Researchers investigate the nature of stuttering

Jul 27 2011

Radio-TV-Film senior Alex Murphy has a knack for storytelling through short stories, poetry and screenwriting. One of his undergraduate classes was a professional communication course, which requires students to deliver oral presentations in class.

On the day of his first presentation, Murphy felt well prepared and ready to tackle the assignment. But his four-minute presentation dragged into 15 minutes as he struggled with his stutter to get the words out.

Until that moment, Murphy had been mostly covert about his stutter—he had assumed a quiet and reserved demeanor and devised coping strategies to mask his problem in class—so that neither his professor nor his classmates were aware. Upon finishing his presentation, Murphy threw down his notecards in frustration and stormed out of the classroom.

Days later, his professor suggested he reach out to Courtney Byrd, an assistant professor in the College of Communication's Department of Communication Sciences and Disorders, who is working to find the causes of stuttering and effective treatments for the disorder.

Scratching the Surface of a Complex Disorder

Stuttering is a communication disorder in which the flow of speech is broken by repetitions (li-li-like this), prolongations (lllllike this), or abnormal stoppages (no sound) of sounds and syllables. Some people who stutter present secondary behaviors, such as lack of eye contact, blinking and head movement—behaviors that are usually an attempt to force the word out. These secondary behaviors can add another layer of complexity to study of the disorder.

Stuttering affects 3 million Americans and four times as many men as women.

About 5 percent of young children go through a period of stuttering that lasts six months or more. However, the majority of these children recover by late childhood, leaving only about 1 percent with a long-term stutter. Byrd cautions parents who suspect their young child is experiencing a stutter.

"Some pediatricians tell parents to 'wait and see' if a child outgrows stuttering on his or her own. That advice can be traced back to one of the more historic and common misperceptions that calling attention to stuttering will result in the child becoming a stutterer," said Byrd. "Children who stutter should be evaluated by a speech-language pathologist as soon as possible. Early intervention is key."

Because developmental stuttering typically presents itself between the ages of 2 and one-half and 5 years of age, and—for some—can persist through adulthood, Byrd focuses her research on both children and adults. Young children, most of whom are not yet aware of their stutter, provide an undistorted look at the disorder. Treatment is most effective when administered as close to onset as possible.

Adolescent and adult stutterers have a different awareness of the disorder as a result of a lifetime of stuttering. Of particular interest to Byrd is seeing if those unique behaviors she has identified in young children at onset of stuttering persist in those adults whose stuttering persists.

In 2006, Byrd established the Developmental Stuttering Lab in the College of Communication to investigate the nature of stuttering from its onset and provide evidence-based treatment for children and adults who stutter.

"My first goal is to understand why people stutter," said Byrd. "You'll never hear a stutterer say 'I don't know what I'm trying to say.' It's not a semantics issue. They have the word there, but they cannot get it out fluently."

Learning how stutterers select and organize the sounds they use to make words helps researchers identify the obstacles that result in stuttering and develop therapies to overcome them.

To achieve this, Byrd's team of graduate and undergraduate students spend a significant amount of time in the lab evaluating how typically developing preschoolers acquire language and learn how to put sounds together fluently. These lab evaluations range from observing parents playing and talking with their children, to analyzing characteristics of disfluent speech, to measuring speech fluency as a child describes a picture, to asking children to identify words based on partial sounds. These data are used to create benchmarks against which to compare children who stutter and pinpoint the breakdown in fluency.

Byrd's research suggests it takes children who stutter longer to select sounds because they're not efficiently organized, which means stuttering is not strictly motoric, or a speech behavior. There is a linguistic component as well.

According to Byrd, up until about age 2 and one-half, children's speech consists of a constellation of unrelated, but familiar words: mommy, daddy, baby, milk, book and so on. Once they hit age 3, children undergo a vocabulary growth spurt when they start to organize language into global syllable shapes, or neighborhoods, of words that differ by only one individual sound segment, such as back, bath, bag, bad and bat.

