Jump to content

Stuttering

Listen to this article
From Wikipedia, the free encyclopedia
This is an old revision of this page, as edited by SandyGeorgia (talk | contribs) at 19:01, 27 October 2007 (+WP:FN fixes). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.
"Stutter" redirects here. For other uses, see Stutter (disambiguation).
Stuttering
SpecialtySpeech–language pathology Edit this on Wikidata

Stuttering, also known as stammering in the United Kingdom, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the stutterer is unable to produce sounds. 'Verbal non-fluency' is the accepted[citation needed] umbrella term for such speech impediments. The term stuttering is most commonly associated with involuntary sound repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by stutterers as blocks, and the prolongation of certain sounds, usually vowels. Much of what constitutes "stuttering" cannot be noted by the listener; this includes such things as sound and word fears, situational fears, anxiety, tension, self-pity, stress, shame, and a feeling of "loss of control" during speech. The emotional state of the individual who stutters in response to the stuttering often constitutes the most difficult aspect of the disorder. The term "stuttering", as popularly used, covers a wide spectrum of severity: it may encompass individuals with barely perceptible impediments, for whom the disorder is largely cosmetic, as well as others with extremely severe symptoms, for whom the problem can effectively prevent most oral communication.

Stuttering is generally not a problem with the physical production of speech sounds or putting thoughts into words. Despite popular perceptions to the contrary, stuttering does not affect and has no bearing on intelligence.[citation needed] Apart from their speech impediment, people who stutter may well be 'normal' in the clinical sense of the term. Anxiety, low confidence, nervousness, and stress therefore do not cause stuttering per se, although they are very often the result of living with a highly stigmatized disability and, in turn, exacerbate the problem.

The disorder is also variable, which means that in certain situations, such as talking on the telephone, the stuttering might be more severe or less, depending on the anxiety level connected with that activity. In other situations, such as singing (as with country music star Mel Tillis or pop singer Gareth Gates) or speaking alone (or reading from a script, as with actor James Earl Jones), fluency improves. (It is thought that speech production in these situations, as opposed to normal spontaneous speech, may involve a different neurological function.) Some very mild stutterers, such as Bob Newhart, have used the disorder to their advantage, although more severe stutterers very often face serious hurdles in their social and professional lives. Although the exact etiology of stuttering is unknown, both genetics and neurophysiology are thought to contribute. Although there are many treatments and speech therapy techniques available that may help increase fluency in some stutterers, there is essentially no "cure" for the disorder at present.[citation needed]

Classification

Developmental stuttering is stuttering that originates when a child is learning to speak and develops as the child matures into adulthood. Several other speech disorders resemble stuttering:

Characteristics

Primary behaviors

Primary stuttering behaviors are the overt, observable signs of speech fluency breakdown, including repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. These differ in from the normal disfluencies found in all speakers in that that stuttering disfluencies may last longer, occur more frequently, and are produced with more effort and strain.[1] Stuttering disfluencies also vary in quality: normal disfluencies tend to be a repetition of words, phrases or parts of phrases, while stuttering is characterized by prolongations, blocks and part-word repetitions.[2]

  • Repetition occurs when a unit of speech, such as a sound, syllable, word, or phrase is repeated and are typical in children who are beginning to stutter.
  • Prolongations are the unnatural lengthening of continuant sounds, for example,"mmmmmmmmmilk". Prolongations are also common in children beginning to stutter.
  • Blocks are inappropriate cessation of sound and air, often associated with freezing of the movement of the tongue, lips and/or vocal folds. Blocks often develop later, and can be associated with muscle tension and effort.[3]

Secondary behaviors

Secondary stuttering behaviors are unrelated to speech production and are learned behaviors which become linked to the primary behaviors. Secondary behaviors include escape behaviors, in which a stutterer attempts to terminate a moment of stuttering. Examples might be physical movements such as sudden loss of eye contact, eye-blinking, head jerks, hand tapping, interjected "starter" sounds and words, such as "um," "ah," "you know".[4][5] In many cases, these devices work at first, and are therefore reinforced, becoming a habit that is subsequently difficult to break.[6] Secondary behaviors also refer to the use of avoidance strategies such avoiding specific words, people or situations that the person finds difficult. Some stutterers successfully use extensive avoidance of situations and words to maintain fluency and may have little or no evidence of primary stuttering behaviors. Such covert stutterers often have high levels of anxiety, and extreme fear of even the most mild disfluency.[7]

