OVERVIEW OF THE DISORDER
This section previews the next few chapters on the nature of stuttering and gives me a chance to reveal my own slant on the disorder. I think this may be helpful for anyone , but espe cially for those readers who have not had a course in stutter ing and who may, therefore, know few details of its nature.
Do All Cultures Have Stuttering?
Stuttering is found in alJ parts of the world and in all cultures and races. It is indisc1iminate of occupation, intelligence, and income; it affects both sexes and people of all ages, from toddlers to the elderly. It is an old curse, and there is evidence that it was present in Chinese, Egyptian, and Mesopotamian cultures more than 40 centuries ago. Moses was said to have stuttered (Garfinkel, 1995) and to have used a trick typical of many of us who stutter – getting his brother to speak for him. I did something similar when I was asked to read a prayer aloud in Sunday school.
What Causes People to Stutter?
The cause of stutter ing is still something of a mystery. Scientists have yet to discover what causes stuttering, but they have many clues. First, there is strong evidence that stuttering often has a genetic basis- that is, som ething is inherited that makes it more likely a child will stutter. This genetic “something” has to do with the way a child’s brain develops its neural pathways for speech and language. For example, the neural pathways for talking may have bot tlenecks, dead ends, or other obstacles to the rapid flow of information. The pathways may also be vulnerable to disrup tion by other brain activity, such as emotions. Another clue about the nature of stuttering is that most stuttering begins in children between ages 2 and 5. Thus, the onset of stutter ing occurs about the same time that many typical stresses of early childhood are occurring. One child may begin to stutter during a dramatic growth in vocabulary and syntax. Ano ther’s stuttering may first appear when the family moves to a new home. Still another child may start soon after a baby brother or sister is born. Many different factors, actingsingly or in combination, may precipitate the onset of stuttering in a child who has a neurophysiological predisposition,or inborn tendency, for stuttering. Once stuttering starts, it may disappear within a few months, or it may get gradually worse. When it gets worse, learned reactions may be an impo rtant factor in its sever ity. Playmates at school or thoughtless adults may cause a child to become highly self-conscious about his stuttering. TI1e child will quickly learn that by pushing hard, he can get traction on a word that has been stuck. He may find that an eye blink or an “um” said quickly before trying to say a hard word may short-circu it stuttering temporarily. By the time a child is a teenager, learned reactions influence many of the symptoms. He has learned to anticipate stuttering and may thrash around in a panic when he speaks, trying to escape or avoid it. By ad ulthood , his fear of stuttering and desire to avoid it can permeate his lifestyle. An adult who stutters often copes with it by limiting his work, friends, and fun to those situations and people that pnt few demands on speech. Figure 1.1 provides an overview of many of the contribut ing factors in the evolution of stuttering. In this and the s ubse quent four chapters, I’ll describe in detail our current under standing of these influences.
Can Stuttering Be Cured?
As implied above, it often cures itself. Some young children who begin to stutter recover without treatment. For others, early intervention may be needed to help the child develop normal fluency and prevent the development of a chron.ic problem. Once stuttering has become firmly established, however and the child has developed many learned reac tions, a concerted treatment effort is needed. Good treat ment of mild and moderate stuttering in preschool and early elementary school children may leave them with little trace of stuttering, except perhaps when they are stressed, fatigued, or ill. Most of those who stutter severely for a long time or who are not treated until after puberty make only a partial recovery. They often learn to speak more slowly or stutter more easily and learn to be less bothered by it. Some, however, will not improve, despite our best efforts .