Stuttering problem
Hello,
I have a simple question trying to determine where to place the disorder of stuttering?
Is stuttering a language problem?
or a speech motor problem?
or a genetics problem?
If the causes of stuttering is a genetics problems then shouldn’t genetic scientists be the ones working on finding the causes of stuttering…….
You wouldn’t ask an Italian chef to cook Japanese food Sushi and vice versa right?
thank you!!!
I’m tempted to answer your interesting question with “yes.”
As Van Riper discussed many years ago, there appear to be several “paths” (at least the 4 he mentioned) to developing stuttering. I do not think CVR believed there was a “stuttering gene” however.
The last research has in fact uncovered a genetic link in some (not all) people who stutter. I know that Dennis Drayna (and others) are working on that question.
You can find the following linked to the Stuttering Home Page (www.stutteringhomepage.com)
2005 ISAD online conference article by Dennis Drayna http://www.mnsu.edu/comdis/isad8/papers/drayna8.html
There is a PPT by Drayna from 2009 – Update on Genetics Research on Stuttering – PPT by Dennis Drayna, NSA 2009
Another PPT by Dennis Drayna from 2010 Discovery Of Genetic Mutations That Cause Stuttering ASHA 2010
Drayna is scheduled to present another update at the ASHA convention this November.
The study I am most familiar with involved a family discovered through a past ISAD online conference, continues to be studied:
M. Hashim Raza, E. Michael Gertz, Jennifer Mundorff, Joseph Lukong, Judith Kuster, Alejandro A. Schaeffer, Dennis Drayna (April 2013) Linkage analysis of a large African family segregating stuttering suggests polygenic inheritance, Human Genetics 132:385-396 DOI 10.1007/s00439-012-1252-5
Judy Kuster
You are right Rick. Here are definitions or descriptions of stuttering which indicates that a) stuttering is a psychiatric disorder b) stuttering is a language disorder c) stuttering is a motor disorder d)stuttering is a learned disorder. Treatment approach is directly influenced by your definition or description.
a) Coriat (1943) described stammering as a psychoneurosis.
b) Eisenson (1958) described stuttering as a transient disturbance in communicative propositional language usage.
c) Van Riper (1971) described stuttering as a temporal disruption of the simultaneous and successive programming of muscular movement in the production of speech.
d) Brutten and Shoemaker (1967) described stuttering as a form of fluency failure that results from conditioned negative emotion.
However, my personal opinion is that it is also a choice to describe stuttering as a problem or not. I usually argue that stuttering can be a gift…and obviously in that case it is not a problem but a condition.
Actually, it seems that stuttering is all of the things you mentioned and more, but it isn’t the sum of its parts. Stuttering is what you see, hear, feel or sense when the speech system is not functioning automatically in the way it’s meant to function. It is a system problem. In some people there may be genetic factors. However, as yet we don’t know what this is. Geneticists are trying to find out. Perhaps one day they will find the gene/s responsible and some genetic engineering would be possible. However, that’s not known or possible today. What we can do today is help the person who stutters get her/his system to function naturally. This is possible.
Hello Rick,
As you see, the question is not so simple. I concur with with Judy, Joseph, and Barbara have written, but let me add one more small perspective.
People need categories to make sense of their reality. Obviously the term “stuttering” is one such category. It describes complex array of behaviors that can arise from or be related to an even more complex array of conditions, situations, and so on. I’m not a “Whorfian” advocate to the extent that something only exists in one’s reality if the person has a word for that something. Nevertheless, you are asking a question that is related to categorization. A “language” problem implies one thing in speech-language pathology, i.e., a disorder related to the syntax, semantics, and pragmatics associated with a given natural language. In linguistics, language would include phonology, an area we SLPs consider within the realm of “speech.” Personally, using the SLP understanding of the term, I do not believe that stuttering is typically a “language problem,” but I hasten to add that many who stutter do have subtle language differences that coexist with their stuttering. Perhaps a majority do, but I don’t think that has been established. In any case, their “language” problems are far outweighed by their “speech” problems (see the next paragraph).
I would concur that stuttering is a “speech motor problem,” using the SLP understanding. It would be a speech problem if it does not involve syntax, semantics, or pragmatics, but instead involves how the language is actually produced. But we like to think of the “why” of the problem, and that leads us to the motor system. To me, “speech motor” implies that the problem of stuttering is somehow “downstream” in the speech production process from formulating the content of the message and even choosing the lexical items (words), phonemes, and allophones (sounds) to be uttered. Presumably stuttering occurs somewhere in the translation of the intent to the actual movements involved in generating speech (breathing, voicing, and articulating).
