Food for thought on Stuttering
According to the DSM-5 stuttering, Inserted in communication disorders, is defined according to the age of onset: we therefore speak of Evolutionary Stuttering (Fluence Disorder with onset in childhood) and Late-onset Stuttering (Disorder of fluency with onset in adulthood).
In the ICD-10, stuttering is included in “Other disorders characterized by a childhood onset”.
Only in the DSM-5 is the presence of anxiety as a consequence of stuttering included among the criteria.
The World Health Organization (WHO) defines stuttering as a disorder in the rhythm of speech in which the patient knows precisely what he or she would like to say, but at the same time is unable to do so due to constant stops, repetitions and / or extensions of a single phoneme or syllable. These manifestations of the disorder are referred to as the primary symptoms of stuttering.
Although there are several theories on stuttering, the cause is still unknown; it is considered as a multifactorial disorder and among the factors taken into consideration we find: brain structure and functions, genetic factors, sensorimotor system, linguistic factors, personality, learning factors and environmental context.
Stuttering is a disorder of verbal fluency that usually occurs in the first years of life, following linguistic development and which, if not treated early, can become complex, so much so that social interaction and consequent personal well-being are difficult.
It has been estimated that 2/3 of the cases of individuals who develop stuttering in preschool and after puberty go into spontaneous remission. Stuttering affects men the most, with an estimated male / female ratio of 3: 1, although this ratio is bound to change depending on the age of onset.
In addition to developmental stuttering, there are other forms that usually arise in adulthood, although they can also rarely occur in the child. These are acquired or secondary forms, such as:
- Neurogenic stuttering: when it is possible to identify an injury to the nervous system that causes an alteration in the normal fluence of speech. The causes can be represented by ischemias, brain tumors, head injuries, neurodegenerative diseases (such as Parkinson’s disease or dementia);
- Psychogenic stuttering: they are characterized by the presence, in the period preceding the onset, of strong emotional stress or traumatic events on a psychological level.
The speech therapy treatment makes use of specific fluence control exercises through correct pneumo-phono-articulatory coordination. Relaxation techniques are often associated with tools such as the metronome, to train the articulated and regular production of speech, or electronic devices that allow you to adjust the frequency of speech.
In addition, cognitive-behavioral therapy is used and in some situations the prescription of drugs.
Cinema has often talked about this difficulty, always relating it to an emotional and psychological problem, and this is the main reason that encouraged me to talk about it.
There are very powerful images described for example through some characters, just to name a few, I can tell you about Billy, the young man from “One Flew Over the Cuckoo’s Nest” who, suffering from stuttering from an early age, stops stuttering one evening following a party during which he does not care about the judgment of his mother towards him and that after yet another psychological violence suffered by the hospital nurse, who threatens to tell everything to her, instead begins to stammer again.
In “IT” Stephen King describes another character, Bill, who, following the brutal killing of his little brother George, begins to stammer; we learn in the course of history that in adulthood this problem has been overcome and when, as an adult, Bill receives a phone call from an old childhood friend, the problem arises again, letting us understand that his difficulty is intimately linked to that period of his life.
In “The King’s Speech” George VI decides to undertake a rehabilitation process with a speech therapist-therapist, Lionel, who investigates the possible psychological roots of the King and establishes a relationship with him based on mutual trust that will lead the latter to face his problems related to stuttering. This film has the merit of having highlighted the importance of knowing how to build a solid therapeutic alliance and it is clear that the success of the therapy undertaken depends very much on the relationship that has been created between the two and also on the important emotional bond that the King has with his beloved.
Furthermore, in different ways, these characters offer us interesting food for thought on the subject and show us how those who have this difficulty tend to be laughed at and as a consequence of this to lose confidence in themselves with very serious consequences on the psyche.
It also strikes me very much how, for example, some actors, who in real life have this type of disorder, by acting they manage to overcome stuttering almost completely. We should ask an actor what happens when he plays someone else; it would undoubtedly be interesting to let us tell.
All this to say once again how fundamental it is to face the problems that affect the quality of life and our relationships from various points of view, placing the person and the causes that generate discomfort and not just the manifest symptom at the center of the treatment process.
From this short article, which only wants to offer food for thought and push the reader to further investigations on a very delicate issue, one can understand how vast and complex this disorder is and that taking care of the person who suffers from it must account of all the factors that can contribute to making it emerge.