from the people the child talks to -- parents, brothers and sisters, friends -- and from the child too. As children grow, more is expected of them, and a child who is smart enough to think of the argument that he or she will eat dinner even if some candy is eaten now, is expected to be able to speak easily enough to utter the argument without too much hesitation and at a rate of speech that is age-appropriate. Not all of the demands for fluency come from the people the child is talking to. Some of them come from within the child. Just as parents expect a child to produce speech that is appropriately fluent for the child's age, intelligence, and linguistic sophistication, so too does the child have some sense of how easy it should be to talk. Some children have a lot to say but lack the capacity to say it easily, and they may become very frustrated because they expect more, demand more, of their speech mechanisms than it has the capacity to produce. As long as children's capacities for fluent speech are developing fast enough to meet the increasing demands that are made on them, including those they make on themselves, they will not hesitate, repeat sounds, stutter, or stumble in speaking very often. But when too much is asked of the mechanism, children will try to make it do what it lacks the capacity to do. And as a result, their speech will contain more than the usual amount of repetition of words, syllables, and phrases.
If, in addition, they find the presence of those repeated elements too time-consuming, or if they come to believe that these repetitions are bad, that they shouldn't talk that way, they will try to force the repeated words out, they will try to repeat the words and syllables faster so as to get to the rest of the sentence, and they will start to struggle when they talk. This struggle to talk, manifested by an unusual amount of repetition, by the repetition of smaller elements of speech such as syllables and sounds, by the presence of vocal strain and tension, and by the presence of muscular tension in the speech mechanisms, is stuttering
Unfortunately, we don't know very much about why stuttering develops in some children but not in others. There is clearly a tendency for stuttering to run in families, and some of this tendency seems to result from inheritance. Genes do make a difference, but it is also clear that they do not make the entire difference, since there are many children whose parents stutter but who develop normal speech, and there are many children who stutter despite having no one in the family who stutters. Besides, the way in which stuttering develops is clearly a result of the child's interaction with his or her immediate environment.
We do know that stuttering is not caused by tickling the child, nor is it acquired by imitation of some other child who stutters. We also know that the child who stutters is not developmentally delayed or mentally ill, and that he or she does not have a personality disorder. Sometimes children who stutter are socially withdrawn, shy, or nervous, but these are probably reactions to the disorder. Nevertheless, these reactions probably do make the problem worse.
Some children do not follow the gradual path of development described above. Instead, they begin to stutter suddenly, usually under circumstances that involve emotional distress, either sudden or prolonged -- absence of one or both parents, moving to a new location, starting a new school, death or serious illness in the family, hospitalization of the child or of a sibling. Typically also, the emotional distress is somehow related to speaking, and there is sometimes a period of not talking at all (mutism) before the child begins to stutter. Stuttering can also develop suddenly following a head injury, but this is quite rare in children.
