Possible psychogenic stuttering..?
Hello experts,
Please help! I’m working with a young man (24) who has come for help with his stuttering. He has also been diagnosed with OCD, Generalized Anxiety Disorder, and Major Depressive Disorder. He is seeing a counselor, who I have so far been unable to reach.
According to him, he stuttering began suddenly in March, about as severe as it is today – but, according to his mother, it began some time last year while he was in officer training in the army, which she noticed while talking to him on the phone. She claims that it got significantly WORSE in March.
Speechwise, his stuttering is very severe (SSI), with a moderate to severe impact (OASES). He has NO noticeable secondary behaviors; good eye contact, no word avoidance, etc., except that after repeating the same word very many times, he will get speech moving by increasing his volume and over-articulating (very unnatural sounding), which he can maintain without stuttering to the end of his utterance. He always repeats my question before answering (OCD?), and his stuttering is always part or whole-word repetition. Interestingly, he often repeats the final word of his utterance.
Today, I tried to see if he would adapt over repeated reading of the same word, and he was unable to. I tried DAF, and this seemed to have no effect. Choral speech did allow him to be fluent, but this was not 100%. Also, his stuttering is just as severe across situations, people, telephone, etc.
There is some conflicting information about past speech problems; he and mom both say that he had therapy around age 9 or 10, but he says that he thought it was for stuttering, which he says resolved after a few months of therapy. Mom says he had therapy because he had begun to pause mid-sentence during conversation, and then continue after a short while. She also said that this behavior was not corrected through therapy.
Initially, I suspected the return of developmental stuttering complicated by the OCD (hence the repeating of words to ‘get it right’, as he stated), and now I’m leaning toward psychogenic stuttering.
I welcome any and all suggestions, ideas, hypotheses!
Thanks,
Charley Adams
University of South Carolina
Hi Charley! Interesting client and I wouldn’t rule-out psychogenic stuttering or a psychological component of some degree, but I would first want to check his medication history, especially if there were any changes in meds around or a few weeks prior to March. With the three diagnoses he has, he is undoubtedly on a variety of meds. Of course, you’d need to collaborate with whoever is prescribing the drugs he may be on, but you might check https://www.drugs.com/answers/support-group/side-effect/ with the search term “stuttering” to see if any consumer reports stuttering as a side effect for them. Also try listing all the drugs he is on, using the keyword stuttering in scholar google or other search strategies. I had a woman contact me several years ago whose husband was on a variety of drugs, and singly, there was no mention of stuttering as a side effect with any of them, so he doctor had ruled it out as a cause of his stuttering. But with a careful search, I found an article that implicated the drug cocktail of drugs he was on, which did in fact have a side effect of stuttering.
Hi Judy,
Thanks for your suggestions. I’ll try to get a complete medication list this week!
Charley
Hi Charlie,
I am working with an interesting case at the moment which has some relevance here. This female client had a minor TBI for which nothing significant showed up in MRI. Repetition (4-5 iterations) on every word/syllable with significant struggle and effort. Increase in volume to compensate (as with your client). No adaptation, no improvement with choral speaking or DAF, no improvement when singing. Doctors were calling it a variety of things including PTSD, reaction disorder… basically “psychogenic stuttering”.
I thought the same thing initially and began working with her with that in mind, but did not see the usual results I see with psychogenic stuttering. I read an article by Bijleveld that was presented at the Oxford Fluency Conference in 2014 which made me think that there could be neurological findings yet to be discovered. I began working with that in mind, and found that my client’s severe disfluency is responding better to treatment strategies consistent with a disorder of apraxia than a disorder of stuttering. She has improved tremendously, is back at work (an attorney), and though still disfluent, is able to communicate comfortably and effectively.
We are stuttering experts, but we can’t forget the work we do with our aphasia patients.
In conclusion, think out of the box!
Vivian