Mysteries About Stuttering
In this article, we address two major themes: We start first with what we call popular “mysteries”—supposed facts about stuttering that the lay public finds odd or surprising. These tend to involve conditions under which stuttering behaviors vary in frequency. We will then turn to what are best called “myths,” almost all seeking to explain what causes stuttering, and how a frustrated speaker might cure it, or be helped to cure it.
Singing and stuttering
Many people, including people who stutter themselves, are surprised that stuttering is reduced or absent when people who stutter sing. Actually, given what we know about stuttering and conditions that ameliorate it, we’d be shocked if people could stutter when singing. Consider the differences between speech and singing: words are lengthened and elided into one another, a component of fluency-shaping therapies that target “continuous phonation.” Singing also has a rhythm or beat, which serves as a metrical timing guide—speaking to a predictable beat is also fluency facilitating, perhaps because evidence for motor, speech, and non-speech timing deficits in PWS have accumulated over the years (Sares et al., 2019). For the most part, there is no language formulation during singing—lyrics are known ahead of time, unlike in spontaneous conversation. PWS stutter slightly more when singing unfamiliar songs and lyrics (Healey et al., 1976). Less well-understood differences between speech and stuttering, such as higher involvement of the less dominant (typically right) hemisphere, may also exert an influence, as suggested by Jeffries et al. (2003). Singing may have less meaningful semantic content for the speaker. Finally, to the extent that people do not expect to stutter as much while singing, this may in fact reduce affective and cognitive pressures that make fluency breakdown more likely. The rationale that stuttering is reduced in singing solely due to typically slower articulation in song than in speech seems unlikely (Glover et al., 1996) Likewise, the hypothesis that singing decreases vocal effort is also unlikely (Colcord & Adams, 1979). In conclusion, song is characterized by many physiological and linguistic features that should logically improve stuttering. Curiously, however, the brain mechanisms that underlie singing still function atypically in AWS, as shown by Neef et al. (2016) when they imagined humming a song. Thus, the reasons why singing ameliorates stuttering in many PWS is still imperfectly understood. Unfortunately, unless the person who stutters is willing to go through life like operatic cartoon star Mighty Mouse, the fluency provided by singing is not very useful for everyday communication.
Why don’t people who stutter have trouble speaking all the time?
It is quite clear that stuttering can be very variable, both in adults and children. This variability has been documented in ways that have significant ramifications for assessment and intervention (Constantino et al., 2016). This may encourage the belief that the person who stutters could be fluent if they simply tried a little harder, or took advice/therapy techniques “more seriously.” Probably no other intertwined set of “mystery” and “myth” has caused so much heartache, in our opinion. We note that much of the research suggests that both CWS and AWS have motor systems highly vulnerable to instability, which may be increased under conditions of linguistic, motor, affective and cognitive pressure, as well as other factors, such as anxiety (e.g., Jackson et al., 2016).
That symptoms of a medical or physical problem vary unpredictably, wax, wane, go into remission, and re-emerge is not unique to stuttering. Numerous physiological disorders, such as Tourette’s syndrome, asthma, and diabetic blood sugar control have unpredictable symptoms as a major feature. Few would question if the person actively seeking treatment for any of these conditions simply needed to “try harder” to minimize symptoms. Perhaps because so much of people’s everyday lives involve speaking, and speech symptoms are quite apparent, variability of fluency in stuttering has achieved a somewhat mythic status. Gerlach et al. (2020) tackle this mystery in a child-friendly way in an article that can be used to discuss the issue with a child’s schoolmates (https://kids.frontiersin.org/article/10.3389/frym.2019.00153).
Likewise, the perception that therapy techniques should completely remedy the speaker’s behavioral, affective, and cognitive symptoms if used religiously suffers from numerous weaknesses, in our personal opinions. It first presumes what the speaker who stutters most wants to obtain from therapy (is it fluency? or increased comfort in speaking? or that listeners learn to “tolerate” disfluency in some people’s speech [as in the emerging “neurodiversity” movement, quickly gaining support in the autism community) (Constantino, 2018). It next presumes that we have identified effective treatments for stuttering that address the speaker’s personal goals. We have a certain distance to travel in order to assume the truth of this presumption. It also ignores the role we now know is played by therapeutic expertise and the therapeutic alliance in achieving therapy outcomes.