Severity

When the behaviors of a stutter are infrequent, brief, and are not accompanied by substantial avoidance behavior, the stutter is usually classified as a mild or a non-chronic stutter. Non-chronic stuttering is often called "situational stuttering" because the afflicted person generally has difficulty speaking only in isolated situations—usually during public speaking or other stressful activities—and outside of these situations the person generally does not stutter. When the behaviors are frequent, long in duration, or when there are visible signs of struggle and avoidance behavior, the stutter is classified as a severe or chronic stutter. Unlike mild or situational stuttering, chronic stuttering is present in most situations, but can be either exacerbated or eased depending on different conditions (see Positive conditions). Severe stutters often, but not always, are accompanied by strong feelings and emotions in reaction to the problem such as anxiety, shame, fear, self-hatred, etc. This is usually less present in mild stutterers and serves as another criteria by which to define stutters as mild or severe.

Variability

The severity of a stutter is not constant and stutterers often go through weeks or months of substantially increased or decreased fluency. Stutterers universally report having "good days" and "bad days" and report dramatically increased or decreased fluency in specific situations. Below is an overview of the circumstances that harm and help the fluency of most stutterers:Subtle changes in mood or attitude often greatly increase or decrease fluency, with many stutterers developing tricks or methods to achieve temporary fluency. Stutterers commonly report dramatically increased fluency when singing, whispering or starting speech from a whisper, speaking extremely slowly, speaking in chorus, speaking without hearing their own voice (e.g., speaking over loud music), speaking with a metronome or other rhythm, speaking with an artificial accent or voice, speaking in a foreign dialect, or when speaking while hearing their own voice with a delay or pitch change. Stutterers also display increased fluency when speaking to nonjudgmental listeners, such as pets, children, or speech pathologists. It is perhaps most interesting to note that most stutterers experience extraordinary levels of fluency when talking to themselves. A rare few even experience increased fluency when they exclusively "have the floor" (public speaking or teaching), when they are intoxicated, or when they are explicitly trying to stutter. There is no universally accepted explanation for these phenomena. Non-stutterers often interpret such instances of fluency as evidence that a stutterer can in fact speak "normally", which may partly explain the popular belief that stuttering is a transient nervous condition. Nevertheless, the appearance of fluency in certain situations in no way indicates that a stutterer can consciously produce similar fluency at other times, or that the disorder is any less "real".


All speech is more difficult when under pressure. Commonly, social pressures, like speaking to a group, speaking to strangers, speaking on the telephone, or speaking to authority figures, will irritate and make worse a stutter. Also, time pressure often exacerbates a stutter. Pressure to speak quickly when answering or conversing is usually very difficult for a stutterer, particularly on the telephone where stutterers do not have body language to aid themselves. This usually leaves dead silence in the place of nonverbal communication, which will indicate to the listener that the stutterer is not there or the line has been disconnected. Other time pressures will also worsen a stutter, such as saying one's own name, which must be done without hesitation to avoid the appearance that one does not know his or her own name, repeating something just said, or speaking when somebody is waiting for a response. By 16 years of age, a person who stammers will have had a great deal of experience of stammering and, for many, these experiences have been quite negative. The threat of being teased, bullied or not accepted takes a tremendous toll on the stutterer's everyday life. A person dealing with this may often feel like he or she has limited opportunities and options since today speaking out in public is almost a necessity, especially when one wants to be successful in one's career.

Feelings and attitudes

Stuttering may have a significant negative cognitive and affective impact on the stutterer. In a famous analogy, Joseph Sheehan, a prominent researcher in the field, compared stuttering to an iceberg, with the overt aspects of stuttering above the waterline, and the larger mass of negative emotions invisible below the surface.[8] Feelings of embarrassment, shame, frustration, fear, anger guilt are frequent in stutterers,[9] and may actually increase tension and effort, leading to increased stuttering.[10] With time, continued exposure to difficult speaking experiences may crystallize into a negative self-concept and self-image. A stutterer may project his attitudes onto others, believing that they think he is nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program.[11]

Sub-types

Developmental stuttering

Stuttering is generally a developmental disorder beginning in early childhood and continuing into adulthood at least 20% of children of those affected.[12]


