When Words Fail: A Conversation with Stuttering Expert Dr. Barry Guitar

Every day, over three million Americans struggle with stuttering. For some it is a mild, intermittent problem. For others, stuttering is a source of constant fear and frustration, and becomes a central factor in choices about work and relationships.

Dr. Barry Guitar, of the University of Vermont, is familiar with the isolating effects of stuttering. As a recognized expert in research and treatment of this condition, he has worked with people from preschool to adulthood, and has written two books and many articles on stuttering therapy. And like many renowned stuttering experts, Guitar is also a person who stutters.

Can you describe what is happening when a person stutters?
The person knows just what they want to say, but the word seems to be stuck. It can happen in a couple ways. Either you make a sound over and over again, but you can't seem to move to the next sound, "Li, li, li, li like this," or the sound seems to go on and on, "LLLLLLLLike this," and you can't move to the next sound. Or you can't seem to get anything out at all. In that case, there is just silence, and your muscles are holding back the sound.

Do experts know what is happening in the brain when a person stutters?
Not really. Doctors know that the brain of adults who stutter is different from other adults, in terms of the localization of speech processing. The right side of the brain in people who stutter seems to be more active than in normal speakers. It is as if the person is trying to re-route the signals around a problem on the left side of the brain, which is the side that normal speakers use. But when the moment of stuttering happens, doctors don't know exactly what is going on in the brain that keeps speech from flowing forward.

At what age does stuttering ordinarily develop?
It almost always happens between the ages of 2 and 5-years-old, when kids are learning to talk. There is so much language and speech development going on in the brain at that time, it is almost more than they can handle. It is especially overwhelming if children are very advanced in language, or have too much to say, and want to make sentences longer and talk faster than the actual motor system can handle.

Alternately, if the child has a bit of a delay in language, some of the language processes are slower than others so there is a kind of 'disynchrony'. It shows up when the person speaks and the words don't flow very smoothly.

What causes stuttering?
In a little more than half of the kids who stutter, there is a family history of stuttering. But there are also kids who stutter who do not have a family history. There may be an inherited factor there, but that the other family members never developed the stutter.

In other cases, there is nothing inherited, but difficult birth conditions may make the brain develop a little bit differently, so it would be due to a congenital factor.

If there is a predisposition, how does it finally express itself?
All of these things are latent until 2 and 5-years-old. Then the potential to stutter becomes a reality. It can happen when a child is slow in language learning, but it can also be activated by the normal stresses that all kids go through, like a death in the family or moving to a new school and home. So there are a number of normal stresses that can initiate stuttering in a person who has the predisposition to stutter.

Certain personalities will react to stuttering by trying to stop it, and tensing up. Approximately 75 percent of the kids who start to stutter will recover spontaneously. However, some kids never recover spontaneously.

They may be more upset by it because everybody in their environment reacts to their stuttering with concern. Or they may be more upset by it and they react to unexpected or strange happenings by tensing up and trying to fight it.

Could you describe some common psychological reactions to stuttering?
It's very common for children who start to stutter to be embarrassed by it. They will stop talking, or they will avoid talking.

And the frustration and embarrassment can increase to feelings of shame. They will choose not to talk to their playmates as much, or as they get into school, a good number of them won't raise their hand in class. They will say, "I don't know," when they actually do know the answer to the question. They're afraid they might stutter if asked to answer the question. So they become a little more socially withdrawn and so it affects their academic performance, as well as their social life.

As that goes on, the person goes into high school and thinks about what they want to do with their life, and thoughts about career, marriage and family are often affected by stuttering. They may choose a career, and general path in life, in which they don't have to use their speech very much.

How did you come to manage your own stuttering?
At first I managed it-or didn't manage it-by fighting it, and having these long struggle blocks. I can remember being called on by a professor in a college seminar, and having a block that went on for more than a minute, on the word 'style'. That was kind of typical of some of my more difficult moments.

I would also put in extra sounds to get started. If somebody asked for my name, for example, I would say, "Ah, ah, ah, ah, ah, Barry." That could go on for a long time. I mean, I could have 15 or 20 "ahs" before it came out.

When I was 20, somebody suggested that I go out and get therapy with Charles Van Riper, who was one of the founding fathers of stuttering therapy in the United States. I worked with him for about a year, and it profoundly changed my life. He basically freed me up. I became open about stuttering, and could mention it to people. I became less uptight about it, and I was able to stutter in an easier way because I wasn't trying to hide it or fight it. When I would get stuck on a word, instead of pushing harder and harder, I learned to relax my muscles and go through it more slowly.

There are just two pieces to it, really. One is becoming less fearful, and then being able to change the form of the stuttering so it is more like normal speech.

You then became a teacher yourself. How would you describe your teaching philosophy?
I use different approaches for different people, often depending on age. But basically, my philosophy is that I use whatever approach I think the individual needs.

If I'm working with a preschool child, I use a radical approach that is hardly used at all in the United States and, in fact, is disapproved of by a lot of people. But I've found it to be profoundly effective with preschool kids. In this therapy, the parent is central, and I meet with the parent weekly. He or she works with the child every day for 15 minutes and praises the child in that time. The child is encouraged to talk in a way that they are mostly fluent, and the parent praises the child occasionally for their fluency. They keep very careful records of how the child is doing day by day. When the records indicate that the child is fluent throughout the day, then the parent actually begins to ask the child to change their speech when it becomes stuttery. That's the radical part. People think this is anathema. For hundreds of years, the accepted line of thinking was, "Don't correct a child." Now we're asking parents to say, After a lot of praise for fluent speech, "Oops, that was a little bumpy. Can you try that again?" when the child has a stutter. The parent is carefully guided by a trained clinician because it's a very powerful approach and it must be done with a great deal of care.

But in preschool kids, stuttering will often disappear in several months time with this method, and never comes back. The child will never remember that they stuttered.

And for school-age children?
With school-age children, I help them confront the fear that comes with stuttering, and we change the way they stutter, without trying to be perfectly fluent. I encourage them to be open about it, and learn to stutter more easily.

Does stuttering ever go away and then come back?
Yes. Stressful events can precipitate the return of some stuttering in people who thought they were beyond it.

So is stuttering ever really curable?
It certainly is in preschool kids, but it's less so in kids after age five or so. The good news is, the right therapy can help people of any age to make it so that stuttering is almost a non-issue.

What is the most helpful way to respond to someone who is stuttering?
Listen and let the person finish what they want to say and don't fill in words for them. If the person stuttering appears to be embarrassed about the stuttering, it's quite okay for the listener to say, "Take your time. I'm not in any hurry," or just mention the stuttering -- that it's okay with the listener. But that would only be if the person is really struggling.

How can a parent help a child who may be starting to stutter?
One of the things they should do is to slow their own speech rate down. Mr. Rodgers is the perfect model. It's basically impossible for a parent to do all the time, but it's good to set aside 15 minutes a day for one-on-one time with their child, at a regular time, and slow their speech rate down. The child knows they've got the parent's attention, the parent is speaking slowly, and is listening carefully to them.

Also, if a parent is worried about their child stuttering, they should see a speech language pathologist, preferably one who is specialized in stuttering.

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