Stuttering, stammering: what are its causes?

Stuttering is a speech disorder in which the fluency of speech is interrupted by the involuntary repetition of single syllables or words.

The speech interruptions may be accompanied by pauses where the person is unable to make any sound. These pauses are also called speech blocks.

Although stuttering is not a behavioral or emotional disorder, it is included in this category.

It is a serious speech disorder. It causes significant problems in an individual's personal life, in society, at school and at work.

In the case of stammering, it is not a mental disability. The brain of a stammering individual functions quite normally.

The first signs of stammering often appear as early as preschool children aged 3-5 years. The incidence is higher in boys.

In 90% of children, stuttering occurs before the age of 4.

The environment in which a child grows up, especially the family, plays a significant role in the onset and development of this disorder.

A common trigger is psychological trauma, which can be acute or last for a long time.

Often, however, it also arises in congenital predispositions.

When stuttering suddenly appears in a child, it is usually a well-defined emotional experience. The experience is usually negative, but a strong emotional experience, such as an unexpected overwhelming reward, is no exception.

International Stuttering AwarenessDay is on 22 October.

Stuttering is divided into

Initial (incipient), which occurs in preschool children and in children at the transition to school, between the ages of 5 and 7.

Persistent (fixed), which persists throughout the school period, between the ages of 7 and 13.

Chronic, which persists into adolescence and adulthood, from 14 years of age.

The cause can be developmental and neurogenic.

The developmental cause of stuttering occurs already in young children. It is among the most common forms.

Neurogenic cause of stuttering is acquired with later onset. It occurs in older children, in people after head injuries, after stroke or after brain injury.

It can also be caused by drug use, medication, psychological and emotional trauma.

Developmental cause of stuttering

• The most common cause, up to 88% of cases, is adverse family circumstances
• Change in communication environment
• The arrival and birth of a new family member
• Change of residence
• Separation of the child from the family, even temporarily, can cause this condition
• Fear

An innate predisposition, probably due to severe stress or psychological trauma, also plays a significant role in the cause of stuttering.

Heredity, minor brain damage, minor abnormalities in brain development and environment also come into play.

Psychological causes of stuttering

From a psychological point of view, the cause of the sudden onset of stuttering may be:

• animal attack
• hospitalisation of the child
• the death of a close family member (parent, grandparent, favourite family member)
• car accident
• a fall from a height
• but also a strong emotional experience, e.g. unwrapping a present

How to prevent stuttering

• Do not frighten the child.
• Don't pressurise him with fear, for example of the arrival of the devil.
• Avoid dealing with situations that could affect the child psychologically and affect him/her, e.g. being locked in a dark room, punishment with a cold shower.
• Don't force your child to do something he or she is very afraid of.
• Don't talk in a way that makes the child afraid. Don't let the child watch any horror films. Avoid sudden loud noises that might frighten the child.

Risk factors for stuttering

• Developmental delays in childhood
• Genetic predisposition if stuttering runs in the family
• Stress in the family

Stuttering is manifested during active communication, which is most aggravated when concentrating.

Stuttering is aggravated by excitement, anxiety, fatigue, stress, pressure, psychological strain, performing in front of an audience, and also a decrease in self-esteem.

It is much less pronounced in reading.

Stuttering is least likely to occur when whispering or singing.

Most people with stuttering speak fluently without stammering when talking to themselves or when singing.

Symptoms vary and depend on the severity of the disorder.

• The mild form is manifested by repetition of first syllables or consonants, sometimes with stretching.
• In the moderate form, there are also spasms at the beginning, stretching and repetition of syllables. Sometimes there are also movements of the facial muscles, trunk, arms and head.
• In the severe form, speech is disrupted and the spasms at the beginning of words are very strong to the point of being insurmountable.