Myths about what stuttering is, to the person who stutters:
One lay belief is that stuttering is a condition characterized primarily by the repetition of speech elements; this is typically how stuttering is portrayed in the popular media. But this is not true. Blocking is the most unique feature of stuttering and is also one of, if not the most, disturbing speech feature, since is strips the speaker of the ability to vocalize, and signals a loss of control (Tichenor & Yaruss, YEAR). We note that blocking is not likely to be experienced by a typical speaker except in nightmares when one wishes to call for help from some boogey-man, but cannot manage to say anything.
Myths about the causes of stuttering:
Stuttering is caused by nervousness, anxiety, or shyness.
Anxiety and nervousness, especially about speaking, is logical in PWS. It has the capacity to aggravate speech fluency, but does not play a role in the onset of stuttering. It is also logical that even close to the onset of stuttering, a child (or teen or adult) who stutters may avoid social situations and speaking opportunities. However, there are few research findings to substantiate the hypothesis that children begin to stutter as a manifestation of social anxiety.
Stuttering is a psychological disorder. The study of stuttering has long been plagued by the “chicken and egg” problem. It now seems fairly apparent that living with any chronic disorder, such as stuttering, can lead to social maladjustment, anxiety, and depression, among other diagnosable mental health conditions.
Stuttering is caused by intellectual deficiency. People who stutter are no less intelligent as a group than people who do not stutter. Rates of stuttering may be elevated in some developmental disorders that are also associated with intellectual disability. This myth is likely to be fueled by the assumption that a person who finds it difficult to articulate thoughts is having difficulty in formulating them.
Stuttering is caused by emotional trauma.
This argument essentially proposes that stuttering is a form of conversion reaction, such as hysterical blindness, in which an emotional trauma somaticizes into a physical symptom. However, stuttering is a very poor fit for this category of phenomena. The majority of somatic disorders involve gross motor ability (e.g., walking), perceptual systems (e.g., vision), overall well-being (e.g., chronic pain or weakness), headache/stomachache, or unexplained seizure-like disorder. Moreover, conversion disorders are not seen in very young children, and are undocumented before later childhood and the teen years. Sar et al. (2009) report that patients were, on average, over 30 years of age, with none under age 18. Conversion reactions tend to affect women more than men, a profile in direct contrast to the typical gender distribution in stuttering. Sar et al. found that 27 out of 32 of their conversion cases were female. Another fact is that early stuttering often does not resemble advanced stuttering, even that seen in the child’s family. In contrast, Brown and Lewis-Fernandez (2011) note that a “significant proportion of conversion disorder patients have recently encountered similar symptoms in their local environment.”
To summarize, Creed and Gureje (2012) observe that “somatization disorder is associated with female gender, few years of education, low socio-economic status, a general medical illness, a psychiatric disorder (especially anxiety and depressive disorders) (as well as) recent stressful life events”—this doesn’t sound much like children who stutter.
More recently, Kanaan and Craig (2019) argue the very construct of conversion disorder (CD). Their major arguments against the construct itself include the fact that, unlike PTSD, the “trauma” is not obvious to either the patient or others. The number of possible traumas appears virtually unlimited (e.g., we have had parents suggest shifts to day care, visits to/of relatives, birth of a sibling, events that do not seem traumatizing to the majority of young children) in contrast to events that appear to be associated with PTSD. Similarly, the list of behaviors ascribed to CD seems rather unbounded, while in PTSD, the patient tends to relive the symptoms (fear, anxiety, dissociation) that characterized the traumatic event itself. Finally, but very importantly, psychotherapy has been conspicuously unsuccessful in treating stuttering in both children and adults.
Stuttering is caused by imitating someone.