"This global syllable shape selection strategy enables 3-year-olds to efficiently organize and access their limited vocabulary," said Byrd. "However, by age 5 an expanded vocabulary compounded by faster utterances, and longer, more complex, phrases makes it inefficient for typically developing children to rely on this strategy. In fact, it inhibits their ability to produce speech fluently.

"In contrast to typically developing children and adults, my research has shown both children and adults who stutter continue to rely on the global syllable shape organization system, which is inefficient and slows their ability to access the individual sound segments that represent the words they're trying to say. The outcome is what we perceive as stuttered speech."

"My hope is that my research will lead to the identification of key etiological factors that could in turn serve to transform treatment," said Byrd, "But stuttering is a complex disorder. It waxes and wanes and its origins are unclear."

One contributing factor to stuttering is genetics. About 50 percent of people who stutter report a relative in their extended family stuttered. This is the case for Geoff Coalson, a doctoral student and a stutterer who works alongside Byrd conducting studies to explore different linguistic-based theories and stuttering.

"Like most stutterers, I spend 90 percent of my time and energy thinking about my own stuttering. I decided it might be best to enter a field where I could put that vested energy to good use," said Coalson, who didn't learn about his grandfather's stutter until he was in high school. "Older generations were often less open to discussing perceived flaws, and by the time I was born my grandfather had developed strategies for managing it so that it was more covert."

Coalson said myths about stuttering persist. For example, anxiety, low confidence, nervousness and stress do not cause stuttering.

"These symptoms may result from stuttering, but they are not the cause of stuttering," he said. "Of course, fluency suffers when any speaker becomes anxious about speaking, including stutterers. So, I can understand the perceived confusion about the chicken vs. egg relationship between anxiety and stuttering. Just know that if anxiety caused stuttering, it would track much more cleanly with and be more prevalent within populations with anxiety disorders, which it does not."

In addition to investigating the nature of stuttering, Byrd and the Development Stuttering Lab's Director of Therapy Services Elizabeth Hampton have delivered speech therapy to more than 100 children and adults who stutter—most of whom have also participated in the research projects. The therapy they provide is based on what researchers and therapists understand as the best treatment in the field.

Byrd also is piloting new and innovative treatment programs based on her research that may eventually become part of the standard treatment protocol should there be sufficient evidence to support them in the future.

"While we work with clients to improve their fluency through speech therapy, we also give them practical coping mechanisms," Byrd said. "For example, the simple act of self-disclosure can ease the burden and make the stutterer and others feel comfortable."

Additionally, Byrd and Hampton's stuttering treatment has provided unique clinical research opportunities to both undergraduate and graduate students interested in working with people who stutter.

The Developmental Stuttering Lab offers continuing education workshops for practicing speech-language pathologists, provides biweekly counseling groups to parents of children who stutter, organizes biannual public forums for individuals who stutter and their families, and collaborates with the National Stuttering Association (NSA) on its monthly local chapter meetings.

"I was attracted to this line of research because stuttering affects every area of someone's life. It speaks to both the head and the heart," Byrd said. "I have yet to meet a person who stutters who hasn't taught me something significant. There's so much left to discover about the nature of the disorder. We've just begun to scratch the surface."

Let Me Finish

Thanks to Byrd, Murphy spent the summer and the following fall semester participating in speech therapy sessions overseen by clinicians and graduate students in the Developmental Stuttering Lab and attending the NSA's monthly meetings.

"The therapy and NSA meetings have had a huge impact on my life," Murphy said. "They made me realize how long I'd been hiding from my stutter and how much better life would be if I opened up and didn't try to hide my disability."

Last fall, he turned the camera on the stuttering community through his Introduction to Documentary Filmmaking class. He filmed the short documentary "Let Me Finish," featuring Byrd's insights on stuttering and members of the NSA Austin chapter sharing their stories, discussing the physical and psychological effects of stuttering and dispelling myths perpetuated by the media.

"While my stutter still affects my social life, it no longer controls it," Murphy said. "I have not let it stop me from doing what I want to do."