Mm-m-my speech

The success of The King’s Speech has thrown the spotlight on the ancient problem of stuttering.

ALBERT Einstein did it, so did James Earl Jones, Elvis Presley, Tiger Woods, Marilyn Monroe, Tim Gunn, and current United States vice-president Joe Biden.

And also United Kingdom’s King George VI, as famously portrayed by Colin Firth in The King’s Speech, which won four Oscars last Monday, including one each for Best Motion Picture of the Year and Best Performance by an Actor in a Leading Role for Firth.

Stuttering has been recorded as early as the ancient Egyptian civilisation, even meriting its very own hieroglyphic.

According to speech language pathologist Farah Azlina M. Alkaf, it is not uncommon for young children, who are learning to speak, to stutter.

“The prevalence of stuttering in two- to five-year-olds is much higher than the prevalence in the general population,” she says, although she cautions that this is a statistic from Western countries. “We don’t have any statistics for Malaysia,” she explains.

The theory behind this phenomenon is that the speech muscles of these children cannot keep up with their thoughts, or desire to express themselves verbally.

“They think faster than they can speak,” says Farah, who has 13 years of experience in speech therapy.

She adds that this might be the reason why most children grow out of stuttering by themselves within two years of developing the condition.

When should parents start to worry then?

What is stuttering?

Farah explains that there are a few factors speech language pathologists look for in diagnosing stuttering. According to her, the characteristics that differentiate stuttering from the efforts of a child learning how to speak include part-word repetition, prolongation, interjection and blocking.

Repeating whole words like “it’s, it’s, it’s a cat”, or phrases like “it’s a, it’s a, it’s a cat” is normal. However, part-word repetition like “k-k-k-cat” is a sign of stuttering.

Prolongation means making sounds longer, like “ba-a-a-a-a-by” or “s-s-s-s-s-sit”.

Stutterers also frequently use filler words like “um”, “ah” or “you know”, which are words or phrases that we use when we don’t know or are unsure of what to say next. This is called interjection.

Another characteristic that was well demonstrated by Firth in The King’s Speech is blocking. This is when the stutterer is trying to speak, but cannot get any words, or only part of a word, out of his mouth.

Some of these characteristics can also be accompanied by secondary behavioural traits, which are physical actions the stutterer does when they try to get their words out.

Examples of this include blinking their eyes rapidly, scratching their head, and looking away to avoid eye contact.

Some stutterers also show the stress they are under by tensing their muscles. Those who have watched the movie can see an example of this as Firth frequently tenses his neck muscles when he stutters.

Speech language pathologists also look out for a family history of stuttering, as the condition runs in families. In fact, just last year, researchers published a paper in the February issue of the New England Journal of Medicine that identified three genes that are believed to cause stuttering.

They estimated that around 9% of stutterers possess mutations in one or more of these three genes, and their plans for follow-up research include a worldwide epidemiological study to better determine the percentage of stutterers who have these gene mutations.

Farah says that stuttering can also accompany other developmental speech problems like starting to talk late, a limited vocabulary, and not seeming to understand what is being said to them.

The stuttering also has to have lasted for more than six months.

In multilingual patients, the stuttering can be limited to one language – usually the one the patient is most fluent in – or can occur across all the languages spoken.

Says Farah: “I’m not quite sure of the theory behind it, but possibly, it’s because you are not familiar with the language, you have to slow down and think about the words before you say them, and this helps to reduce stuttering.”

But there is no one factor that definitively says someone needs speech therapy. “We need to look at the combination of factors and the child himself,” she says.

Causes and therapy

In her years of practice, Farah has treated stutterers ranging from young children to teenagers and adults.

She says that her older patients have usually stuttered most of their lives, but only start to seek treatment for specific reasons, like having to take the SPM (Sijil Pelajaran Malaysia) oral exams, having to give presentations in university, or taking up jobs or positions in sales, marketing or management, which requires them to do a lot of public speaking.

Certain situations are more difficult for stutterers, she says.

These include talking on the phone, giving presentations, introducing themselves or other people, making appointments and ordering food in restaurants.

However, stutterers generally find it easier to speak to children or younger people, and animals, as they feel less performance anxiety in these situations.

Strangely enough, stutterers are able to express themselves more fluently when they sing or act. This may be why artistes like Hrithik Roshan, Bruce Willis, Marc Anthony and Carly Simon are successful despite their impediment.

As the causes of stuttering are still being investigated, the treatment for the condition is largely behavioural. There are no physical causes for the condition.

“Everything is focused on developing skills and a set of behaviours that allows you to recognise situations or words that you will stutter, then using therapy to reduce the stuttering,” says Farah.

This includes helping the patient to understand and analyse how they feel and deal with difficult situations where they stutter, as well as helping them to remember and apply the speaking techniques they have learnt in such situations.

In The King’s Speech, it is suggested that King George VI’s stutter is caused by emotional and psychological reasons.

That was the common belief at that time, and is still thought to be the cause of stuttering by some people nowadays.

But research has shown that this is not true. Studies looking at children with traumatic childhoods show that coming from such a background does not automatically create a stutter.

As mentioned earlier, stuttering has a genetic component to it.

Scientists also believe that neurophysiology – or the way the brain is wired – plays a part in causing the condition. This can be seen in cases of neurogenic stuttering, where people who have never previously stuttered, start doing so after a stroke or head injury.

However, psychological factors do affect stutterers, particularly those who have grown up with the condition.

Farah explains that therapy involves incremental steps, starting from a clinical setting, like asking them to read out loud, and moving on to practical situations, for example, asking them to make a reservation over the phone.

“We’re talking more about teens and adults, because they have more years of negative experience, and there is a whole bunch of feelings associated with their stuttering,” she says.

“For kids, there is not so much negative experience, so some techniques focus on eliminating the stutter.”

But most therapeutic programmes – for both adults and children – focus instead on ensuring that the stutter does not become a lifelong chronic problem for the patient.

Acknowledging the problem

As for speaking to stutterers, Farah says that it is important to be patient, especially with children, and resist the temptation to “fill in the words” for them.

“Allow them to finish saying what they want to say,” she says. “And don’t look away; concentrate on the person and allow him to speak.”

She adds that telling them to “calm down”, “relax” and “take a deep breath” does not work.

“What is advocated is that you tell them, ‘You seem to have difficulty saying the word, is there anything I can do?’

“Acknowledge the problem, and give them permission to ask for help,” she says.

For adults, it is suggested that they be more “aggressive” about the problem, that is, telling other people about their stuttering.

Many stutterers, especially older ones, believe that admitting to their problem is a weakness and diminishes their authority.

However, Farah says that openly acknowledging the condition takes some of the pressure off them, and can help reduce performance anxiety, which in turn, will decrease their stuttering.