stutter

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Classification according to ICD-10
F98.5 stutter
ICD-10 online (WHO version 2019)

Stuttering (also balbuties , from Latin balbutire , stuttering) is a disturbance of the flow of speech , which is characterized by frequent interruptions in the course of speech, by repetitions of sounds, syllables and words. Stuttering is characterized by the situation-dependent occurrence of the symptoms, whereby freedom from symptoms can often alternate with severe stuttering. Nervousness is not considered a trigger, but in some cases it can be a result of stuttering. This article deals with the so-called idiopathic stuttering ( English persistent developmental stuttering ), which is to be distinguished from stuttering with a known psychological or physical cause. According to new findings from linguists at Purdue University / USA, the disorder is not or not only based on a motor malfunction, but is also based on a different processing structure of the brain in stutterers. Stuttering is treatable (alleviation of symptoms), but not curable (removal of the cause).

phenomenology

Symptoms that can be observed from outside can be described as external symptoms, and symptoms that cannot be observed from outside as internal symptoms.

External symptoms

The external symptoms of stuttering are divided into primary and secondary symptoms. Primary symptoms represent the very core of the stuttering, while secondary symptoms are a - partly conscious - reaction to the primary symptoms.

The primary symptoms include:

  • rapid repetitions of sounds , syllables or words (also called clonic stuttering),
  • Lengthening of sounds (so-called stretching),
  • silent or audible blockages (also called tonic stuttering),
  • repeated interposed sounds for more than two seconds (so-called interjections).

The secondary symptoms include:

  • Avoidance behavior and
  • Escape behavior.

Avoidance behavior tries to avoid stuttering in advance by avoiding sounds, words, speaking situations and similar reactions. Often words that are perceived as difficult are replaced by synonyms or entire sentences are restructured. In contrast, escape behavior is intended to overcome primary symptoms that occur. Increased tension of the speech muscles or other muscles, also grimacing or jerky movements can be signs of escape behavior.

Inner symptoms

Inner symptoms are those that cannot be directly observed by the listener. These are negative feelings , thoughts, and attitudes that arise in response to stuttering. Common internal symptoms are fear , shame, and feelings of inferiority .

diagnosis

The diagnosis of stuttering is made when typical symptoms are significant to an extent. According to ICD-10 , stuttering should be diagnosed when symptoms such as repetitions and stretching of language elements and frequent pauses occur continuously or repeatedly, lead to a significant interruption in the flow of speech and the disorder lasts for at least three months.

When making a diagnosis, care should be taken to ensure that representative data on speech fluency are collected, as some clients speak more fluently in the diagnostic situation than in everyday situations. Therefore, the client or their relatives should be asked about the fluency of speech in everyday life. Sound recordings from everyday situations can also be helpful.

Differential diagnosis:

Stuttering must be distinguished from the following disorders:

  • Physiological lack of fluency: In children with fluids, it must be decided whether it is normal fluids (often incorrectly referred to as developmental stuttering) or pathological stuttering.
  • Rumble : A disorder of the fluency of speech characterized by an increased speed of speech and unclear pronunciation.
  • Acquired stuttering: A stuttering that can be traced back to a psychological or physical trauma or to a neurological illness, for example , is not stuttering in the ( idiopathic ) sense described here .

Epidemiology

The lifetime prevalence of stuttering is about five percent, the point prevalence in older children and adults about one percent. In children, the ratio of boys and girls is about 2: 1. The corresponding ratio in adults is 4: 1 to 5: 1. People with neurological diseases, such as epilepsy , are more likely to be affected.

Course and prognosis

Stuttering always begins before the age of twelve, in half of those affected between the ages of three and four, and in 90 percent before the age of six. The majority of stuttering children lose the disorder by puberty. Girls start stuttering earlier, but they are also more likely to lose it. After puberty, complete remission is unlikely or impossible. However, improvement with or without therapy can occur at any age.

root cause

The cause (medical: etiology ) of the stuttering has not been clarified. There are a variety of theories that try to explain the causes or development of stuttering. At this point in time, there is insufficient evidence for any of these theories.

