|About the presenter: AAnelise Junqueira Bohnen, Master of Science in Speech Pathology and Audiology (Ithaca College, Ithaca, NY, 1979). Specialized in Fluency Disorders, was a participant in The Stuttering Foundation of America workshops. Completed a PhD program in Applied Linguistics (Federal University of Rio Grande do Sul, Brazil, 2009). Works with disorders of fluency since 1980 in private practice, taught at three Universities for more than 10 years in the same area. Currently works as a clinician and is President of The Brazilian Fluency Institute. Presented a thesis entitled Words stuttered by children and adults: characterization of stuttering as a language disorder with an international evaluation committee.|
Stuttering usually begins around the age of three, when speech-language skills are being acquired and expanded. This is not a simple coincidence. The connections and interactions between language development and the emergence of stuttering in children have been extensively reported in the international literature. Would language distinctions make any differences on the manifestations of stuttering? In Brazilian Portuguese there was no study that analyzed the isolated stuttered word.
Here I intend to share with you some of the results obtained in my doctorate research to emphasize stuttering as a language disorder through the analysis of 1326 stuttered words collected from 1986 to 2005.
First of all, it was necessary to understand how this disorder manifested itself at the word level. It was important to demonstrate if the stuttered words had similar characteristics, despite gender, age, and time span. Because words are the most stable of all the linguistic units in relation to its internal structure, any new elements (including breaks) usually cannot be inserted into it in normal speech. Careful clinical observation and the literature indicate that stuttering occurs primarily at the beginning of words, independent of linguistic, socioeconomic, cultural and or psychological contexts. Thus, the focus of my analysis was the isolated stuttered word, understood as a linguistic unit of sound, uttered inappropriately, due to a brain's faulty neuromuscular sequencing of articulatory movements.
How the data was obtained?
The words analyzed were produced by 60 adults and 60 children in their first recorded interview in my office, randomly chosen during a 20-year period of time (from 1986 to 2005). Only the first 100 spoken words were used from each recording, totaling 12,000 spoken words, of which 1326 were stuttered. These were then analyzed one by one according to several characteristics: type of stuttering, gender, age, time span, extension of the word, stressed or unstressed syllables, and position of the stuttering in the word.
I chose three descriptions of stuttering to base my study on. This was important because in my country the idea that stuttering is a psychological problem is still strong, and, if I intended to demonstrate that stuttering is rather a language problem, I needed descriptions provided by international institutions. The first description is the one offered by the World Health Organization via the International Classification of Diseases and Related Health Problems, 10th Revision (ICD 10). The second was from the American Psychiatric Association and its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), and the third description was from the American Speech-Language-Hearing Association (ASHA).
The ICD 10, under the code F98.5, says: "stuttering: speech that is characterized by frequent repetition or prolongation of sounds or syllables or words, or by frequent hesitations or pauses that disrupt the rhythmic flow of speech. It should be classified as a disorder only if its severity is such as to markedly disturb the fluency of speech". The DSM IV TR, under the code 307.0, says that "stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for the individual's age. This disturbance is characterized by frequent repetitions or prolongations of sounds or syllables. Various other types of speech disfluencies may also be involved, including interjections, pauses within a word, filled or unfilled pauses in speech, word substitutions to avoid problematic words, words produced with an excess of physical tension, and monosyllabic whole-word repetitions. The disturbance in fluency interferes with academic or occupational achievement or with social communication [. . . .] Stuttering may be accompanied by motor movements (eye blinks, tics, tremors of the lips or face, jerking of the head, breathing movements, or fist clenching). Stress or anxiety have been shown to exacerbate stuttering[. . .]".
ASHA states that "stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called 'disfluencies' [. . .]. In most cases, stuttering has an impact on at least some daily activities. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder. Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. Speech may become completely stopped or blocked. Blocked is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word". (You can find the entire descriptions at http://www.who.int/classifications/icd/en; http://www.psychiatryonline.com/dsmLibrary.aspx; and http://www.asha.org/public/speech/disorders/stuttering.htm).
As you can see, they all state that what characterizes stuttering are breaks in spoken words such as blocks, repetitions and prolongations. None of these three descriptions indicate incidence or prevalence of these types in the speech of people who stutter.
Frequency of typologiesIn my research, the consistency of the results given by the statistical analysis of the disruptions suggests that children reached similar frequencies for blocks, repetitions and prolongations. In contrast, adults blocked and repeated more than prolonging. In other words, blocks and repetitions remained stable or even may increase slightly over time, but prolongations decreased as Brazilian Portuguese speakers who stutter grew older.