As for a “genetic problem,” clearly there are genetic influences that impact the likelihood that someone will stutter. I don’t claim to know much about genetics, except I am aware that those who do know about genetics (e.g., Ehud Yairi) have indicated that about 50% of individuals who stutter have identifiable genetic markers. Of course, that leaves 50% who do not have such identifiable markers. Whether or not future research will find such markers in that group, we’ll have to wait and see. But, in 2014, you could say stuttering is a “genetic problem” in about half the cases.
I’m not sure this makes any sense, especially my oversimplifications, but there it is.
Ken
In the ‘Nature and treatment of stuttering’ by Richard Curlee and Gearld Siegel, Anne Smith and Ellen Kelley have a chapter discussing a dynamic multifactorial model of stuttering. Everything you mentioned and more. There are many components (genetic, behavioral, socio-cultural, language, acoustic, speech motor, brain physiology) that can be factors. But, they are present in different degrees or combinations in different people who stutter. And the ‘dynamic’ part is that even this changes – that these vary across the lifespan of an individual. All these factors are also impacted by the environment.
The analogy of the blindfolded men describing the elephant works really well for Stuttering!
Anu Subramanian
Rick,
You ask a great question, and quite natural for all us seeking to find answers, and “make sense of their reality” (as Ken wrote above, which is love!). It is funny, I was just teaching an Intro Class yesterday about Autism and causes. I asked the question, “What do we know causes Autism.” The class of 60 was silent. Which was the point. We don’t have definite answers to a cause of stuttering. We have ideas, philosophies, and some wonderful research being developed daily around the world. What we DO have are ways we can help those who stutter. What we do have are compassionate and passionate therapist who strive to assist those struggling with stuttering in both a psychological and physical sense. What do have are clients and families willing to love and trust us as clinicians and willing to work.
Just like with other disorders, we have caring individuals looking in many areas to find answers. And, just like most disorders and diseases, the more we look, the more questions we develop. Such is the life of a researcher and an evolving mind of people who care. That being said, your question may appear “simple”, yet that question alone sparks interest and inspires us all to keep examining this disorder for the betterment of those who struggle with it. Thanks for participating! With compassion and kindness,
Scott
I think this question is encouraged by historical models of both communication and its disorders that are outmoded. There are no boundaries between the speech and language systems inside of people. Clearly, some individuals struggle more to articulate, others to find words, etc. But many historical “speech” disorders have language correlates, now that we know where to look (e.g., Parkinsons’s), others are highly co-morbid (e.g., there is a hugely larger risk for children diagnosed with one communication disorder to have at least one other), and stressors within one “system” obviously impact function in “another system” (e.g., we have known for years that grammatical challenge lowers articulation accuracy in children with articulation problems). Stuttering quite obviously does the last (as researchers at Purdue, such as Ann Smith) have robustly documented; the speech coordination of PWS is adversely affected when they are asked to produce more complex language targets (even in isolated phrases). Research also now suggests that PWS (both children and adults) do not seem to have language processing abilities that seem quite typical, even when listening to language (the work of Christine Weber-Fox at Purdue also is a good place to start).
Thus, stuttering seems to involve both speech and language function at some level, although this does not make it unique as research into communication disorders gets more sophisticated and people move away from trying to make disorders fit into neat cubby holes.
A deeper question is whether, in childhood, finding meaningful language, speech and fluency interactions can help us understand better how to assess more fully, treat more adequately, and predict which children will need specific help because their prognosis for chronic stuttering seems elevated. There is already emerging evidence to this effect from exciting work done to track CWS longitudinally in a number of research facilities.
I will end with what might appear to be a tangential observation, but I think it’s meaningful. A tendency to view stuttering as a speech disorder, IMHO, appears to encourage the view that it should be easily treatable (as in a query I got from a district coordinator of education services a few years back: “How come the kids who stutter never get off the caseload?” When I asked if she would ask the same question of children with language disorders, she seemed surprised, and said, “of course not. But the children with articulation disorders do, and stuttering is a speech disorder.” So, I think this question, as others indicate, is an important one, if only because thinking “categorically” may not be in the best interests of science or of policy, either.
Regards to all,
Nan Bernstein Ratner