The mean onset of stuttering is 30 months, or two and a half years old.[13] Stuttering rarely begins after age six. All children experience normal dysfluencies as they learn to talk, which they will outgrow. A current issue is whether stuttering develops progressively from normal childhood dysfluencies, or whether stuttering is something entirely different. Many parents are unsure whether their child's dysfluencies are normal, or whether he or she is beginning to stutter. As speech and language are difficult and complex skills to learn, almost all children have some difficulty in developing these skills. This results in normal dysfluencies that tend to be single-syllable, whole-word or phrase repetitions, interjections, brief pauses, or revisions. In the early years, a child will not usually exhibit visible tension, frustration or anxiety when speaking dysfluently and most will be unaware of the interruptions in their speech. With young stutterers, their dysfluency tends to be episodic, and periods of stuttering are followed by periods of relative fluency. This pattern remains through all stages of a stutterer's development, but as the stutter develops, the dysfluencies tend to develop more into repetitions and sound prolongations, often combined together (e.g., "Lllllets g-g-go there").

Usually by the age of six, a stutter is exacerbated when the child is excited, upset or under some type of pressure. Also around this age, a child will start to become aware of problems in his or her speech. After this age, stuttering includes repetitions, prolongations, and blocks. It also becomes more and more chronic, with longer periods of disfluency. Secondary motor behaviors (eye blinking, lip movements, etc.) may be used during moments of stuttering or frustration. Also, fear and avoidance of sounds, words, people, or speaking situations usually begin at this time, along with feelings of embarrassment and shame. By age 14 , the stutter is usually classified as an "Advanced stutter," characterized by frequent and noticeable interruptions, with poor eye contact and the use of various tricks to disguise the stuttering. Along with a mature stutter come advanced feelings of fear and increasingly frequent avoidance of unfavorable speaking situations. Around this time many become fully aware of their disorder and begin to identify themselves as "stutterers." With this may come deeper frustration, embarrassment and shame.

Acquired stuttering

In rare cases, stuttering may acquired in adulthood as the results of neurological event such as a head injury, tumour, stroke or drug abuse/misuse. The stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback (see below) which may promote fluency in stutterers with the developmental condition, are not effective with the acquired type.[12][14] Psychogenic stuttering may also arise after a traumatic experience such as a bereavement, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant events, it is constant and uninfluenced that different speaking situations, and there is initial little awareness or concern shown by the speaker in their speech.[15]


Causes

No single, exclusive cause of stuttering is known. A variety of hypotheses and theories suggest multiple factors contributing to stuttering.

Genetics

Among preschoolers, boys who stutter outnumber girls who stutter about two to one, or less.[16][17] But more girls recover fluent speech, and more boys don't.[18] By fifth grade the ratio is about four boys who stutter to one girl who stutters. This ratio remains into adulthood.[19]


Brain scans of adult stutterers have found several neurological abnormalities:

  • During speech adult stutterers have more activity in their right hemispheres, which is associated with emotions, than in their left hemispheres, which is associated with speech. Non-stutterers have more left-hemisphere activity during speech. It is unknown whether this abnormal hemispheric dominance results from something wrong with stutterers' left-hemisphere speech areas, with right-hemisphere area unsuited for speech taking over speech tasks; or whether the unusual right-hemisphere activity is related to fears, anxieties, or other emotions stutterers associate with speech.
  • During speech, adult stutterers have central auditory processing underactivity. One study suggested that stutterers may have an inability to integrate auditory and somatic processing, i.e., comparing how they hear their voices and how they feel their muscles moving.[20]
  • A brain scan study examined the planum temporale (PT), an anatomical feature in the auditory temporal brain region. Typically people have a larger PT on the left side of their brains, and a smaller PT the right side (leftward asymmetry). A brain scan study found that stutterers' right PT is larger than their left PT (rightward asymmetry).[21]
  • Adult stutterers have overactivity in the left caudate nucleus speech motor control area. Because stuttering is primarily overtense, overstimulated respiration, vocal folds, and articulation (lips, jaw, and tongue) muscles, it should be no surprise that the brain area that controls these muscles is overactive.[citation needed]

No brain scan studies have been done of stuttering children. It is unknown whether stuttering children have neurological abnormalities.

