Up until her mid-20s, Catherine Moroney says she was “very frightened” of speaking because she stutters.
“I can’t hide my stuttering,โ Moroney, who lives in Pasadena, Calif., told The Current. “For many years, I would squirm and hide if asked about it.”
Stuttering varies in frequency and severity from person to person, and it can disrupt the natural flow of speech in different ways, the National Stuttering Association in the U.S. says. According to the Stuttering Foundation, based in Memphis, Tenn., it affects more than 80 million people worldwide.
Someone who stutters might repeat sounds or words, stretch out certain sounds or experience a block โ a moment when they struggle to get a word out, even though they know exactly what they want to say.
Now, a first-of-its-kind set of interdisciplinary consensus guidelines, published in the journal Psychiatric Times in August, is calling for stuttering to be recognized as a complex, brain-based condition rather than simply a speech problem.
Catherine Moroney is on the board of directors at the Canadian Stuttering Association. She says people who stutter might not pursue personal and professional opportunities. (Submitted by Catherine Moroney)
For people who stutter, disruptions in speech can make everyday interactions unexpectedly difficult, said Moroney, 59, who is the secretary on the board of directors at the Canadian Stuttering Association. While she has lived and worked in the U.S. for many years as a physicist and software engineer, she was raised and educated in Canada and holds Canadian and U.S. citizenship.
Dealing with customer service over the phone can be frustrating, she said, when automated systems fail to recognize stuttered speech and the agents themselves hang up rather than take the time to listen. In emergencies, people who stutter might also be “unable to impart the necessary information quickly” when attempting to call 911.
People who stutter might hold back from pursuing personal and professional opportunities. They can face dismissive reactions from others, Moroney said, including people who “suddenly disengage from all attempts at further communication” after hearing them stutter.
Guidelines call for rethinking of stuttering
Dr. Gerald Maguire, founder of the U.S.-based Stuttering Treatment and Research Society and a person who stutters, said it’s “physically and mentally exhausting” for someone with the condition to think of the words they want to say.
Maguire convened a 35-member panel of physicians, speech-language pathologists, researchers and people who stutter to develop the new guidelines.
Dr. Gerald Maguire is the founder and chair of the Stuttering Treatment and Research Society. He convened a panel of experts to develop new guidelines on stuttering. (Submitted by Gerald Maguire)
They call for more individualized treatment, recognizing that stuttering affects people differently and that care should reflect each person’s needs rather than a one-size-fits-all approach.
One of the biggest misconceptions in health care is that stuttering is simply a childhood condition people will outgrow, or a behavioural habit that can be fixed with speech therapy, said Maguire, who’s also director of residency training and chair of psychiatry at College Medical Center in Long Beach, Calif.
“There’s just been just a lack of knowledge and a lack of training on stuttering,” he said.
By recognizing stuttering as a brain-based condition, Maguire said, it could help dispel common myths and open the door to “multiple treatment approaches,” combining “different forms of biological or medical therapies with talk therapies of different forms.”
โItโs not just one magic potion,โ Maguire said. “Just like [how] we treat depression or anxiety, it’s gonna be a combination.”
It would also mean giving speech-language pathologists a stronger grounding in the neuroscience of stuttering and “empower individuals who stutter to have better treatment options,” he said.
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Studying the brains of those who stutter
Soo-Eun Chang, a professor of psychiatry at the University of Michigan in Ann Arbor who studies the neurological basis of stuttering, said the guidelines are a “valuable document” because they call for “a more comprehensive approach to stuttering therapy and highlight the importance of an individualized, rather than a uniform management strategy.”
For now, speech therapy with a speech-language pathologist who specializes in stuttering is considered the “gold standard” treatment, she said.
Traditional approaches teach people techniques that help them change how they produce speech, including breaking down how they breathe, start the sounds of a word, and position their mouths and tongues to help them “produce fluent speech.”
But while these techniques can help some people speak more fluently, Chang said it “oftentimes does not stick [and] has limited effects.” That’s because speaking, much like walking, is usually automatic, so consciously thinking through each movement can make speech feel like a “very effortful and non-natural thing.”
Soo-Eun Chang, a professor of psychiatry at the University of Michigan, is a neuroscientist and a speech-language pathologist whose research focuses on the neural basis of stuttering. (Submitted by Soo-Eun Chang)
The guidelines also bring “a very welcome awareness,” particularly as research into stuttering remains a relatively “tiny niche field,” Chang said.
In her own research, she collected brain scans of children who stutter, hoping to identify early differences in brain structure between those who eventually recover and those whose stuttering persists.
Her preliminary findings suggest that children who recover from stuttering develop stronger connections in the “white matter tracts” of the brain โ “electrical cables that interconnect between different parts of the brain that might be key in terms of helping support fluent speech control.”
In children whose stuttering persists, however, the connections appear to plateau, suggesting differences in how their brains develop over time.
The research, Chang said, could eventually help identify which children are more likely to continue stuttering, rather than take a wait-and-see approach that could potentially lead to a missed opportunity for early intervention.
It could also help researchers pinpoint which areas of the brain become stronger during recovery, potentially informing newer treatments, such as brain stimulation techniques to encourage that growth, she said.
A ‘call to action’
The new guidelines are a “call to action” and starting point, as there’s still much work to be done in the field, Maguire said, adding there’s an urgency to do so because the condition can affect people’s livelihoods.
“People today … are still being discriminated against for stuttering,” he said. “We have data that people who stutter are underemployed.
“We don’t want other people [who stutter] in the next generation to be told to just ignore it.”
One of the biggest misconceptions is that stuttering is simply a childhood condition people will outgrow, or a behavioural habit that can be fixed with speech therapy, Maguire says. (Studio Romantic/Shutterstock)
Catherine Moroney also sees the guidelines as an important step toward encouraging more research into stuttering and helping people who stutter โ as well as those who support them โ better understand the condition.
Moroney said that when she underwent speech therapy, she initially spoke fluently when she completed the program but then “lost all those gains a few months later.”
It wasn’t until she connected with the stuttering community and attended her first conference that she realized she wasn’t alone.
Since then, Moroney has built a career as a physicist and software engineer, including work for NASA analyzing satellite data. “[I] finally [learned] to be open about my stuttering and learn how to accept it and myself.”
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