The facts of early stuttering suggest that this cannot be a meaningful contributor to stuttering onset. First, in many cases, the child does not have a current role model, even in cases where familial predisposition can be ascertained. More compellingly, as Walt Manning has observed, early stuttering rarely has the attributes more typically seen in the speech and non-speech behaviors of adults who stutter: often there is relative lack of awareness, and few concomitant physical, affective, and cognitive features. Both sets of facts strongly argue against children adopting stuttering speech in imitation of someone else. Children growing up in homes with non-native speakers do not learn to speak with an accent (e.g., Floccia et al., 2012), suggesting that imitation of role models does not play much of a role in children’s speech development.
Forcing a left-handed child to become right-handed causes stuttering.
Although improvements to imaging technologies do suggest atypical cortical organization in people who stutter, no evidence exists to show that the etiology of stuttering can be traced back to switching handedness in young children. No studies have provided evidence for the "switching hypothesis" or increased prevalence of stuttering among left-handers (Andrews & Harris, 1964; Porfert & Rosenfield, 1978; Webster & Poulos, 1987). Switching handedness does not seem to reorganize brain functions for language (Siebner et al., 2002).
Identifying or labeling a child as a stutterer or calling attention to children’s stuttered events results in chronic stuttering.
In our opinion, the strongest argument against this myth is the relatively successful track record of the Lidcombe Program in treating early stuttering. The therapy requires parents to provide overt feedback to moments of stuttering. Even if one questions whether Lidcombe intervention is superior to other options, this myth would predict that few children benefit from Lidcombe and that most experience a worsening of symptoms, a hypothesis strongly rejected by published data.
If you can’t hear, you won’t stutter (stuttering doesn’t exist in the Deaf community).
This myth has many “codicils” mostly centering around the hypothesis that stuttering reflects a problem unique to the speech motor encoding system or the auditory feedback system. Historically, most communication disorders were thought to be limited to the oral/aural mode. As research into sign languages and systems has enlarged, we know that native signers can experience aphasia, or developmental language impairment (Quinto-Pozos, 2014; Quinto-Pozos et al., 2011). For stuttering, reasonable analogies have been detected among native users of the world’s sign languages (e.g., Cosyns et al., 2009)
If hearing acuity is thought to play a critical role in enabling the development of stuttering, recent work by Arenas, Walker and Oleson (2017), suggests that children who are hard of hearing are as likely, if not more likely, to present with co-morbid stuttering as the general population. The authors speculate a possible causal role of delayed language achievement in making stuttering more likely in the hearing-impaired children that they studied. They note that earlier work in this regard predates the “mainstream education,” where deaf children can be tracked more effectively.
Stuttering is more frequent in children who are raised bilingually.
Despite occasional reports to the contrary, the rate of clinically-relevant stuttering (as opposed to spoken language disfluency) has not been shown to be elevated in bilingualism, which is the natural state of language use for most of the world’s speakers, outside of the United States.
Less common myths and their cultural origins
Many of these myths are collected and available for review at Judy Kuster’s StutteringHomePage: http://www.mnsu.edu/comdis/kuster/Infostuttering/folkmyths.html; we do not attribute each one individually, especially because many overlap among communities around the world.
We note that region- or experience-specific hypotheses (e.g., seeing a snake in the rural U.S. South, eating grasshoppers in one African myth) do a poor job of accounting for the worldwide incidence of stuttering. The major value of understanding culture-specific myths about how stuttering arises is not to debate their evidence-base, but to understand how parents, family members, and the person who stutters may inaccurately attribute cause for stuttering. If a myth indicts parents’ child-rearing practices, or places blame for the stuttering on the PWS, discussion of popular but misguided theories can help clients and others into more constructive discussion of the life impacts of stuttering and how to address them.
A number of African American myths regarding stuttering (Robinson & Crowe, 1998), suggest that stuttering is caused by foods the mother ate while breastfeeding the child, or the child ate, exposing the child to tickling; self-reflection in a mirror; cutting the child’s hair prior to the emergence of first words; or exposure to snakes (or other traumatic experiences) during pregnancy. Still others echo myths of early trauma and stuttering (child was scared, bitten by an animal, dropped, etc.). Still a last category is religious, also seen in numerous communities worldwide, that stuttering is the work of evil forces, such as the Devil. Physiological beliefs about the cause of stuttering also vary around the world, including problems with tongue structure. There is currently no evidence to suggest that anatomical differences in tongue, lip, or laryngeal structure or function play a role in stuttering.