The first brain imaging studies in stuttering were done on two subjects using SPECT scanning before and after the administration of haloperidol. The researchers found that the subjects with stuttering had less blood flow in the Broca's and Wernicke's area and associated this with dysfluency. They found that haloperidol not only reduced stuttering but reversed this functional abnormality. Numerous PET and functional MRI studies have presented data that is in agreement with this first study.

Volumetric MRI studies have found that portions of the Broca's and Wernicke's areas are smaller in people who stutter and this correlates well with the hypometabolism in these two brain regions. New forms of structural MRI have found that there is a disconnection in white matter fiber tracts in the left hemisphere and greater numbers of white matter fiber tracts in the right hemisphere.

Treatment

A wide variety of stuttering treatments are available. No single treatment is effective for every stutterer. This suggests that stuttering doesn't have a single cause, but rather is the result of several interacting factors. If so, then combining several stuttering treatments may be more effective than relying on a single treatment. Many speech-language pathologists favor such an integrated approach to stuttering, and tailor therapy to each individuals' needs.[citation needed]

Fluency shaping therapy

Fluency shaping therapy trains stutterers to speak fluently by relaxing their breathing, vocal folds, and articulation (lips, jaw, and tongue).

Stutterers are usually trained to breathe with their diaphragms, gently increase vocal fold tension at the beginning of words (gentle onsets), slow their speaking rate by stretching vowels, and reduce articulatory pressure. The result is slow, monotonic, but fluent speech. This abnormal-sounding speech is used only in the speech clinic. After the stutterer masters these target speech behaviors, speaking rate and prosody (emotional intonation) are increased, until the stutterer sounds normal. This normal-sounding, fluent speech is then transferred to daily life outside the speech clinic.

Stuttering modification therapy

The goal of stuttering modification therapy is not to eliminate stuttering. Instead, the goals are to modify moments of stuttering so that stuttering is less severe and reduce the fear of stuttering, while eliminating avoidance behaviors associated with this fear. Unlike fluency shaping therapy, stuttering modification therapy assumes that adult stutterers will never be able to speak fluently, so the goal is to be an effective communicator despite stuttering.[citation needed]

Stuttering modification therapy has four stages:[citation needed]

  • In the first stage, called identification, the stutterer and clinician identify the core behaviors, secondary behaviors, and feelings and attitudes that characterize the stuttering.
  • In the second stage, called desensitization, the stutterer tells others about stuttering, freezes core behaviors, and intentionally stutters ("voluntary stuttering").
  • In the third stage, called modification, the stutterer learns "easy stuttering." This is done by "cancellations" (stopping in a dysfluency, pausing a few moments, and saying the word again); "pull-outs," or pulling out of a dysfluency into fluent speech; and "preparatory sets," or looking ahead for words one may stutter on, and using "easy stuttering" on those words.
  • In the fourth stage, called stabilization, the stutterer prepares practice assignments, makes preparatory sets and pull-outs automatic, and changes their self-concept from being a person who stutters to being a person who speaks fluently most of the time but who occasionally stutters mildly.

Anti-stuttering devices

See also: Anti-stuttering devices

Altered auditory feedback, so that stutterers hears their voice differently, has been used for over 50 years in the treatment of stuttering.[22] Altered auditory feedback effect can be produced by speaking in chorus with another person, by providing blocking out the stutterer's voice while talking (masking), by delaying the stutterer's voice slightly (delayed auditory feedback) and/or by altering the frequency of the feedback (frequency altered feedback). Studies of these techniques have had mixed results, with some stutterers showing substantial reductions in stuttering, while others improved only slightly or not at all.[22] In a 2006 review of the efficacy of stuttering treatments, none of the studies on altered auditory feedback met the criteria for experimental quality, including the absence of control groups.[23]

Anti-stuttering medications

The effectiveness of pharmacological agents, such as anti-convulsants, anti-depressants, antipsychotic and antihypertensive medications, and dopamine antagonists in the treatment of stuttering has been evaluated in studies involving both adults and children.[24] A comprehensive review of pharmacological treatments of stuttering in 2006 concluded that few of the drug trials were methodologically sound.[24] Of those that were, only one, not unflawed study,[25] showed a reduction in stuttering to less than 5%. In addition, potentially serious side effects of pharmacological treatments were noted.[24]

Prognosis

Among preschoolers, the prognosis for recovery is good. About 65% of preschoolers who stutter recover spontaneously recover, in their first two years of stuttering.[13][26] Only 18% of children who stutter five years recover spontaneously.[27] The peak age of recovery is 3.5 years old. By age six, a child is unlikely to recover without speech therapy.

