MEDICAL MATTERS:Speech therapy offers the best hope for those afflicted by stammering – or stuttering, as it is known in the US, writes MUIRIS HOUSTON.
WHAT HAVE Charles Darwin and John Updike got in common? Both have an anniversary of sorts at this time of year.
Updike, the Pulitzer prize-winning novelist, died last week from lung cancer, while the bicentennial of the birth of Darwin, the father of evolutionary science, occurs next week. And both had a stammer that, however difficult it may have made their lives, did not stop them from communicating their original ideas and concepts with great fluency.
Stammering – or stuttering, as it is more commonly referred to in the US, is by no means a modern phenomenon. Galen recommended that the tongues of people who stammer “be soundly cauterised”, which, even allowing for the scientific ignorance of the time, seems a little drastic.
But even now, the condition is misunderstood, and readily causes discomfort in those listening to a person struggling with their speech.
“There is no doubt that I have lots of words inside me – but at moments, like rush-hour traffic at the mouth of a tunnel, they jam,” was Updike’s fairly relaxed description of his stuttering.
For others it is hugely distressing. “Few people realise the true nature of the stammer. It is a monstrous and unpredictable parasite. It tries its best to thwart all of life’s opportunities, to destroy my self-esteem, and prevent me from expressing my true personality,” was the anguished description by a doctor of her stammer, writing in the British Medical Journal in 1994.
One of the myths surrounding stammering is that those affected are less intelligent and more nervous or neurotic than the rest of the population. But research has firmly knocked this perception on the head. However, the severity of a stammer can be influenced by psychological factors such as how the person with a stammer perceives their ability to communicate. Some stammer more when they are tired, excited or upset.
The definition of stammering used by the British Stammering Association is of a condition “characterised by stoppages and disruptions in fluency which interrupt the smooth flow and timing of speech. These stoppages may take the form of repetitions of sounds, syllables or words, or of prolongation of sounds so that words seem to be stretched out, and can involve silent blocking of the airflow of speech when no sound is heard.”
The cause of stammering is unknown, although it is thought to be a processing disorder of brain cells. It seems to have both genetic and environmental influences and recent brain imaging studies have shown that the brains of people who stammer behave differently when they process speech. People without a stammer largely process speech in the left hemisphere of the brain, while there is an unusually large volume of activity in the right hemisphere of those who stutter. And there is a suggestion that those with a stammer have increased levels of the neurotransmitter dopamine in their brains.
How common is stammering?
About 5 per cent of children under the age of five will go through some phase of stuttering. By school age between 1 and 3 per cent of children stammer, while the prevalence in adults is about 1 per cent of the population. And about four times as many men as women stammer.
Most cases of childhood stammering are labelled as developmental. Neurogenic stuttering, caused by neurological damage from a stroke or a brain tumour, usually begins as an adult. Drug therapy, using drugs normally prescribed for schizophrenia, has been tried with limited success.
The most common intervention for stuttering is speech therapy. It is the treatment of choice for children and particular success has been reported with the Lidcombe programme in children of preschool age. This is a behavioural approach which produces significant long-term improvements in children’s speech.
Adults often turn to a different approach called “block modification” which has three phases: identification, densensitisation and modification.
This approach is based on the iceberg model, which recognises that a larger, covert component of stammering lies beneath the surface, leading to avoidance of certain activities.
Readers interested in further information and support should contact the Irish Stammering Association at mail@stammeringireland.ie or tel: 01-872 4405.
- Dr Houston welcomes feedback at mhouston@irishtimes.com, but regrets he cannot respond to individual medical queries