Folk theories of how to treat stuttering
In this section, we mainly address folk therapies with no known scientific support. Nonetheless, we refer readers to a very long list of such folk interventions available at http://www.mnsu.edu/comdis/kuster/Infostuttering/folkmyths.html with the caveat that there is no scientific evidence that any of these will ameliorate stuttering symptoms, let alone “cure” stuttering.
A number of folk theories that generously use “punishment” presume that the child (or adult) has volitional control over the stuttering. Such “treatments” probably stem from one of the mysteries of stuttering discussed earlier—why it is not always present. Such treatments encourage the speaker to “pay attention” and avoid displaying stuttering behaviors; these include slapping the child (with or without an associated object, or under certain weather conditions).
Still other treatments fall under a rubric that also has the speaker limit body movements of the feet or hands (perhaps in response to secondary/accessory physical behaviors. Additional treatments, most obviously “pioneered” by Demosthenes, have the speaker attempt to talk with an object in the mouth (a pebble, or in some African cultures, a nutmeg). Some effective fluency therapies do contain elements of increased proprioceptive skill and a heightened awareness of articulatory gestures encouraged by such tasks.
Others have a germ of truth in either speech restructuring or desensitization, such as speech practice in front of a mirror. In numerous cultures, medication, often in the form of herbs or other potions, may be recommended. We note that none have any published support of effectiveness, to our knowledge.
Complementary/alternative therapies for stuttering
First, we must distinguish among those that are useful in dealing with potential affective concomitants, such as anxiety, from those that address speech symptoms. For instance, yoga can be useful in promoting a sense of calm in PWS (e.g., Kauffman, 2016). We do note, however, one small study suggests yoga can also temporarily reduce stuttering symptoms (Gatzonis & Fabus, 2015). While every effective therapy starts with a minimum of a case study, we note that there are many more anecdotal recommendations for helping the PWS than there are published, peer-reviewed evaluations of the numerous treatments reported on the StutteringHomePage and elsewhere. While there is likely to be more than a single effective treatment to address the multiple concerns of people who stutter, we still recommend caution in pursuit of treatment recommendations without published support.
Stuttering in young children [and even adults] who stutter will improve if they “Slow down, and relax.”
We reserve the final myth about how to help a person who stutters, particularly young children, for the end. Probably no other recommendation has been proffered so often and by so many. A survey conducted by the Stuttering Foundation of America https://www.stutteringhelp.org/wirthlin-survey-synopsis-results found that almost 90% of adults believed that this advice was helpful when dealing with a child who stutters. In our professional experience, this has also been coupled with “take a deep breath,” which has brought more than one gasping CWS into our clinic. While many myths, such as ignoring the problem, appear to be on the decline, this myth remains active, and, as always, very unhelpful. As many point out, if this actually did work, there would be no stuttering and, thus, no need for A Handbook on Stuttering.
Summary
We firmly believe, especially in the age of Internet self-education, that it is wise to confront some typical “alternative facts” that circulate the globe regarding stuttering. It is only by pointing out that many of these views of stuttering are not, in fact, grounded in research and science that we may perhaps avoid the spectre of PWS and their families attempting useless and ill-advised approaches to stuttering, at some personal cost (if not measured in dollars, measured in potential harm, if not heartache and potential loss of self-efficacy).
We are sure that we have not discovered all of the potential misunderstandings that involve stuttering and people who stutter. But perhaps, if a concept regarding what we know about stuttering, the person who stutters, and appropriate intervention concepts is not to be found elsewhere in A Handbook on Stuttering, it may very well be a myth.
In constructing this discussion of myths and mysteries, the authors would like to thank many of the groups that advocate for those who stutter for collecting and web posting many of the myths and mysteries we discuss, as well as numerous, meticulously documented contributions to the International Stuttering Day On-Line Conference, (http://isad.isastutter.org/).
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