Young children who stutter may be more emotionally sensitive and have greater difficulty regulating their feelings than children who don't have the common speech problem, according to a new study by Vanderbilt University researchers. Some experts say the finding may offer new clues to treating the frustrating and sometimes disabling disorder.
Stuttering, characterized by the repetition or prolongation of words or the inability to start saying a word, affects about 3 million Americans and usually surfaces between the ages of 2 and 5. For reasons that are not well understood, the problem usually disappears by late childhood, especially in those who begin stuttering before their third birthdays. But in other cases, stuttering can persist into adulthood, causing serious social problems.
There is no cure for stuttering; the most effective treatment involves speech therapy, which can last a few sessions or for years, depending on the severity and duration of the problem. Early intervention is believed to shorten both. Unlike some other speech problems, stuttering often waxes and wanes and can worsen in certain situations, such as public speaking.
Scientists believe that the speech problem has a strong genetic component -- about 60 percent of stutterers have an affected family member -- and that it is three or four times more common in males. Those affected include actors James Earl Jones, Marilyn Monroe, Bruce Willis and Nicholas Brendon, singer Carly Simon, author John Updike, Rep. Frank Wolf (R-Va.), basketball star Kenyon Martin and basketball Hall of Famer Bill Walton, according to the nonprofit Stuttering Foundation, an advocacy group.
While researchers and clinicians have long suspected that stress and other emotional factors can influence stuttering, the federally funded Vanderbilt study, published in the Journal of Communication Disorders, is one of the first to demonstrate a link.
"Parents and teachers are not to blame for stuttering," said speech pathologist Edward Conture, one of the study's authors and an internationally respected expert on stuttering. "What we're trying to find out is how emotions contribute to its onset and development in children."
Emotional factors, he said, have received little scrutiny.
Much of the research in the field has focused on speech mechanics and physiology, researchers say.
Conture and his co-author, developmental psychologist Tedra Walden, emphasize that their study did not find that emotional factors cause stuttering, only that there was an association with emotional reactivity in the 111 preschoolers studied.
Jane Fraser, president of the Stuttering Foundation, expressed skepticism about the apparent link with emotions. In the not-too-distant past, she noted, the disorder was attributed to psychological trauma, inferior intelligence or bad parenting; studies have disproven all these theories, she said.
"It's so hard to talk about this problem without getting immersed in causality," Fraser noted. Emotions "are a contributing factor but a minor one" when compared with genetics or neurological factors.
Other experts were more enthusiastic about the results.
"I think it's a great study," said Vivian Sisskin, a speech pathologist at the University of Maryland at College Park, who for more than 25 years has worked with children and adults who stutter. Often, she said, parents have told her that their stuttering child is a highly sensitive perfectionist; the study, she said, is a scientific affirmation of a widely observed phenomenon.
"This is good research that provides insight into ways to support the whole child," said Kathleen Whitmire, director of school services and speech language pathology at the American Speech-Language-Hearing Association in Bethesda. But she added that because the children were not assessed before the onset of the disorder, it's hard to determine the relationship between emotions and stuttering.
Speech therapy for young children costs about $50 to $100 per session and may not be covered by insurance. It typically focuses on practice exercises designed to smooth speech and to help model proper sounds; parents are taught to do the same and to provide positive reinforcement.
To test the hypothesis that stutterers tend to be more reactive, the team led by Conture and Walden asked parents of 65 children between 3 and 5 who stutter to complete a standardized and widely used behavioral questionnaire about their child's reactions to various situations and the ease with which they refocused their attention.
Parents of 56 children who do not stutter completed the same inventory. Researchers assessed all children's language abilities.
Conture said that an analysis of the two groups yielded statistically significant differences in three areas: Stutterers were about 25 percent more reactive than non-stutterers and 25 percent less able to regulate their reactions to everyday situations. They were 33 percent less able to refocus their attention when aroused -- such as if another child grabbed a toy they were playing with -- and were more likely to become fixated on the situation.
Future studies, said Conture, will more precisely quantify those differences using brain wave monitoring and other measurements independent of parental reports.
Christina Dietrich of Arlington, whose nearly-4-year-old son is in speech therapy with Sisskin to treat his moderate stutter, says the findings describe her son.
"He's very easily frustrated and he has a short fuse," she said. "He's definitely an emotional boy," and his speech problem worsens when he is upset or agitated.
Barry Guitar, a professor of communication sciences at the University of Vermont, said he thought the Vanderbilt study might help answer one of the questions he hears most often as a speech pathologist: Why does the problem ebb and flow unpredictably?
Conture and Walden say that it is not just negative emotions such as anxiety that produce stronger emotional reactions in stutterers, but that the same effect is seen when a child is excited.
Some parents he works with, Guitar said, have long been puzzled about why their child seems to speak well for months, only to have problems around, say, the Christmas holidays when all the relatives are around. "Parents have told me they felt so guilty about this and couldn't figure it out," he said. "It may just be that they have an inherently reactive kid." ?
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