Epidemiology

Stuttering affects males two to five times more often than females.[28][12][17] The lifetime prevalence, or the proportion of individuals expected to stutter at one time in their lives, is about 5%.[29] Most stuttering begins in early childhood and according studies suggest 2.5% of children under the age of 5 stutter.[30][31] Due to high rate (approximately 65-75%) rates of early recovery,[28][32] the overall prevalence of stuttering is generally considered to be approximately 1%.[33][12]

The stuttering occurs at similar rates in different countries around the world.[12] A US-based study indicated that there were no racial or ethnic differences in the incidence of stuttering in preschool children.[30][31]

Stuttering and society

See also: Cultural references to stuttering
Lewis Carroll, the well-known author of Alice in Wonderland, was afflicted with a stammer, as were his siblings.

For centuries stuttering has featured prominently in both popular culture and in society at large. Because of the unusual-sounding speech that is produced, as well as the behaviors and attitudes that accompany a stutter, stuttering has been a subject of scientific interest, curiosity, discrimination, and ridicule. Stuttering was, and essentially still is, a riddle with a long history of interest and speculation into its causes and cures. Stutterers can be traced back centuries to the likes of Demosthenes,[citation needed] Aesop,[citation needed] and Aristotle[citation needed]—some[vague] interpret a passage of the Bible to indicate Moses also to have been a stutterer.[34] Misinformation and superstition have influenced society's perceptions of the causes and remedies of a stutter, as well as the intelligence and perceived disposition of people afflicted with the disorder.

Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman Emperor Claudius was initially shunned from the public eye and excluded from public office.[citation needed] His infirmity is also thought to have saved him from the fate of many other Roman nobles during the purges of Tiberius and Caligula.[citation needed] Isaac Newton, the English scientist who developed the law of gravity, also had a stutter.[citation needed] Other famous Englishmen who stammered were King George VI[citation needed] and Prime Minister Winston Churchill, who led the UK through World War II. Although George VI went through years of speech therapy for his stammer, Churchill thought that his own very mild stutter added an interesting element to his voice: "Sometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience…"[35]

Ancient views of stuttering

Notker Balbulus, from a medieval manuscript.

For centuries "cures" such as consistently drinking water from a snail shell for the rest of one's life, "hitting a stutterer in the face when the weather is cloudy", strengthening the tongue as a muscle, and various herbal remedies were used.[36] Similarly, in the past people have subscribed to theories about the causes of stuttering which today are considered odd. Proposed causes of stuttering have included tickling an infant too much, eating improperly during breastfeeding, allowing an infant to look in the mirror, cutting a child's hair before the child spoke his or her first words, having too small a tongue, or the "work of the devil."[36]

Roman physicians attributed stuttering to an imbalance of the four bodily humors: yellow bile, blood, black bile, and phlegm. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century. Italian pathologist Giovanni Morgagni attributed stuttering to deviations in the hyoid bone, a conclusion he came to via autopsy. Later in the century, surgical intervention, via resection of a triangular wedge from the posterior tongue to prevent spasms of the tongue, was also tried.[citation needed]

Blessed Notker of St. Gall (ca. 840–912), called Balbulus (“The Stutterer”) and described by his biographer as being "delicate of body but not of mind, stuttering of tongue but not of intellect, pushing boldly forward in things Divine," was invoked against stammering.

Discrimination and awareness

File:Porky Pig1.jpg
One of the most famous stuttering fictional characters is the animated cartoon character "Porky Pig" from the Looney Tunes theatrical cartoon series.

In addition to personal feelings of shame or anxiety, discrimination is a significant problem for stutterers. The majority of stutterers experience or have experienced bullying, harassment, or ridicule to some degree during their school years from both peers and teachers who do not understand the condition.[37] It can be especially difficult for stutterers to form friendships or romantic relationships,[citation needed] both because stutterers may avoid social exposure and because non-stutterers may find the disorder unattractive. The stigma of stuttering carries over into the workplace, often resulting in severe employment discrimination against stutterers.[citation needed] Consequently, stuttering has been legally classified as a disability in many parts of the world, affording stutterers the same protection from wrongful discrimination as for people with other disabilities. The UK Disability Discrimination Act 1995 and the Americans with Disabilities Act of 1990 both expressly protect stutterers from wrongful dismissal or discrimination.[38][39]

The U.S. Congress passed a resolution in May 1988 designating the second week of May as Stuttering Awareness Week, while International Stuttering Awareness Day (ISAD), is held internationally on October 22. In September 2005, ISAD was recognised and supported by over 30 Members of the European Parliament (MEPS) at a reception given by the European League of Stuttering Associations.