The existing theories can be divided into psychodynamic, genetic, neuropsychological, breakdown and learning theories.

  • Psychodynamic theories assume that unconscious conflicts or goals, such as the goal of getting attention or care, lead to stuttering. One example is Theo Schoenaker's theory , which is based on Alfred Adler's individual psychology . In academic linguistics, psychodynamic theories are generally considered refuted.
  • Genetic theories assume an inherited disposition which makes the development of stuttering more likely. In twin studies, for example, it has been shown that the concordance is higher in identical twins than in dizygotic twins. Genetic theories cannot explain the entire phenomenon of stuttering.
  • Neuropsychological theories assume that the brain develops differently in stutterers than in normal speakers, from which stuttering results. For example, some studies have found that people who stutter have less pronounced lateralization of language processing than normal speakers. Neuropsychological studies are often correlative, which is why they do not allow a satisfactory interpretation of causal relationships.
  • Breakdown theories state that the resources for processing speech and speech in the case of stutterers do not meet the requirements, which leads to the breakdown of speech processing. These theories are supported by the fact that stutterers are more likely than normal speakers to have speech development disorders and other language disorders .
  • Learning theories explain the - especially secondary - symptoms through a combination of classical and operant conditioning . Classical conditioning explains the connection between primary stuttering and secondary behaviors: The repeated coupling of primary and secondary behaviors leads to the secondary behaviors being automatically triggered by the primary ones. Operant conditioning explains why avoidance behaviors are exhibited: Avoidance behaviors lead to decreased anxiety and are therefore increased , which increases the likelihood of such behavior.

therapy

history

The French doctor Marc Colombat de L'Isère (1797–1851) earned his first services in the development of a therapy .

General

A complete healing  - as absolute freedom from symptoms in all situations - is difficult or impossible to achieve in stuttering, especially in adulthood. Since stuttering is often a severe limitation for those affected, the many approaches that usually promise a cure within a few days are dubious. It is therefore advisable to seek independent advice from professionals who do not have commercial interests before starting therapy.

Modification Approach

This behavioral therapeutic approach is based on the assumption that stuttering is fundamentally incurable, since the basic neuronal structure of speech in an adult with its motor, psychogenic and sometimes neurotic influences is so pronounced that fundamental changes are impossible. The approach is therefore primarily aimed at adopting the stuttering way of speaking, living with it and learning to explicitly modify it. The procedure is based on behavioral therapy and includes aspects such as

This approach was developed at the University of Iowa in the 1930s. The main representative is the American Charles Van Riper (1905 to 1994), who can be regarded as one of the founders of speech-language pathology in the USA (academic profession with a degree from the Philosophical Faculty, therefore not to be compared with speech therapists , rather with clinical ones Speech scientists ). Much of his writings deal with the subject of stuttering.

Speech-technical approach

On the other hand, there is an approach which, with a view to borrowing from singing, breathing and vocal techniques, is aimed at learning a “new” way of speaking. Based on the observation that the majority of stutterers have no problems singing or speaking in a choir, more sonorous speaking, intonation, breathing technique and rhetorical aspects are practiced. The founders and advancers of this approach are Karl Hartlieb , Oscar Hausdörfer , Ronald Muirden , Erwin Richter , Rudolf Denhardt , PA Kreuels and Leonard del Ferro . An electronic language flow aid can possibly also be used.

Mental approach

With this predominantly mental (conceptual) method, which has its origins in competitive sports, speaking should be learned anew and naturally in an orderly manner without fear and the old stuttering structures should be learned over. By regularly reading and implementing the auto-suggestive and beneficial principles, the unconscious should be brought into the desired direction of individual and fluent speech. Roland Pauli is the founder of the Ropana method. Another method is the Hausdörfer technique, in which a person must strive to become phlegmatic .

