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63-405: Stuttering , also known as stammering , is a speech disorder characterized externally by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses called blocks in which the person who stutters is unable to produce sounds. According to adults who stutter, however, stuttering is defined as a "constellation of experiences" expanding beyond

126-519: A burning coal in his mouth had caused him to be "slow and hesitant of speech" (Exodus 4, v.10). Galen 's humoral theories were influential in Europe in the Middle Ages for centuries afterward. In this theory, stuttering was attributed to an imbalance of the four bodily humors —yellow bile, blood, black bile, and phlegm. Hieronymus Mercurialis , writing in the sixteenth century, proposed to redress

189-566: A category of family members that largely overlaps with the term nuclear family , but without spouses. If the persons are related by blood , the first degree relatives share approximately 50% of their genes. First-degree relatives are a common measure used to diagnose risks for common diseases by analyzing family history. A second-degree relative (SDR) is someone who shares 25% of a person's genes. It includes uncles , aunts , nephews , nieces , grandparents , grandchildren , half-siblings and double-first cousins. Third-degree relatives are

252-411: A coefficient of r = 2 = 0.1%. If follows that the value of r can be given to an accuracy of a few percent if the family tree of both individuals is known for a depth of five generations, and to an accuracy of a tenth of a percent if the known depth is at least ten generations. The contribution to r from common ancestors of 20 generations ago (corresponding to roughly 500 years in human genealogy, or

315-483: A common ancestor and may not pass through a common ancestor to a common ancestor's ancestor), and L(p) is the length of the path p . To give an (artificial) example: Assuming that two individuals share the same 32 ancestors of n = 5 generations ago, but do not have any common ancestors at four or fewer generations ago, their coefficient of relationship would be Individuals for which the same situation applies for their 1024 ancestors of ten generations ago would have

378-490: A family history of stuttering. There is evidence that stuttering is more common in children who also have concurrent speech, language, learning or motor difficulties. For some people who stutter, congenital factors may play a role. In others, there could be added impact due to stressful situations. However there is not evidence to suggest this as a cause. Less common causes of stuttering include neurogenic stuttering (stuttering that occurs secondary to brain damage, such as after

441-446: A negative self-concept and self-image. People who stutter may project their own attitudes onto others, believing that the others think them nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program. The impact of discrimination against stuttering can be severe. This may result in fears of stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being

504-520: A possible target of bullying or discrimination, or feeling pressured to hide stuttering. In popular media, stuttering is sometimes seen as a symptom of anxiety, but there is no direct correlation in that direction. Alternatively, there are those who embrace stuttering pride and encourage other stutterers to take pride in their stutter and to find how it has been beneficial for them. Stuttering can co-occur with other disabilities. These associated disabilities include: The cause of developmental stuttering

567-536: A segment of the extended family and includes first cousins, great-grandparents and great-grandchildren. Third-degree relatives are generally defined by the expected amount of genetic overlap that exists between two people, with the third-degree relatives of an individual sharing approximately 12.5% of their genes. The category includes great-grandparents, great-grandchildren, granduncles, grandaunts, grandnephews, grandnieces, first cousins, half-uncles, half-aunts, half-nieces and half-nephews. Most incest laws concern

630-679: A shared forum within which they can access resources and support from others facing the same challenges of stuttering. Among ages 3–5, the prognosis for spontaneously recovery is about 65% to 87.5%. By 7 years of age or within the first two years of stuttering, and about 74% recover by their early teens. In particular, girls are shown to recover more often. Prognosis is guarded with later age of onset: children who start stuttering at age 3½ years or later, and/or duration of greater than 6–12 months since onset, that is, once stuttering has become established, about 18% of children who stutter after five years recover spontaneously. Stuttering that persists after

693-541: A significant negative cognitive and affective impact on the person who stutters. Joseph Sheehan described this in terms of an analogy to an iceberg, with the immediately visible and audible symptoms of stuttering above the waterline and a broader set of symptoms such as negative emotions hidden below the surface. Feelings of embarrassment , shame , frustration , fear , anger , and guilt are frequent in people who stutter, and may increase tension and effort. With time, continued negative experiences may crystallize into

