Time: 5:56:56 AM
Remote Name: 184.108.40.206
Thank you for your kind comments.
To answer your first question would require writing a book. Actually I have. It's called Stuttering, and it is published by Pro-Ed. But the short answer is that stuttering begins for reasons that we do not yet know, but because its beginning is quite similar in children, it makes sense to work on the assumption that the cause is not environmentally based. The genetic data also support this idea. Because of the timing of stuttering's typical onset and the very common relation to language spurts, I would guess that the cause is somehow related to language acquisition, but that is not really saying very much. However, once a child is repeating words and syllables, what happens next -- the development of stuttering -- is clearly a result of the child's reactions to the frustration of not being able to say what he or she wants to at the moment, which adds muscular tension to the speech act, speeds up the repetitions, truncates the repeated syllable, and often adds secondary reactions. Parental reactions to this now more alarming picture surely influence the child, sometimes for good and sometimes for ill, depending on the reactions. Most parents, probably all parents, mean well, but their reactions are not always helpful. It is a tricky balancing act for a parent, being open with a child about stuttering when it seems safer to pretend nothing is happening, showing attention and gentle concern but not panic, etc. I see nowhere any evidence that the labelling of the child's speech differences as stuttering has any effect at all. Children at this age usually don't know what the word means. We try to teach parents to talk to their children about stuttering and to use labels that are meaningful to the child, usually the labels the child comes up with. The children who don't recover during this early period slowly lose their plasticity of language development, and if they are still stuttering when they lose plasticity, the stuttering is then part of their approach to and execution of the speech act, given the stimuli that evoke the old reactions. As a result the disorder becomes a part of the child's speaking and is consequently difficult to correct. It is also difficult to correct because so much of the behavior is based on struggle and avoidance, which are very difficult behaviors to shed. Then, of course, the child goes to school and encounters peer reactions, which are sometimes devastating, and tend to produce shame and further avoidance, particularly trying to hide the stuttering behaviors. This period leads to chasing the fluency god, wild tricks, and a sense of defectiveness. If the disorder persists, additional emotional reactions develop, including a desire to simply withdraw from social contact, which often shows up in the junior high school years, and can seriously delay the development of social skills.
So, I guess you can see that the cause is probably genetic or neurological or both, but the original cause is really not very important to the nature of the disorder. It is the development of the child's reactions that determine what the disorder is like, and those reactions are learned. Stuttering may start out as a genetic/neurological disorder, but it becomes a largely psychological problem, including behavioral, emotional, and cognitive areas. As a result, it requires treatment that is based on sound psychotherapeutic principles and techniques. This is not to say that psychologists should treat it, because they don't usually know very much about it. Instead, I believe that SLP's should treat it after learning how to use the psychotherapeutic techniques and principles that apply to this particular speech disorder. It is not that hard to learn, and it pays off in better treatment of clients and more confidence in the clinician.