Stuttering has 3 groups of symptoms

Dysfluency - slurred speech

• In stuttering, a type of dysfluency occurs as
  • Repetition of words - I see car, car
  • Repetition of words
  • Repetition of syllables
  • Single syllable repetition of words
  • Long syllables
  • Vowel lengthening
  • Blocking or stopping in a sentence - silent pauses
  • Pause in a word
  • Verbal twists and sentence corrections

Excessive muscular effort

• Speech difficulties may be accompanied by
  • Rapid eye blinking
  • Trembling of the lips
  • Facial tics
  • Head jerking
  • Clenching of fists
  • Flushing
  • Sweating

Mental tension

• Manifested by:
  • Internal restlessness
  • Frustration
  • Fear of speaking
  • Avoidant communication behaviors (avoiding calls, making phone calls, preferring to send text messages or emails)

Tones, clones and tonoclones

Tones, clones and tones interfere with serious communication.

They are joined by

• unnatural facial expressions
• head and body twitches, tics.
• the child breathes irregularly, sometimes with signs of convulsions
• facial flushing
• sweating
• rapid pulse

Often there is logophobia, which is a fear of speaking.

When communicating with the symptoms of stuttering, one encounters:

• Tonic form of stuttering - Manifested by pressure at the beginning of a syllable of a word. The pressure may be so strong that the word is not pronounced.
• Clonic form - Characterized by repetition of syllables at the beginning of a word. In the severe form, repetition may occur in the middle of a word.
• The tonic-clonic form is the most common form and is combined with the tonic and clonic forms.

What happens in stuttering?

In stuttering, there is involuntary contraction of the respiratory, vocal cord and articulatory muscles.

In stuttering, there is:

Impaired breathing movements

The stuttering individual disproportionately wastes expiratory airflow.

Some persons with tonic stuttering exhale air before making a sound and complete the word with only residual air.

Others exhale air while overcoming a word barrier when speaking in a stuttered manner.

Breathing in children at rest is normal, quite physiological. As soon as he wants to say something, there is a change in the air stream exhaled.

Interference with phonatory movements

A disorder of voice production that results from a disturbance in the phonatory movements of the larynx.

The violent and spasmodic production of voice causes damage to the vocal cords by blood supply and swelling of the mucous membrane, causing simultaneous voice disorder.

Symptoms of stuttering in a nutshell

• Difficulty beginning words, sentences
• Prolongation of words, vowels in a word
• Repetition of vowels, words, syllables
• Pauses within a word causing it to break
• Adding words to speech, e.g. "ahem", in anticipation of difficulty in pronouncing the next word
• Excessive tension or movements of the face, upper body
• Anxiety when speaking
• Inability to communicate effectively

Examples

• Adding sounds - ehm, ajaaj...
• Repeating whole words - apple, apple on the table
• Repeating phrases - she is - she is 8 years old
• Changing words when communicating in a sentence - I was... I left
• Incompletion of thought - named.... forgetting names

Comprehensive and thorough diagnostics are essential for treatment design.

The child will undergo examinations such as:

• phoniatric - dealing with voice, speech and hearing disorders
• speech therapy - examination of pronunciation, expression, language skills, speech understanding
• neurological - examination and diagnosis of neurological disorders
• psychological - examination of personality, intellect, memory, attention
• in some cases
  • internal examination, during which the general medical history of the individual, his/her health condition, as well as previous illnesses, injuries, surgeries that may have resulted in stuttering are determined
  • rehabilitation examination
  • psychiatric examination

In the diagnosis and evaluation of stuttering (dysfluency), the following are evaluated:

• The frequency of pauses that are noticeable in stuttering
• Qualitatively, signs of pauses may be manifested by non-physiological symptoms such as forced pauses caused by spasms (involuntary muscle contractions), excessive speech effort, or speech that is audibly different
• Localization of pauses
• Duration of pauses

Stuttering occurs most often in children between the ages of 2 and 7 years.

Stuttering occurs in 80-90% of cases in children under 4 years of age.

It either progresses slowly and gradually or can start suddenly.

The most common manifestation is the gradual repetition of the initial consonant, repeating the first word without the child realising that he is repeating it.

Over time, the speech disorder becomes more frequent and more disruptive.

Stuttering eventually disappears in 65-85% of children.

Sometimes stuttering becomes chronic and persists into adulthood. It can lower self-esteem.

The personality of the stutterer is greatly affected by stuttering and often leads to passivity and social isolation.

Speech blocks can lead a person to an inferiority complex, self-hatred and depression.