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756-484: A specific language impairment are likely to be diagnosed, whereas only 4% of the population overall is likely to be diagnosed. There are also language disorders that are known to be genetic, such as hereditary ataxia, which can cause slow and unclear speech. Many of these types of disorders can be treated by speech therapy , but others require medical attention by a doctor in phoniatrics . Other treatments include correction of organic conditions and psychotherapy . In

819-915: A speech disfluency exists, and (2) assess if its severity warrants concern for further treatment. During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech ( Riley's Stuttering Severity Instrument Fourth Edition (SSI-4) ). They might also employ

882-871: A speech disorder can be targets of bullying because of their disorder. This bullying can result in decreased self-esteem . Religion and culture also play a large role in the social effects of speech disorders. For example, in many African countries like Kenya cleft palates are largely considered to be caused by a curse from God. This can cause people with cleft palates to not receive care in early childhood, and end in rejection from society. For those with speech disorders, listeners reactions are often negative, which may correlate negative effects to self-esteem. It has also been shown that adults tend to view individuals with stutters in more negative ways than those without them. Language disorders are usually considered distinct from speech disorders, although they are often used synonymously. Speech disorders refer to problems in producing

945-488: A stroke) and psychogenic stuttering (stuttering related to a psychological condition). Auditory processing deficits were proposed as a cause of stuttering due to differences in stuttering for deaf or Hard of Hearing individuals, as well as the impact of auditory feedback machines on some stuttering cases. Some possibilities of linguistic processing between people who stutter and people who do not has been proposed. Brain scans of adult stutterers have found greater activation of

1008-533: A stutter can lead people who stutter to react in different ways including behavioral and cognitive reactions. Some behavioral reactions can manifest outwardly and be observed as physical tension or struggle anywhere in the body. Almost 80 million people worldwide stutter, about 1% of the world's population. Stuttering is not connected to the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress do not cause stuttering, but they may trigger increased stuttering in people who have

1071-424: A test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future. Stuttering is a multifaceted, complex disorder that can impact an individual's life in

1134-472: A variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of

1197-416: Is a normal part of speech development and temporarily present in preschool-aged children who are learning to speak. "Developmental stuttering" is stuttering that has on onset in early childhood, i.e. when a child is learning to speak. About 5-7% of children are said to stutter during this period. Despite its name, the onset itself is often sudden. This type of stutter may persists after the age of seven, which

1260-438: Is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback are not effective with the acquired type. Finally, "psychogenic stuttering", which is less than 1% of all stuttering conditions, may also arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous:

1323-411: Is classified as "persistent stuttering". "Neurogenic stuttering" (stuttering that occurs secondary to brain damage, such as after a stroke) and "psychogenic stuttering" (stuttering related to a psychological condition) are less common and classified separately from developmental. "Neurogenic stuttering" typically appears following some sort of injury or disease to the central nervous system. Injuries to

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1386-535: Is complex. It is thought to be neurological with a genetic factor. Various hypotheses suggest multiple factors contributing to stuttering. There is strong evidence that stuttering has a genetic basis. Children who have first-degree relatives who stutter are three times as likely to develop a stutter. In a 2010 article, three genes were found by Dennis Drayna and team to correlate with stuttering: GNPTAB , GNPTG , and NAGPA . Researchers estimated that alterations in these three genes were present in 9% of those who have

1449-418: Is known to be a higher incidence of apraxia of speech , which is a disorder affecting neurological pathways involved with speech. Poor motor function is also suggested to be highly associated with speech disorders, especially in children. Hereditary causes have also been suggested, as many times children of individuals with speech disorders will develop them as well. 20-40% individuals with a family history of

1512-492: Is no cure for stuttering, several treatment options exist and the best option is dependent on the individual. Therapy should be individualized and tailored to the specific and unique needs of the client. The speech–language pathologist and the client typically work together to create achievable and realistic goals that target communication confidence, autonomy, managing emotions and stress related to their stutter, and working on disclosure. Self-help groups provide people who stutter

