Stuttering Types and Treatments

Acquired Neurogenic Stuttering (ANS)

  • Onset: Typically after childhood.
  • Causes:
    • Stroke
    • TBI (Traumatic Brain Injury)
    • Drug toxicity
    • Parkinson's disease

Subgroups of Acquired Neurogenic Stuttering

  • Dysarthric Stuttering:
    • Associated with conditions like Parkinson's disease.
    • Related to the way a person speaks due to the degenerative disease.
  • Apraxic Stuttering:
    • Likely due to issues in basic motor planning.
  • Dysnomic Stuttering:
    • Usually accompanies aphasia.
    • Dysnomia: Difficulty with word retrieval, leading to fillers and incorrect word usage.

Other Causes of Stuttering

  • Stress or injuries in the military
  • Sudden onset due to PTSD or TBI

Behaviors

  • Initial syllable or whole word repetitions
  • Prolongations
  • Tensions with facial grimacing
  • Articulatory posturing
  • Blocking before a sound occurs
  • Medication-Induced Stuttering: Some medications (e.g., for epilepsy) can induce stuttering.

Functional Stuttering

  • Onset in teen years or later (rare in children).
  • Occurs after prolonged stress or traumatic events.
  • Behaviors are not deliberate but similar to developmental stuttering:
    • Repetitions
    • Prolongations
    • Blocks
    • Unusual secondary behaviors
  • Possibility of rapid response to treatment with trial therapy.
  • No comorbidity with aphasia, dysarthria, or apraxia of speech.

Malingering

  • Not true stuttering.
  • Used to gain attention or for some motive (e.g., medication, qualification).
  • Characteristics:
    • Similar to developmental stuttering but scheduled and intentional.
    • Inconsistencies in stuttering.
    • Improved eye contact.
    • More common in adults.

Cluttering

  • Speaking rate: Not continuously rapid but has sudden impulsive bursts with misarticulations.
  • Accompanied by concomitants:
    • Distractibility
    • Hyperactivity
    • Learning difficulties
    • Articulation problems
    • Auditory processing difficulties.
  • Common in individuals with ADHD or specific learning disabilities.
  • Can be accompanied by stuttering; requires distinguishing between core behaviors and cluttering behaviors through speech analysis.

Treatment for ANS

  • Behavioral treatments:
    • Pacing: Speaking one syllable at a time.
    • External movements: Finger taps for tactile feedback.
    • Neurosurgery: Implantation of electrodes to stimulate the thalamus.
    • Medications: Some medications may have positive effects, as seen in developmental stuttering.
  • Considerations:
    • Severity: Is treatment necessary for mild cases?
    • Other neurological problems (e.g., dementia): Will they interfere with treatment progress?

Treatment for Functional Stuttering

  • Trial therapy can be successful.
  • Controlled fluency: Speaking slowly and fluently (about 40 syllables per minute), gradually increasing the rate.
  • Fluency enhancing strategies:
    • Easy onset
    • Light contacts
    • Easy repetitions
    • These strategies aim to ease the entry into words and make stuttering easier.

Treatment for Malingering

  • No direct treatment for stuttering since it is not genuine.
  • Comprehensive assessment is crucial to confirm.
    • Develop a trusting relationship.
    • Obtain and analyze a speech sample.
    • Gather a full case history.
    • Interview friends and family.
    • Look for inconsistencies and details that do not align with developmental stuttering.
    • Severe stuttering (over 45% of syllables) with good eye contact can raise suspicion.

Treatment for Cluttering

  • Increase the client’s awareness of their rate and ability to decrease it.
  • Improve linguistic skills:
    • Increase rate and awareness: Simulate speaking rates with motor movements (arm or leg), pacing with music, teaching phrasing, and pausing.
    • Improve linguistic skills: Chunk and sequence thoughts, verbally express them, use structured skits for turn-taking.