Mobile applications

Stuttering treatment with mobile application

There are special mobile applications and PC programs for stuttering therapy . The purpose of applications of this type is to restore the language area - I say -> I listen -> I build the phrase -> I say etc. using various methods of stutter correction.

The user interacts with the application through modified acoustic feedback: speaks into the microphone of the headset and hears his own voice , which is processed by a certain method.

Among the methods of correcting stuttering in applications , the most common are:

  • Masking of the acoustic feedback ( MAF - Masking Auditory Feedback ). This is masked by " white noise " or sinusoidal noise of the user's own speech. Scientists believe that stutterers can speak better if they cannot hear their own language. This method is considered outdated and ineffective.
  • Delay of the acoustic feedback (engl. DAF - delayed auditory feedback ). This method assumes that there is a fraction of a second delay in sending the user's voice from the microphone to the headphones . The purpose of the method is to teach the stutterer to stretch vowels and decrease the speed of speech. After long delay speech correction, smaller delays are tuned in, which increases speech speed until it normalizes.
  • Change of the acoustic feedback frequency ( FAF - Frequency-shifted auditory feedback ). The method is to shift the frequency of the user's speech tone, which he cannot hear, compared to his own voice . The intervals of the shift can vary from a few semitones to half an octave . The methods of the DAF and the FAF are based on the observation that stutterers can read a text without errors if they speak it synchronously in a group - at least two people. If the stutterer's own speech is played back via headphones with a time delay of a few hundredths of a second and preferably also a frequency shift, this echo gives the affected person the impression that another person is speaking, which can make speaking easier.
  • Use of metronome and tempo correctors. This method implies the use of rhythmic beats of the metronome. The effectiveness of the method is due to the fact that the rhythm has a positive effect on the stuttering person, especially if he speaks at a slow pace.
  • Use of visual feedback. This method assumes that the speech parameters of the user (e.g. speaking speed) are defined and displayed as visual information on a screen. The main purpose of the method is to allow the user to manage the voice effectively by achieving the predetermined target parameters. It is assumed that during the process of pronunciation, the user will see a visual representation on the screen of both current and target parameters (e.g. speech speed). This method assumes that the speech parameters of the user (e.g. speech speed) Speech tempo) and is displayed as visual information on a screen. The main purpose of the method is to allow the user to manage the voice effectively by achieving the predetermined target parameters. It is assumed that during the process of pronunciation, the user will see on the screen a visual representation of both current and target parameters (e.g. speaking rate).
  • Use of ready-made or rhymed texts. The procedure assumes that reading specially prepared or rhymed texts helps a person to restore the flow of language and thus to eliminate the language circle breakdown.

The comparative properties of various mobile applications for treating stuttering are shown in the table below:

Comparative properties of mobile applications for the treatment of stuttering
LOGOPEDICS. ERGOTHERAPY. Stuttering Speech Therapy -

DAF logotherapy

Zaikanie.NET BREATHMAKER DAF

professional

MPiStutter axSoft

Speech corrector

Stamurai -

Stuttering /

Stammering

Treatment app

Speech woe Kekemelik Egzersizleri
operating system iOS Android Windows Windows Android

iOS

iOS Android

Windows

Android iOS Android
DAF + + + + + + + + +
FAF + + + + +
metronome + +
Vibro metronome +
Rhyme text + + + + +
Speech speed + + +
Showing facial expressions from the camera + +
timer + +
background

mode

+ + + + + + +

Further approaches

Many other therapies and therapeutic approaches focus on partial aspects such as breathing technique , use of voice and sound generation or work with aids such as hypnosis . However, experts are divided on the effectiveness of these approaches, although "cured" clients are repeatedly presented in the media.

public perception

World Stuttering Day

The "Stuttering Awareness Ribbon" (symbol of the annual online conference)

An international online conference of stutterers takes place from October 1st to October 22nd, ending with World Stuttering Day (October 22nd, 1998). The Stuttering Awareness Ribbon , a sea-green ribbon tied in a bow, has been the symbol of this event since 2009 . The aim of the initiatives is to draw the attention of those not affected to the problems of the stutterers; the color sea green stands for the calmness that stutterers experience when they find understanding.