1575-426: Is present in every culture and in every race, although the attitude towards the actual prevalence differs. Some believe stuttering occurs in all cultures and races at similar rates, about 1% of general population (and is about 5% among young children) all around the world. A US-based study indicated that there were no racial or ethnic differences in the incidence of stuttering in preschool children. Different regions of

1638-423: Is represented as Φ ij . The kinship coefficient between a non-inbred individual and itself, Φ ii , is equal to 1/2. This is due to the fact that humans are diploid , meaning the only way for the randomly chosen alleles to be identical by descent is if the same allele is chosen twice (probability 1/2). Similarly, the relationship between a parent and a child is found by the chance that the randomly picked allele in

1701-407: Is the ability to speak two languages. Many bilingual people have been exposed to more than one language since birth and throughout childhood. Since language and culture are relatively fluid factors in a person's understanding and production of language, bilingualism may be a feature that impacts speech fluency. There are several ways during which stuttering may be noticed in bilingual children including

1764-527: The coefficients of inbreeding for A and O, respectively. The coefficient of relationship r B C {\displaystyle r_{BC}} is now obtained by summing over all path coefficients: By assuming that the pedigree can be traced back to a sufficiently remote population of perfectly random-bred stock ( f A = 0 for all A in the sum) the definition of r may be simplified to where p enumerates all paths connecting B and C with unique common ancestors (i.e. all paths terminate at

1827-450: The probability that a pair of randomly sampled homologous alleles are identical by descent . More simply, it is the probability that an allele selected randomly from an individual, i, and an allele selected at the same autosomal locus from another individual, j, are identical and from the same ancestor. The coefficient of relatedness is equal to twice the kinship coefficient. The kinship coefficient between two individuals, i and j,

1890-649: The United States, school-age children with a speech disorder are often placed in special education programs. Children who struggle to learn to talk often experience persistent communication difficulties in addition to academic struggles. More than 700,000 of the students served in the public schools' special education programs in the 2000–2001 school year were categorized as having a speech or language impairment. This estimate does not include children who have speech and language impairments secondary to other conditions such as deafness". Many school districts provide

1953-431: The age of seven is classified as persistent stuttering, and is associated with a much lower chance of recovery. The lifetime prevalence , or the proportion of individuals expected to stutter at one time in their lives, is about 5–6%, and overall males are affected two to five times more often than females. As seen in children who have just begun stuttering, there is an equivalent number of boys and girls who stutter. Still,

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2016-484: The body. These could range anywhere from tension in the head and neck, behaviors such as snapping or tapping, or facial grimacing. These behavioral reactions are those that might not be apparent to listeners and only be perceptible to people who stutter. Some people who stutter exhibit covert behaviors such as avoiding speaking situations, substituting words or phrases when they know they are going to stutter, or use other methods to hide their stutter. Stuttering could have

2079-419: The brain and spinal cord, including cortex, subcortex, cerebellum, and even the neural pathway regions. It may also be called "acquired stuttering" and it may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and

2142-432: The contribution from common descent from a medieval population) falls below one part-per-million . The coefficient of relationship is sometimes used to express degrees of kinship in numeric terms in human genealogy . In human relationships, the value of the coefficient of relationship is usually calculated based on the knowledge of a full family tree extending to a comparatively small number of generations, perhaps of

2205-593: The danger of bleeding to death and their failure to stop stuttering. Less drastically, Jean Marc Gaspard Itard placed a small forked golden plate under the tongue in order to support "weak" muscles. Italian pathologist Giovanni Morgagni attributed stuttering to deviations in the hyoid bone , a conclusion he came to via autopsy . Blessed Notker of St. Gall ( c.  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,"

2268-466: The external disfluencies that are apparent to the listener. Much of the experience of stuttering is internal and encompasses experiences beyond the external speech disfluencies, which are not observable by the listener. The moment of stuttering often begins before the disfluency is produced, described as a moment of "anticipation" - where the person who stutters knows which word they are going to stutter on. The sensation of losing control and anticipation of

