Methods of Treating Stuttering

Stuttering has existed in every era and civilization. For just as long, various specialists have been trying to find its causes and searching for ways to treat it.

Over the centuries, many theories about the origin of stuttering and many methods of treatment have been proposed. Hippocrates recommended moistening the tongue with wine. The great Greek orator Demosthenes walked along the beach speaking with pebbles in his mouth. Aurelius Cornelius Celsus, in the first century BCE, advised chewing onion, garlic, and mustard and washing the head with cold water. Erasmus Darwin, the stuttering grandfather of Charles Darwin, regularly practiced pronouncing difficult sounds. Later, stuttering was treated with silence, special diets, surgery, and homeopathy, but none of these methods gained widespread acceptance.

In the twentieth century, stuttering was considered primarily a psychogenic or neurological disorder. Accordingly, psychological and psychoanalytic approaches and pharmacotherapy were applied to resolve possible neurotic conflicts.

Pharmacological treatment of stuttering.

According to the literature, stuttering improves with some medications and worsens or appears with others. When considering pharmacological treatment of stuttering, it must be kept in mind that all medications are effective only while being taken and have side effects that prevent their long-term use. Over the past decade, specialists have reached a consensus that pharmacological therapy does not have a significant effect on speech and is not indicated for the treatment of stuttering.

Speech therapy.

At present, speech therapy remains the primary method of treating stuttering in both children and adults, having demonstrated its effectiveness over decades. Speech therapy varies in content and program, but some of its techniques are used by nearly all specialists.

Slowed speech. The most widely used technique proven to be effective is slow speech. By reducing the number and intensity of speech spasms, it gives a person additional time to construct an utterance.

Rhythmic speech. It has been demonstrated that many people who stutter speak more fluently when reading aloud or performing spontaneous speech tasks if they synchronize their speech with the rhythm of a metronome. The metronome tempo can be controlled by the clinician and adjusted according to the person's rate of speech. For people who stutter, a slower metronome tempo allows them to control their rate of speech and, in turn, improves fluency. This technique has proven its effectiveness and has been used in clinical practice for several centuries.

What to Do If Your Child Has Started Stuttering.

Assisted speech: loud, slow, inhale through the nose. Begin speaking with your child slowly (at a rate of approximately 2–3 syllables per second), clearly and distinctly. If your child wants to spontaneously say something to you, try to anticipate what they want to say and finish the word or sentence together with them. If it did not work out — if they stuttered — repeat that word again and again together until it comes out right. If you cannot guess what they are trying to say, simply imitate speech together. As a rule, choral speech is fluent, or becomes fluent within a few seconds. Speaking in unison with someone is one of the preserved forms of speech. This technique is used both in stuttering treatment and during psychotherapy sessions with adults.

A hypnotist brings 10–20 people who stutter up onto a stage and spends 1–2 hours convincing them, through various techniques and gestures, that he is about to cure them all. After his magical passes, as proof of the cure, he asks everyone to say the word "WE" loudly in unison. This works because, first, it is echoed speech — everyone is repeating a word they have already heard; second, it is choral speech, in which the likelihood of stuttering is minimal; third, it is a short, easy word with a labial consonant; and fourth, by the end of the session everyone has come to believe they are already cured. As a result, almost everyone says it fluently! Inspired by this success, the group repeats the hypnotist's words in chorus: "WE CAN," then "WE CAN SPEAK." After the session, many are left with the belief that they no longer stutter, and so there is no fear of speaking — which is responsible for a significant portion of the muscle spasms. People speak more freely, more easily. But as a rule, after some time they notice they are still stuttering and speech returns to its previous level. Repeat sessions no longer produce the same effect.

Many times throughout the day, ask your child questions, answer them yourself, and then repeat the answer together until your child can say it fluently.

Before every utterance, take a deep, slow breath through the nose (lasting 2–3 seconds) and begin speaking immediately after the inhale. This will help eliminate muscle cramps and spasms that occur during inhalation.

Speak to your child loudly, encouraging them to speak just as loudly. By tensing the vocal cords, you reduce pathological muscle activity in the throat and on the vocal cords.

Repetition. Depending on the severity of the stuttering, your child may be able to repeat a given unit of speech — a sound, a syllable, a word, 2 words, 3, 4, 5 — without stuttering. Choose the unit they can repeat fluently on the second or third try, and repeat that syllable or word together until it comes out smoothly.

In this context, repetition serves as negative reinforcement of stuttering.

Progress depends on the child's age, the severity, and the duration of the stuttering. Positive changes in speech occur in proportion to the percentage of disfluent speech you are correcting to fluent. Correcting 50%–60% of all speech output may produce no change, but will at least prevent the stuttering from progressing. At 70%–80% correction, speech may gradually improve to a level where the stuttering is barely noticeable to others. Correcting 90%–100% leads to noticeable improvement, and if continued, the stuttering will gradually disappear.

If all of this seems difficult, do at least something, even occasionally — this will put a barrier in the way of the stuttering's development. Correct your child's speech at least periodically; ask them to repeat things more loudly and more slowly. Do what you can, because stuttering tends to worsen after every stress and after every illness.

The most severe stuttering I ever observed was in L., an elderly woman. The first time I heard her was over the phone. "Hello!" In response I heard strange, guttural sounds — more like something an animal would make than a human being. I thought it was a wrong number or a prank and hung up. The call and the sounds came again, and this time I waited. After a while, following those sounds, a woman with extremely severe stuttering asked to meet with me. She came to see me at the institute; it turned out that the granddaughter of her friend had recently been treated by me, and she had come simply to talk. Before each phrase, she would spend 5–8 seconds making wave-like movements with her body and producing monotone sounds, and then she would begin to speak with the most severe stuttering I had ever witnessed. It turned out that from the moment she began to stutter, her mother had always reassured her that this was not her problem but the problem of those around her. "Speak however you can — let them wait and listen." She had never been ashamed of her stuttering, had defended two dissertations, had become a Doctor of Chemical Sciences, and had presented at academic councils and conferences. "Speak however you can — let them wait and listen." If not for that advice, perhaps she would have tried to speak using her best speech; perhaps she would have tried to change her tempo, her rhythm, or something else. She did not want treatment, as she was already well on in years, was no longer working, and had little social contact. I talked to her about the nature of stuttering, about treatment, while she sat and listened, with tears running down her face. She was imagining what her life might have been like with normal speech. We all know of people who tell of how they used to stutter and how they recovered. Those I met in my own life said they had recovered on their own, through their work. What their stories had in common was that they had found themselves in an environment where they needed to speak a great deal and speak well — where they were too embarrassed to stutter — in a newspaper editorial office, a news agency, a hospital reception desk. By their account, they tried to speak using their best speech and gradually the stuttering disappeared. Of course, all of this applies to mild, manageable stuttering — the kind where a person can say the same phrase a second time without stuttering. In severe stuttering, the person has no control over it. Then one needs to do special excercises and work with a specialist.