Stuttering or Balbuties represents a rather complex event, so that the Bahandlung must be due to the versatility of the causes multi-track. The term treatment is used here in the broadest sense of the word and not only in the purely medical or speech-pedagogical sense. Therefore, the question posed at the beginning can only be answered with a yes, but also with a conditional no, taking into account all accompanying circumstances that have led to stuttering. What is the underlying cause of stuttering?
Causes
Is it a defect in the so-called speech center of the brain, a congenital, even hereditary condition, is it perhaps an expression of nervousness or a sign of unwillingness, naughtiness or defiance that leads to stuttering? These questions are often asked to the doctor or the speech pedagogue. We will try to answer these questions briefly. A brain defect can only be assumed if there are demonstrable pathological changes in certain brain regions. This type of stuttering is associated with even more speech disorders. However, these rarer cases of stuttering will not be discussed here, nor will stutterers with significant intelligence deficiencies. Stuttering is not a hereditary condition, and scientific research does not prove that it is hereditary. Some people believe that stuttering belongs to the so-called nervous speech disorders. From the medical point of view it can be said that the signs of general nervous overexcitability are often observed in children and adolescents who stutter. They are accompanying symptoms. It is not the general nervousness that is the cause, but a concomitant or secondary symptom, resulting from the overall picture to be described below. From the psychotherapeutic or neurological point of view, we must reject the idea that defiance, naughtiness, or even rebelliousness are the reasons that lead to stuttering. However, we observe that by far the majority of children and adolescents who stutter are those who must be described as neurotic. It is with these that we wish to deal predominantly here. Neuroses are malfunctions of organs or whole organ systems by the controlling and regulating organ, the brain. They almost always result from disturbed relations between the whole organism and its environment. As with every neurosis, neurotic stuttering also conceals a highly complicated physical and bodily process, which is difficult to uncover and not always possible in all cases, since we are not always able to uncover with certainty all the objective bases for the development and elimination of the disturbances of the functional process from the child’s forms of expression. The main causes of the development of children’s neuroses and consequently also of stuttering are based on the disturbances of the interpersonal relations of the child and its environment. In the case of stuttering children, in whom no sufficient environmental disturbances are found, stuttering is sometimes based on character peculiarities, in which almost without exception severe disturbances are present in the area of emotional, volitional and instinctive life. In both character peculiar and neurotic children there are no intellectual backwardnesses, sometimes these children even have quite good intelligence. Stuttering shows itself as a malfunction in the pronunciation technique. Therefore, as accompanying symptoms one not infrequently sees rich, often grimacing co-movements of the entire facial musculature, arms, legs and faulty breathing technique.
Symptoms, complaints and signs
A typical symptom of stuttering is choppy, involuntarily interrupted speech and the involuntary repetition of individual syllables. While some stutterers are only unable to speak the first syllable fluently, others have problems with every word. They do not succeed in pronouncing a sentence intelligibly. In addition to the possibly compulsive repetition of individual syllables and words as typical signs of stuttering, the complaints of many affected persons are primarily of a psychological nature. Language as a means of communication is necessary in many situations so that social relationships can develop and be maintained. If not treated, complaints in this area often cause affected persons to withdraw.They avoid situations in which stuttering is particularly prominent and, in extreme cases, avoid any conversation. There is a risk of unwanted social isolation with possible consequences such as depression and even suicidal tendencies. Children and adolescents in particular suffer extremely emotionally from stuttering, as their peers often show little understanding and ridicule the speech impediment. It is advisable to consult a specialist at the first appearance of symptoms that indicate stuttering. The sooner the signs of a speech defect can be treated, the sooner those affected will find their way back to a normal way of speaking.
Disease progression
Psychologically, children who stutter appear inhibited, but at the same time restless, shy, and occasionally challenging. Most stutterers suffer from their speech disorder, so these children, also because they are often very teased, annoyed, and ridiculed, withdraw from others, thus losing the natural need for contact and the child’s own zest for life. From the point of view of neurologists and psychotherapists, it is fair to say that by far the largest proportion of all children who stutter are those who have environmental disorders. As a result, these children also appear restless in their motor activity (body movements), unsteady in their behavior, and are also considered nervous because of the psychological otherness already described. It is to be seen in such a way that the environmental disturbances condition the stuttering and this in its turn affects the personality of the child in such a way that nervous concomitant and consequential symptoms occur.