Filmography

The 2010 feature film " The King's Speech " deals with the stuttering of King George VI. and a possible therapeutic approach.

In 2018 the documentary “My Stuttering” was released, which presents the topic from an internal perspective by focusing on the various people affected and their strategies with stuttering.

music

In his song MMM-Mädel , Mike Krüger praised himself and the fact that he stuttered when addressing women, Ben's Brother addressed stuttering in her song Stuttering in 2008 , as did Ganz Schön Feist in her speech therapist tango . Another performer who addressed stuttering in his songs was Scatman John, who died in 1999 .

Radio

There are three programs broadcast regularly by local radio stations across Germany that deal with the topic of stuttering and are moderated by stutterers. The first of these broadcasts was the stuttering radio on the station Freie Radio für Stuttgart . It is aimed at stuttering listeners and is intended as an organ within self-help. The program Schöner Stottern auf LORA Munich is deliberately aimed at a broader audience. Another program is called Holper Stolper and is broadcast on Radio free FM .

See also

literature

  • Ulrich Natke, Anke Alpermann: stuttering. Findings, theories, treatment methods. 3. Edition. Huber, Bern 2010, ISBN 978-3-456-84891-4 .
  • Wolfgang Wendlandt: Stuttering in Adulthood. Basic knowledge and practical aids for therapy and self-help. Thieme, Stuttgart 2009, ISBN 978-3-13-129031-1 .