Even though public awareness of stuttering has improved markedly over the years,[citation needed] misconceptions are still common, usually reinforced by inaccurate media portrayals of stuttering and through popular misconception. A 2002 study focusing on college-age students conducted by the University of Minnesota Duluth found that a large majority viewed the cause of stuttering as either nervousness or low self-confidence, and many recommended simply "slowing down" as the best course of action for recovery.[40] While these misconceptions are damaging and may actually worsen the symptoms of stuttering, groups and organizations are making significant progress towards a greater public awareness.[citation needed]

See also

Notes

  1. ^ Ward, David (2006). Stuttering and Cluttering: Frameworks for understanding treatment. Hove and New York: Psychology Press. pp. p.5-6. ISBN 9781841693347. {{cite book}}: |pages= has extra text (help); Cite has empty unknown parameter: |coauthors= (help)
  2. ^ Kalinowski, Joseph S.; Saltuklaroglu, Tim (2006), Stuttering (pp. 31-37 ed.), San Diego: Plural Publishing, ISBN 9781597560115
  3. ^ Guitar, Barry (2005). Stuttering: An Integrated Approach to Its Nature and Treatment. San Diego: Lippincott Williams & Wilkin. p. 14-15. ISBN 0781739209.
  4. ^ Ward, pp.6–7
  5. ^ Guitar, pp.16
  6. ^ Guitar, pp.16
  7. ^ Ward, pp.6–7
  8. ^ Kalinowski and Saltuklaroglu, pp. 17
  9. ^ Ward, pp. 179
  10. ^ Guitar, pp. 16-7
  11. ^ Guitar, pp. 16-7
  12. ^ a b c d e Craig, A. and Tran, Y. (2005). "The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan". Advances in Speech–Language Pathology,. 7 (1): 41–46. PMID 17429528.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  13. ^ a b Yairi E, Ambrose N (1992). "Onset of stuttering in preschool children: selected factors". Journal of speech and hearing research. 35 (4): 782–8. PMID 1405533.
  14. ^ Ward, pp.4, 332-335
  15. ^ Ward, pp.4, 332, 335-337
  16. ^ Yairi E, Ambrose, N (2005). Early childhood stuttering. Austin, TX: Pro-Ed, Inc.
  17. ^ a b Kloth S, Janssen P, Kraaimaat F, Brutten G (1995). "Speech-motor and linguistic skills of young stutterers prior to onset". Journal of Fluency Disorders (20): 157–170. doi:10.1016/0094-730X(94)00022-L.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ Yairi E, 2005; "On the Gender Factor in Stuttering," Stuttering Foundation of America newsletter, Fall 2005, page 5.
  19. ^ Craig A, Hancock K, Tran Y, Craig M, Peters K (2002). "Epidemiology of stuttering in the community across the entire life span". J. Speech Lang. Hear. Res. 45 (6): 1097–105. PMID 12546480.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ Braun AR, Varga M, Stager S, et al. "Atypical Lateralization of Hemispheral Activity in Developmental Stuttering: An H215O Positron Emission Tomography Study," in Speech Production: Motor Control, Brain Research and Fluency Disorders, edited by W. Hulstijn, H.F.M. Peters, and P.H.H.M. Van Lieshout, Amsterdam: Elsevier, 1997.
  21. ^ Foundas AL, Bollich AM, Feldman J; et al. (2004). "Aberrant auditory processing and atypical planum temporale in developmental stuttering". Neurology. 63 (9): 1640–6. PMID 15534249. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  22. ^ a b Bothe, Anne K., Finn, Patrick, Bramlett, Robin E. (2007). "Pseudoscience and the SpeechEasy: Reply to Kalinowski, Saltuklaroglu, Stuart, and Guntupalli (2007)". American Journal of Speech-Language Pathology. 16: 77–83. PMID 17329678.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ^ Bothe, Anne K., Davidow, Jason H., Bramlett, Robin E., Ingham, Roger J. (2006). "Stuttering Treatment Research 1970-2005: I. Systematic Review Incorporating Trial Quality Assessment of Behavioral, Cognitive, and Related Approaches". American Journal of Speech-Language Pathology. 15: 321–341. PMID 17102144.