Stuttering most often appears in childhood during the establishment of language. It affects three to four times more male subjects. Admittedly, in about 75% of cases, the disorders declared in childhood will not persist into adulthood. But what about the others? While some stutterers manage to conceal their disorder at the cost of exhausting avoidance strategies, all agree on the importance of early treatment to demystify a still poorly understood social handicap that can cause laughter, embarrassment, or even the rejection.
Repetitions of words and syllables, prolongations of sounds, frequent or inappropriate use of supporting words such as “bon”, “ben” and “en fait” are all manifestations that can appear alone or in combination, and make one think of a strictly mechanical problem disturbing the different stages of articulated language. Starting with an excess of tone in the muscles of the larynx, which paralyze and block the sounds at the level of the vocal cords, or even the muscles of the lips which contract and make, it seems, the sounds stumble as on an obstacle . “Stuttering is a disorder where neurological and psychological aspects constantly interact,” emphasizes Marie-Pierre Poulat, a speech therapist trained in cognitive-behavioral therapy and specializing in helping patients with stuttering.
However, it should not be considered a disease per se. “It should be defined rather as a motor disorder in the flow of speech, produced with more muscular effort, and signs that can be heard but are also seen, such as blinking of the eyelids or a frozen gaze. It then leads to an obsession with the form of the words to the detriment of its intelligibility in the person who is affected and alters their communication with their interlocutor”, explains Dr Marie-Claude Monfrais-Pfauwadel, ENT doctor, phoniatrist, psychologist and linguist. The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) established by the American Psychiatric Association, defines it as a communication disorder, presenting only in a dual relationship. Indeed, stuttering does not usually manifest itself when speaking alone, nor when singing or playing in the theater.
The age of onset of stuttering is generally between 2 and 6 years old, with a predominance between 3 and 5 years old. This is called developmental stuttering, which may or may not persist. But it can also occur in adulthood as a result of trauma. “To date, the causes of stuttering have not yet been clearly established, even though research in genetics and neuroimaging has made it possible in recent years to make great advances in understanding this disorder,” says Marie Bernard, speech therapist. specializing in the treatment of stuttering. Several studies have demonstrated the role of a multiple genetic component and the existence of a family background conducive to its occurrence.
One of them, published in the Journal of the American Medical Association (Jama), confirms what has been known for twenty years now: people with stuttering have neuronal alterations in brain regions related to to language and attention. To this possibility of constitutional fragility would be added other factors such as an anxious, perfectionist personality, bilingualism requiring the regular alternation of two languages within the same family, a level of educational requirement that is too high or even family events leading to ruptures such as bereavement or divorce…
“We are not born stuttering, but with a predisposition”, insists Dr Monfrais-Pfauwadel who is delighted that France has launched for the first time, in 2021, a research program, called Bénéphidire *, specifically devoted to stuttering on which she has been working for more than 40 years. “Thanks to a functional MRI, that is to say performed in real time, we can obtain a very complete clinical assessment and see how the connections are made between the areas of speech when a person hangs on a word, specifies the doctor. The objective of Bénéphidire is to collect as much data as possible in order to improve the diagnosis and management of this rarely isolated symptom.”
Stuttering is experienced differently depending on the people it affects. There are those, quite rare, who assume it completely to the point of even considering participating in the Eloquence Competition organized for 3 years by the Association Parole Stuttering (APB) at the Bobino Theater in Paris. Others, on the other hand, experience this impeded speech with feelings of frustration, shame, guilt and inferiority. Moreover, the suffering of the stutterer is not proportional to his “speech accidents”. Buying a pain au chocolat instead of a strawberry pie because you sense a difficulty with the word “pie” or “strawberries”, missing an exam or a job interview because you want to hide your stuttering too much, having to wait until ‘a room empties to dare to ask a question… When the smallest facts and gestures of daily life are like an obstacle course punctuated with more or less convincing tricks to say what you have to say, it becomes, therefore, necessary to consult.