Web links

Wiktionary: stuttering  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Peter Reuter: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 (Lemma stuttering).
  2. ↑ J. Benecken: On the psychopathology of stuttering. In: Practice of child psychology and child psychiatry. 2004, 9. pp. 623-636.
  3. ↑ Speech disorder - stuttering starts in the brain. In: Spiegel online . July 24, 2004, accessed October 22, 2012 .
  4. ↑ a b c M. Ptok, U. Natke, HM Oertle: Stuttering - Pathogenesis and Therapy. In: Deutsches Ärzteblatt, 18, A1216–1221.
  5. ^ DJ Stachelski: Information on stuttering.
  6. ↑ B. Hansen, C. Iven: Stuttering and speaking fluency. Speech and communication therapy with (pre-) school children who do not speak fluently. Munich / Jena 2002
  7. ↑ World Health Organization: International Classification of Mental Disorders. Diagnostic criteria for research and practice. Huber, Bern 2006, ISBN 3-456-84286-4 .
  8. ^ Claudia Spindler: Stuttering prevalence studies.
  9. ↑ Christine Michaela Busler: Stuttering, Modification Techniques and Therapy Options . Analysis of case studies from a linguistic perspective. In: Dissertation to obtain the degree of Doctor of Philosophy (Dr. phil.) Approved dissertation. 2002, accessed October 22, 2012 .
  10. ↑ Electronic Devices, Software and Apps ( en )
  11. ↑ Electronic Devices, Software and Apps ( en )
  12. Jump up ↑ J. Kalinowski, J. Armson, M. Roland-Mieszkowski, A. Stuart, VL Gracco: Effects of alterations in auditory feedback and speech rate on stuttering frequency . In: Language and Speech . 36 (Pt 1), 1993, ISSN  0023-8309 , p. 1-16 , doi : 10.1177 / 002383099303600101 , PMID 8345771 .
  13. ^ Adam Jacks, Katarina L. Haley: Auditory Masking Effects on Speech Fluency in Apraxia of Speech and Aphasia: Comparison to Altered Auditory Feedback . In: Journal of Speech, Language, and Hearing Research: JSLHR . 58, No. 6, 2015, ISSN  1092-4388 , pp. 1670-1686. doi : 10.1044 / 2015_JSLHR-S-14-0277 . PMID 26363508 . PMC 4987030 (free full text).
  14. ↑ Bryan D. Burke: Reduced auditory feedback and stuttering . In: Behavior Research and Therapy . 7, No. 3, September 1, 1969, ISSN  0005-7967 , pp. 303-308. doi : 10.1016 / 0005-7967 (69) 90011-4 .
  15. ^ Bothe Anne K., Finn Patrick, Bramlett Robin E .: Pseudoscience and the SpeechEasy: Reply to Kalinowski, Saltuklaroglu, Stuart, and Guntupalli (2007) . In: American Journal of Speech-Language Pathology . 16, No. 1, February 1, 2007, pp. 77-83. doi : 10.1044 / 1058-0360 (2007/010) .
  16. ↑ Luana Altran Picoloto, Ana Cláudia Vieira Cardoso, Amanda Venuti Cerqueira, Cristiane Moço Canhetti de Oliveira: Effect of delayed auditory feedback on stuttering with and without central auditory processing disorders . In: CoDAS . 29, No. 6, 7 December 2017, ISSN  2317-1782 , p. E20170038. doi : 10.1590 / 2317-1782 / 201720170038 . PMID 29236907 .
  17. ^ Joseph Kalinowski, Joy Armson, Andrew Stuart, Vincent L. Gracco: Effects of Alterations in Auditory Feedback and Speech Rate on Stuttering Frequency . In: Language and Speech . tape 36 , no. 1 , January 1993, ISSN  0023-8309 , pp. 1-16 , doi : 10.1177 / 002383099303600101 .
  18. ↑ Zimmerman Stephen, Kalinowski Joseph, Stuart Andrew, Rastatter Michael: Effect of Altered Auditory Feedback on People Who Stutter During Scripted Telephone Conversations . In: Journal of Speech, Language, and Hearing Research . 40, No. 5, October 1, 1997, pp. 1130-1134. doi : 10.1044 / jslhr.4005.1130 .
  19. ↑ Peter Howell, Stephen Davis, Jon Bartrip, Laura Wormald: Effectiveness of frequency shifted feedback at reducing disfluency for linguistically easy, and difficult, sections of speech (original audio recordings included) . In: Stammering research: an on-line journal published by the British Stammering Association . 1, No. 3, September 1, 2004, ISSN  1742-5867 , pp. 309-315. PMID 18418474 . PMC 2312336 (free full text).
  20. ↑ Rolf H. Latusseck: No more stuttering - thanks to the echo effect. In: welt.de. August 24, 2020, accessed April 16, 2020 .
  21. ^ John Paul Brady: Studies on the metronome effect on stuttering . In: Behavior Research and Therapy . 7, No. 2, May 1, 1969, ISSN  0005-7967 , pp. 197-204. doi : 10.1016 / 0005-7967 (69) 90033-3 .
  22. Jump up ↑ Daniel Hudock, Vikram N. Dayalu, Tim Saltuklaroglu, Andrew Stuart, Jianliang Zhang: Stuttering inhibition via visual feedback at normal and fast speech rates . In: International Journal of Language & Communication Disorders . tape 46 , no. 2 , March 2011, ISSN  1460-6984 , p. 169-178 , doi : 10.3109 / 13682822.2010.490574 , PMID 21401815 .
  23. ↑ Jennifer Chesters, Ladan Baghai-Ravary, Riikka Möttönen: The effects of delayed auditory and visual feedback on speech production . In: The Journal of the Acoustical Society of America . tape 137 , no. 2 , 2015, ISSN  0001-4966 , p. 873-883 , doi : 10.1121 / 1.4906266 , PMID 25698020 , PMC 4477042 (free full text).
  24. ↑ World Stuttering Day - October 22nd - one day, one topic. Federal Association of Stutterers Self-Help e. V., accessed on October 22, 2012 .
  25. ↑ My Stuttering (A 2018, Petra Nickel, Birgit Gohlke) .
  26. ↑ stuttering radio
  27. ↑ Radio freeFM