2331-413: The following. It was once believed that being bilingual would 'confuse' a child and cause stuttering, but research has debunked this myth. Stuttering may present differently depending on the languages the individual uses. For example, morphological and other linguistic differences between languages may make presentation of disfluency appear to be more or less depending on the individual case. Because of

2394-465: The imbalance by changes in diet, reduced libido (in men only), and purging . Believing that fear aggravated stuttering, he suggested techniques to overcome this. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century. Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman emperor Claudius was initially shunned from

2457-408: The individual and information about the individual's background, through a case history. The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents. The overall goal of assessment for the SLP will be (1) to determine whether

2520-426: The influence of the works of Wendell Johnson , who claimed that the onset of stuttering was connected to the cultural expectations and the pressure put on young children by anxious parents, which has since been debunked. Later studies found that this claim was not supported by the facts, so the influence of cultural factors in stuttering research declined. It is generally accepted by contemporary scholars that stuttering

2583-452: The magnitude and type of a speech disorder and the proper treatment or therapy: In some cases the cause is unknown. However, there are various known causes of speech impairments, such as hearing loss , neurological disorders , brain injury , an increase in mental strain, constant bullying, intellectual disability , substance use disorder , physical impairments such as cleft lip and palate , and vocal abuse or misuse. After strokes, there

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2646-471: The neurotransmitter dopamine . It was once thought that forcing a left-handed student to write with their right-hand caused stuttering due to bias against left-handed people , but this myth died out. Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a licensed speech–language pathologist (SLP). Diagnosis of stuttering employs information both from direct observation of

2709-464: The order of three or four. As explained above, the value for the coefficient of relationship so calculated is thus a lower bound, with an actual value that may be up to a few percent higher. The value is accurate to within 1% if the full family tree of both individuals is known to a depth of seven generations. A first-degree relative (FDR) is a person's parent (father or mother), sibling (brother or sister) or child (son or daughter). It constitutes

2772-414: The parents approaches a value of 1, expressed as a percentage, and approaches a value of 0 for individuals with arbitrarily remote common ancestors. The coefficient of relationship ( r {\displaystyle r} ) between two individuals B and C is obtained by a summation of coefficients calculated for every line by which they are connected to their common ancestors . Each such line connects

2835-472: The person by the speaking situation. Demands may be increased by internal factors or inadequate language skills or external factors. In stuttering, severity often increases when demands placed on the person's speech and language system increase. However, the precise nature of the capacity or incapacity has not been delineated. Stress, or demands, can impact many disorders without being a cause. Another theory has been that adults who stutter have elevated levels of

2898-400: The public eye and excluded from public office. In and around eighteenth and nineteenth century Europe, surgical interventions for stuttering were recommended, including cutting the tongue with scissors, removing a triangular wedge from the posterior tongue, and cutting nerves, or neck and lip muscles. Others recommended shortening the uvula or removing the tonsils . All were abandoned due to

2961-422: The relationships where r = 25% or higher, although many ignore the rare case of double first cousins. Some jurisdictions also prohibit sexual relations or marriage between cousins of various degree, or individuals related only through adoption or affinity . Whether there is any likelihood of conception is generally considered irrelevant. The kinship coefficient is a simple measure of relatedness, defined as

3024-404: The right hemisphere, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed. The 'capacities and demands model' has been proposed to account for the heterogeneity of the disorder. Speech performance varies depending on the 'capacity' that the individual has for producing fluent speech, and the 'demands' placed upon

3087-480: The sex ratio appears to widen as children grow: among preschoolers, boys who stutter outnumber girls who stutter by about a two to one ratio, or less. This ratio widens to three to one during first grade, and five to one during fifth grade, as girls have higher recovery rates. the overall prevalence of stuttering is generally considered to be approximately 1%. Cross-cultural studies of stuttering prevalence were very active in early and mid-20th century, particularly under

3150-411: The sounds of speech or with the quality of voice, where language disorders are usually an impairment of either understanding words or being able to use words and do not have to do with speech production. First-degree relative The coefficient of relationship is a measure of the degree of consanguinity (or biological relationship) between two individuals. The term coefficient of relationship