The management of stuttering depends on many factors, including the patient’s history and age. “In young children, some speech therapists use the Lidcombe method, which aims to make speech more fluent through adequate feedback, but also programs based on the demand and ability model, which leads parents to act on the child’s environment to improve speech fluency. But whatever the option considered, parental guidance is essential to obtain good results,” says Marie-Pierre Poulat. “Brain plasticity is constant,” says Marie Bernard. However, you should be aware that it is easier to make a stutter disappear before the age of 6 thanks to appropriate therapies. Later, it becomes more complicated and the disorder will have to be approached in its complex dimension, that is to say bodily, psychic and relational, which can lead to multidisciplinary care.
The rehabilitation techniques practiced by specialized speech therapists remain the first resort in most cases. They are frequently combined with cognitive-behavioral therapies to help patients deal with the stress and unease that sometimes develops around this disability.
In the case of stuttering following a traumatic event, the psychological approach, led by a psychologist or psychiatrist, may be an additional option to consider. Getting closer to associations also allows isolated patients in their suffering to find help, support and sound advice. What about drugs? “No medicine cures stuttering, but they can sometimes be considered on an ad hoc basis when stuttering is associated with attention deficit disorder, panic attacks or tics, knowing that they can cause side effects that are sometimes more bothersome than these speech snags,” warns Dr. Monfrais-Pfauwadel.
Now very mobilized on the subject, research focuses on a whole range of drugs acting at various levels on dopamine metabolism, stuttering being associated with an excess of dopamine in the brain. However, most often prescribed for schizophrenia and bipolar disorders, these drugs, far from being innocuous, require prescription precautions before using them to hope to improve the speech flow of stutterers. If this track is interesting, it nevertheless needs to be confirmed by additional studies.
“I started stuttering around the age of 6. Our family doctor said it would pass. But I entered adolescence with a stutter that kept getting worse. After unsuccessfully trying homeopathy, acupuncture and an antipsychotic, the effects of which stupefied me, I ended up with a magnetist… However, I was still a stutterer when I entered professional life. Terrorized by the use of the telephone, I paced the corridors to be able to speak with my colleagues. During meetings, I experienced going around the table like torture!
When I was 40, I consulted a psychologist. I then realized that I was not guilty of being a stutterer. Then I discovered the internet. I was able to chat on forums with people who had gone through the same fears and who explained how they got away with it. I then created my blog, gave conferences, wrote two books on stuttering and my first novel, Third Youth, published in 2021 by Les Nouveaux Auteurs. My stuttering, now much lessened, has opened up new horizons for me.”
The clinical examination makes it possible to distinguish a normal disorder of verbal fluency from a stutter and also to specify the specificities.
Associated disorders
Many children who stutter have an attention deficit that disrupts the relationship with others or motor disorders, coordination or dyspraxia. It is not uncommon for a child who stutters to also have speech learning difficulties or a language delay.
In adults, stuttering sometimes goes hand in hand with psychological disorders such as anxiety disorders, tics, obsessive compulsive disorders (OCD) or social phobia.
A symptom of certain diseases
Stuttering also sometimes manifests itself in neurodegenerative diseases such as Gilles de la Tourette’s syndrome, which is characterized by the presence of multiple tics and in particular vocal tics, but also, Parkinson’s disease and multiple sclerosis.
A neurological origin
Neurological stutters are acquired, not developmental. In other words, these are stutters that occur suddenly after the age of language acquisition. They can be the consequence of a cerebrovascular accident (CVA), head trauma or a tumor and are often associated with epilepsy.
*The Bénéphidire project is one of the first French research programs aimed at developing scientific knowledge on stuttering. Led by the Praxiling laboratory (Paul-Valéry University of Montpellier 3 and CNRS), involving teams from the University of Montpellier, the CHU Gui de Chauliac and the University of Lorraine. In total, it brings together around forty professionals (phoniatrists, neurologists, neuropsychologists, phoneticians and linguists, etc.) specialized in understanding stuttering. Launched in 2021 in the midst of a health crisis, Bénéphidire is looking for people between the ages of 18 and 50 who stutter or have stuttered. A compensation of 80 € is provided for the participants. Their anonymity is strictly guaranteed.
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Contacts
APB Stuttering Speech Association. tel: 01 46 65 36 39
begaiement.org
Stuttering and self-help group – Horizons Self-help
selfhelp-begaiement.fr