Complications
Complications related to stuttering usually arise in the social sphere of the affected person. Especially untreated stuttering makes the person who stutters gradually avoid social situations in many cases. One fears glances and ridicule from third parties and prefers to withdraw. This can lead to a breakdown of the usual everyday life, both in the private and professional sphere. Especially children who neither understand the health-related background of stuttering nor can verbalize their emotions in this regard suffer from the situation. They are threatened with social isolation. If speech is generally avoided due to stuttering, there is also a risk of speech developmental delays, which later require intensive logopedic therapy. Without such treatment, success in school is also at risk. Accordingly, complications surrounding stuttering can best be avoided by quickly initiating therapy. Depending on the individual cause of the stuttering, however, even therapy does not immediately bring the desired results. It takes time until a normal way of speaking can be learned again. To avoid psychosocial complications, psychotherapy may therefore also be indicated to accompany speech therapy.
When should you see a doctor?
Speech disorders do not always require a doctor. If stuttering occurs due to internal excitement, a stressful experience or a hectic situation, it is a temporary phenomenon. As soon as normal speech flow returns some time later, the affected person does not need any further help. Basically, care should be taken to remain calm in these situations. This is sufficient to achieve a long-term improvement. If the stuttering persists in different situations or increases in extent as well as in probability of occurrence, consultation with a doctor should be sought. Involuntary repetition of syllables or choppy pronunciation should be discussed with a physician. Regardless of whether stuttering occurs only in certain environments or in the presence of individuals, the affected person should receive adequate support. A doctor or therapist is needed to clarify the cause. If psychological problems occur in addition to the abnormalities in speech, a visit to the doctor should be made. In case of changes in behavior, sleep disturbances, vegetative irregularities, headaches or changes in personality, clarification of the symptoms is necessary. Social isolation or withdrawal from participation in social life are warning signs that should not be ignored.
Treatment and therapy
In treating stuttering, it is essential to first determine the cause, because an intellectually underdeveloped child requires a very different treatment than a neurotic one.In general, the child who stutters should be approached with calmness and confidence and not pay too much attention to the speech disorder, because the more attention is paid to it, the more insecure the children become and the more the symptom appears. Not to look a stutterer in the mouth during a conversation is well known. Then the stutterer usually speaks more freely and without constraint. Strikingly, stuttering does not occur at all when reading, and never when singing. One has also made use of these facts in the treatment. By the way, the speech technique can be considerably improved or normalized by a specific speech treatment, which is mostly carried out by speech pedagogues and also in speech therapy schools. Depending on the age of the child, if possible at an early stage, special psychotherapeutic measures can be taken. Already at school age the so-called autogenic training can be applied, which serves mainly for relaxation but also for concentration on the functioning of individual organs and organ systems. Hypnosis has not proven to be effective. Suitable medications can calm down the stutterer and increase his physical and psychological stress tolerance, which has a positive effect on the treatment. However, medicines serve only as a supportive therapy. There is no drug that eliminates stuttering. Very essential is the attitude of educators and teachers, especially when it comes to child stutterers, where the causes are related to environmental disturbances. Beatings, scolding, bans and similar drastic so-called educational measures aggravate the symptom of stuttering and lead to further childish maladjustment. The friendlier, calmer, more relaxed the tone is, combined with measures that raise self-confidence, the more beneficial it is for the overall personality of the child who stutters.
Aftercare
Nowadays, stuttering can often be completely stopped or reduced to such an extent that the affected person no longer feels any pressure to suffer, using modern methods of speech therapy. The success of treatment can depend significantly on what the causes and trigger of stuttering were. Situational, sudden stuttering, for example, occurs frequently during child development and then disappears again quite suddenly. In this case, special aftercare is not necessary. Long phases of stuttering with unclear triggers or those related to psychological causes usually require longer therapy. Among other things, those affected learn new speech techniques and methods to help them overcome their stuttering and consciously pay attention to the way they speak. Follow-up appointments can be useful to review and refresh the effectiveness of what has been learned. Many people affected by stuttering need follow-up appointments to receive regular feedback and stabilization, especially if the cause is psychological. If learned speech techniques are not used correctly or consistently, stuttering can also return. Follow-up care then also serves to avoid this problem and to practice correct speech again and again even after acute treatment of stuttering.
What you can do yourself
Stutterers should be open about their condition. Often, social exclusion or shame is the main trigger for stuttering attacks. People who stutter may announce their discomfort when they come into contact with unfamiliar people. With the appropriate looseness, dealing with the disorder becomes much easier and the stuttering often subsides as well. Aids such as so-called auditory feedback devices improve the flow of speech by analyzing and correcting it. It is also helpful to have a friend or caregiver who points out the stuttering to the person with the disease and practices the correct way of speaking with him or her. Because stuttering often occurs as a result of nervousness, stutterers must be treated with patience and understanding. Stuttering must be treated for months and years before it is completely gone. In some patients, the neurological disorder even remains for the rest of their lives. However, training and the use of proper speaking techniques as well as an open approach to the disorder are important factors in dealing with stuttering. Patients who feel restricted by their condition should consult a speech therapist and, if necessary, contact a self-help group.