3213-473: The speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)). Clinical psychologists with adequate expertise can also diagnose stuttering per the DSM-5 diagnostic codes. The DSM-5 describes "Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However,

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3276-565: The specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms fluency and disfluency . Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies"). This type of disfluency

3339-801: The speech disorder, and living with a stigmatized disability can result in anxiety and high allostatic stress load . Neither acute nor chronic stress, however, itself creates any predisposition to stuttering. The disorder is variable , which means that in certain situations the stuttering might be more or less noticeable, such as speaking on the phone or in large groups. People who stutter often find that their stuttering fluctuates, sometimes at random. Common stuttering behaviors are observable signs of speech disfluencies, for example: repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. People who stutter may have reactions, avoidance behaviors, or secondary behaviors related to their stuttering that may look like struggle and tension in

3402-441: The students with speech therapy during school hours, although extended day and summer services may be appropriate under certain circumstances. Patients will be treated in teams, depending on the type of disorder they have. A team can include speech–language pathologists , specialists, family doctors, teachers, and family members. Having a speech disorder can have negative social effects, especially among young children. Those with

3465-452: The stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker. Other disorders with symptoms resembling stuttering, or associated disorders include autism , cluttering , Parkinson's disease , essential tremor , palilalia , spasmodic dysphonia , selective mutism , and apraxia of speech . While there

3528-444: The throat and his face turned purple" and that "born with a stutter and a lisp , both caused in large measure by a defect in his palate, Churchill was at first seriously hampered in his public speaking. It is characteristic of the man's perseverance that, despite his staggering handicap, he made himself one of the greatest orators of our time." Speech disorder There are three different levels of classification when determining

3591-405: The two individuals via a common ancestor, passing through no individual which is not a common ancestor more than once. A path coefficient between an ancestor A and an offspring O separated by n {\displaystyle n} generations is given as: where f A {\displaystyle f_{A}} and f O {\displaystyle f_{O}} are

3654-448: The unusual-sounding speech that is produced and the behaviors and attitudes that accompany a stutter, it has long been a subject of scientific interest and speculation as well as discrimination and ridicule. People who stutter can be traced back centuries to Demosthenes , who tried to control his disfluency by speaking with pebbles in his mouth. The Talmud interprets Bible passages to indicate that Moses also stuttered, and that placing

3717-639: The world are researched unevenly. The largest number of studies has been conducted in European countries and in North America, where the experts agree on the mean estimate to be about 1% of the general population. African populations, particularly from West Africa, might have the highest stuttering prevalence in the world—reaching in some populations 5%, 6% and even over 9%. Many regions of the world are not researched sufficiently, and for some major regions there are no prevalence studies at all. Bilingualism

3780-463: Was born and grew up with a stutter" in her 1941 book I was Winston Churchill's Private Secretary . She related one example, "'It's s-s-simply s-s-splendid,' he stuttered—as he always did when excited." Louis J. Alber, who helped to arrange a lecture tour of the United States, wrote in Volume 55 of The American Mercury (1942) that "Churchill struggled to express his feelings but his stutter caught him in

3843-431: Was defined by Sewall Wright in 1922, and was derived from his definition of the coefficient of inbreeding of 1921. The measure is most commonly used in genetics and genealogy . A coefficient of inbreeding can be calculated for an individual, and is typically one-half the coefficient of relationship between the parents. In general, the higher the level of inbreeding the closer the coefficient of relationship between

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3906-499: Was invoked against stammering. A royal Briton who stammered was King George VI . He went through years of speech therapy, most successfully under Australian speech therapist Lionel Logue , for his stammer. The Academy Award-winning film The King's Speech (2010) in which Colin Firth plays George VI, tells his story. The film is based on an original screenplay by David Seidler , who also stuttered until age 16. Another British case

3969-445: Was that of Prime Minister Winston Churchill . Churchill claimed, perhaps not directly discussing himself, that "[s]ometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience ..." However, those who knew Churchill and commented on his stutter believed that it was or had been a significant problem for him. His secretary Phyllis Moir commented that "Winston Churchill

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