Click Here to read more about the Causes of Stuttering.The term stutter and stammer will may be used interchangeably in this section, but means the same thing.
Treatments for Adult Stuttering and stammering (Dysfluency)
There are a number of treatments for adult stuttering. Speech therapy can help adults that stutter, but is often dependant on a number of factors including the severity of the stammer, the commitment of the individual, the skills of the therapist, the underlying psychological issues of the individual, time and financial constraints and the type of therapy technique chosen. No single treatment is effective for every stammerer and because everyone is different some treatments need to be tailored to the individual. In some cases the stammer will completely disappear, but at some point in the future an event may cause the stammer to recur. Adult stammerers need to be aware that they need to tackle underlying causes of the stammer (psychological issues), as well as the more obvious outward signs of the stammer. icommunicate will endeavour to provide information about the types of therapy programs that are available, but we do not support any therapies that claim to offer a miracle cure for stammering and that have no research based evidence to support these claims. We also believe that any program should be carried out by a suitably trained individual, preferably a speech and language therapist / pathologist. If you decide to embark on a fluency program, we recommend you choose a program that addresses the psychological issues around the stammer as well as the outward signs of the speech difficulty.
There are a number of treatments that try to facilitate speech fluency. We have mentioned some below, but at this time can only give very brief details.
Fluency shaping for stammering
This involves the stammerer taking on-board techniques to alter and improve speech characteristics, such as slowing speech, pausing and prolonging speech sounds. It also focuses on relaxing the speech muscles by looking at relaxed breathing, vocal folds (often called vocal chords), and articulation (lips, jaw, and tongue). Stammerers are usually trained in using certain breathing techniques which encourage them to breathe from their diaphragms, gently increase vocal fold tension at the beginning of words (gentle onsets), slow their speaking rate by stretching vowels, and reduce articulatory pressure. Initially this produces slow, monotonic, but fluent speech, but after the individual masters these target speech behaviors, further work is done on speech rate and intonation so that speech begins to sound more normal. This more fluent normal sounding speech is then practiced outside the speech clinic in everyday situations. The program also needs to include psychological treatment to reduce fears, anxieties and avoidances, discussing stuttering openly, and changing social habits to increase speaking. Some studies have shown that this treatment worked well for many stammerers with about 70% of participants claiming satisfactory fluency 12-24 months after treatment.
Modification therapy for stammering
Fluency shaping aims to make speech more fluent, modification therapy tries to modify your moments of stammering so that they are less severe. This therapy also focuses on reducing your fear of stammering, and trying to eliminate avoidance behaviors associated with this fear. Unlike fluency shaping therapy, stuttering modification therapy assumes that adult stammerers will never be able to speak fluently, so the goal is to be an effective communicator despite stammering.
There are several stages to modification therapy:
The first stage is called identification, the stammerer and clinician identify the core and secondary behaviors, and feelings and attitudes that characterize the stammer.
The second stage is called desensitization, and the stammerer tells people that he has a stammer, tries to ignore core avoidance behaviors, and intentionally stammers (“voluntary stammering”).
The third stage is modification, the stammerer learns “easy stammering” by stopping at moments of dysfluency, pausing, and saying the word again. The stammerer “comes out of” dysfluent speech and “into” fluent speech, and he prepares for difficult words ahead by using an easy stammering technique.
The final stage focuses on stabilization where the stammerer practices his new skills and changes his self-concept from being a person who stammers to a person who speaks fluently most of the time but who occasionally stammers.
Accepting your stammer
Although this is more of an acceptance of the stammer than a plan to fix or alter speech production, it works for some people. The client is encouraged to except himself as a stammerer. The theory is that the more the client tries to be like a fluent person the more stress and anxiety he puts himself under, and thus the more he stammers. By facing up to the stammer and accepting it the client becomes more confident, which in itself, helps him to speak more fluently.
These devices alter auditory feedback to the speaker. The speaker either hears (via headphones) their own voice a fraction of a second later than normal (delayed auditory feedback), hears their voice at a different pitch (frequency-shifted auditory feedback) or produces masked auditory feedback.
These devices have shown dramatically positive effects on stammerers fluency when they are wearing the devices, and they have been found to work well as part of fluency shaping therapy (mentioned above). However, other studies have provided mixed results of their effectiveness as a sole therapy for dysfluency and whether they have a generalising effect when the stammerer is not wearing the device.
Some dopamine antagonist medications have been found to reduce stammering by as much as 50%, but have often been found to have severe side effects for some stammerers.
Living with stammering
Unfortunately, for many people there is no long lasting cure and they have to live with their stammer. Stammerers need to be aware that the vast majority of the population is sympathetic to their difficulties and will wait patiently when they experience a dysfluent episode. Adults who are really concerned about their dysfluency should investigate treatments but be aware that there is no guarantee of a cure. Stammerers must also be aware that any proper treatment should also focus on underlying anxieties and psychological issues otherwise positive treatment affects may not remain in the longer term. Any type of therapy or treatment program should only be carried out by an experienced professional such as a speech and language therapist / pathologist.
Stammering Support Groups
Many stammerers find that joining a support group helps them. Sharing your experiences (both positive and negative) with other people will help you see that others have the same feelings and difficulties. Hearing other people’s experiences can improve your perspective on your own problems, and sharing positive experiences gives other people in the group confidence. Some groups are run by speech and language pathologists / therapists and these groups work together on strategies to help with dysfluency.
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources.
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