Why would prolongations decrease at older ages, if this type of stuttering seems to be less perceived by others than blocks and repetitions? Studies on memory could perhaps help to explain these findings, since the motor area of the brain learns by repetition. Blocks and repetitions are perceptually more striking to the listener than prolongations. Children would learn to detect this impact over time, due to the listeners' reactions to stuttering. It is known that these reactions contribute to less positive attitudes of communication of people who stutter, because the abnormality of speech, when repeated over time, changes the level of certain neurochemicals in the brain, establishing memories, according to a number of experts .
However, stuttering is individual. Some people block more, others prolong more, and others repeat more. The key word here is more. The presence of one stuttering type in the speech of an individual does not exclude the others.
Age, gender and typologies
The characteristics of stuttered words and the different types remained similar among adults and children, males and females, and were stable throughout the whole time interval. The most frequent specific stuttering types were blocks, syllable repetitions and repetitions of one-syllable-words. Stuttering manifested itself independent of the surveyed factors.
In this study, age and gender, over time, separately or combined, did not influence the extension of stuttered words. Once stuttering is not more evident in longer words in adults, results point to a language-based regularity.
As to gender, the statistical results of this study do not show that stuttering is worse in men than in boys, or in women than in girls. However, if stuttering is a disorder of language, the stability found in the age groups and gender is plausible. That is, word length did not influence the types of stuttering because blocks, repetitions and prolongations occurred similarly in adults and children, males and females.
Did syllabic stress matter?
Syllabic stress gives the sentence different implications, an important aspect of communication in conversation, because it draws attention especially to the new information in a sentence. In this research, the question was: since stuttering appears more often on the initial syllables of words, would there be any "preference" for strong or for weak syllables?
As expected, syllabic stress did not appear important to the speakers. In this research, samples transcribed were spontaneously produced speech, outside of a lab controlled situation. And it did not matter if the syllables were stressed or not. Despite linguistic and methodological differences (read lists of words vs. connected but not spontaneous speech) reported in the literature, and despite definitions of syllabic stress, researchers consistently stated that stuttering occurs more often in stressed syllables and at the initial position of words, even though these characteristics change according to different languages. English and German behave a bit different from each other. But the same was not true in Brazilian Portuguese. There seemed to be no interaction between syllabic stress and types of stuttering, as well. Stuttering did not depend on syllabic stress, word length, typology, age group, gender and time elapsed.
Stuttering is on the first syllables of words
From the 1,326 stuttered words in the sample, stuttering occurred on the first syllables of 1286 words, representing 97% of the total. Only 37 stutterings occurred on the second syllable, 2 on the third and only 1 on the fourth. And 48% of them were monosyllables. A morphological analysis of these monosyllables showed that they were mainly prepositions, verbs, conjunctions and personal pronouns. Few studies were reported specifically for these comparisons, and they were done in an experimental way, with words previously selected for control measurements. Studies with spontaneously collected words, spoken by different people who stutter, at different ages, different genres and for various time intervals, are not common.
DSM IV TR says that "one can begin to speak, but gets "stuck" in a sound or syllable (usually the first) until the brain can generate the necessary command to continue with the rest of the word". This is what was found in this investigation.
What seems clear is that there is real difficulty in initiating words, and not in finishing them. This finding can point to the basal ganglia because from the moment the direct pathway of the basal ganglia enables the beginning of the word, the rest of it simply flows. Stutterings occurred in the first syllables of stuttered words 97% of the time. This was statistically significant. Age, gender, typology, syllabic stress, number of syllables per word and time did not interfere with the location of stuttering on the word.
Stuttering variability is an individual characteristic and in this variability resides its complexity. But, when stuttered words, isolated from any context were analyzed, a striking regularity across time was verified. The results point to stuttering as a disorder of language. To stutter in 2005 was the same as to stutter in 1986. Results make possible to state that the regularity of the found characteristics of stuttered words is the regularity of language.
I would like to finish this brief report with a quote by Lord Balfour, who was one of King George VI's counselors. So he said: "The great bulk of people infinitely prefer the continuance of a problem which they cannot explain to an explanation they cannot understand". I hope that the findings of the characteristics of words stuttered in Brazilian Portuguese can contribute to a better understanding of stuttering as a language disorder.
To Dr Gerald Maguire and Dr Cristiane Oliveira for being in my doctoral committee.
To Drs Ana Zilles and Luciene Simoes from the Applied Linguistics Department of the "Instituto de Letras" - Federal University of Rio Grande do Sul - UFRGS.
To Guilherme Junqueira Bohnen who developed the Electronic Semantics program that enabled the transcription and analysis of the stuttered words.
To the people who stutter that left the recordings of their broken speeches with me.