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ^ a b c Bothe, Anne K., Davidow, Jason H., Bramlett, Robin E., Franic, Duska M., Ingham, Roger J. (2006). "Stuttering Treatment Research 1970-2005: II. Systematic Review Incorporating Trial Quality Assessment of Pharmacological Approaches". American Journal of Speech-Language Pathology. 15: 342–352. PMID 17102145.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. ^ Maguire GA, Riley GD, Franklin DL, Gottschalk LA (2000). "Risperidone for the treatment of stuttering". Journal of clinical psychopharmacology. 20 (4): 479–82. PMID 10917410.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  26. ^ Yairi E (1993). "Epidemiologic and other considerations in treatment efficacy research with preschool-age children who stutter." Journal of Fluency Disorders, 18, 197–220.
  27. ^ Andrews G, Craig A, Feyer AM, Hoddinott S, Howie P, Neilson M (1983). "Stuttering: a review of research findings and theories circa 1982". The Journal of speech and hearing disorders. 48 (3): 226–46. PMID 6353066.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. ^ a b Yairi E, Ambrose N, Cox N (1996) Genetics of stuttering: a critical review. Journal of Speech Language Hearing Research 39:771–784.
  29. ^ Mansson, H (2000). "Childhood stuttering: Incidence and development". Journal of Fluency Disorders. 25(1): 47–57. doi:10.1016/S0094-730X(99)00023-6
  30. ^ a b Proctor A, Duff M, Yairi E (2002). "Early childhood stuttering: African Americans and European Americans". ASHA Leader. 4 (15): 102.
  31. ^ a b Yairi E, Ambrose N (2005). Early childhood stuttering. Austin, TX: Pro-Ed, Inc.
  32. ^ Yairi E, Ambrose NG (1999). "Early childhood stuttering I: persistency and recovery rates". J. Speech Lang. Hear. Res. 42 (5): 1097–112. PMID 10515508.
  33. ^ Craig A, Hancock K, Tran Y, Craig M, Peters K (2002). "Epidemiology of stuttering in the community across the entire life span". J. Speech Lang. Hear. Res. 45 (6): 1097–105. PMID 12546480.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ This interpretation is on the Biblical passage "Lord, open my breast, and do Thou ease for me my task, Unloose the knot upon my tongue, that they may understand my words." Traditional Hebrew midrashim (commentaries) give stuttering as the reason for Moses' reluctance to speak. He had Aaron as his public speaker.
  35. ^ "Churchill: A Study in Oratory". The Churchill Centre. Retrieved 2005-04-05.
  36. ^ a b Kuster, Judith Maginnis (April 1, 2005). "Folk Myths About Stuttering". Minnesota State University. Retrieved 2005-04-03. {{cite web}}: Check date values in: |date= (help)
  37. ^ Hugh-Jones S, Smith PK (1999). "Self-reports of short- and long-term effects of bullying on children who stammer". The British journal of educational psychology. 69 ( Pt 2): 141–58. PMID 10405616. {{cite journal}}: |access-date= requires |url= (help); External link in |laysummary= (help); Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)
  38. ^ Merley, Dennis J. Disability Discrimination: Court Serves Stuttering Restaurant Worker with ADA Victory. Felhaber, Larson, Fenlon & Vogt, P.A. Retrieved on 2007-09-22.
  39. ^ Tyrer, Allan. Disability discrimination links. Stammeringlaw.org.uk. Retrieved on 2007-09-22.
  40. ^ Spillers, Cindy. "Public Perceptions 2002". The University of Minnesota Duluth Stuttering Home Page. Retrieved 2005-04-03.

References

Listen to this article
(4 parts, 52 minutes)
  1. Part 1
Spoken Wikipedia icon
These audio files were created from a revision of this article dated
Error: no date provided
, and do not reflect subsequent edits.
(Audio help · More spoken articles)
Wikibooks has a book on the topic of: Stuttering
Look up stammering or stuttering in Wiktionary, the free dictionary.

Retrieved from "https://en.wikipedia.org/w/index.php?title=Stuttering&oldid=167477267"