The disappearance of mild stuttering with maturation has been attributed incorrectly to all manner of treatment (hypnosis, progressive relaxation, speaking in rhythms, etc.) and used to bolster particular theories of causation. Because stuttering may reappear at times of emotional strain, a psychogenesis has been proposed, but—as pointed out by Orton and by Baker and colleagues—if there are any psychologic abnormalities in the stutterer, they are secondary rather than primary. We have observed that many stutterers, probably as a result of this impediment to free social interaction, do become increasingly fearful of talking and may become very self-conscious. By the time adolescence and adulthood are reached, emotional factors are so prominent that many physicians still mistake stuttering for a psychogenic disorder. Usually there is little or no evidence of any personality deviation before the onset of stuttering, and psychotherapy has not had a significant effect on the underlying defect. (The eminent Dr. Stanley Cobb undertook Jungian psychoanalysis for the condition according to R.D. Adams, with no benefit whatsoever.) A strong family history in many cases and male dominance point to a genetic origin, but the inheritance does not follow a readily discernible pattern.
Stuttering is not associated with any detectable weakness or ataxia of the speech musculature. The muscles of speech go into spasm only when called upon to perform the specific act of speaking. The spasms are not invoked by other actions (which may not be as complex or voluntary as speaking), differing in this way from an apraxia and the intention spasm of athetosis. Palilalia, too, is a different condition in which a word or phrase, usually the last one in a sentence, is repeated many times with decreasing volume. We are inclined toward a tentative view that stuttering represents a special category of extrapyramidal dystonic movement disorder, much like writer’s cramp.
Rarely, in adults as well as in children, stuttering may be acquired as a result of a lesion in the motor speech areas. A distinction has been drawn between developmental and acquired stuttering. The latter is said to interfere with the enunciation of any syllable of a word (not just the first), to favor involvement of grammatical and substantive words, and to be unaccompanied by anxiety and facial grimacing. Such distinctions are probably illusory. The reported lesion sites in acquired stuttering are so variable (right frontal, corpus striatum, left temporal, left parietal) as to be difficult to reconcile with proposed theories of developmental stuttering (see Fleet and Heilman).
Another form of acquired stuttering is more manifestly an expression of an extrapyramidal disorder. Here there occurs a prolonged repetition of syllables (vowel and consonant), which the patient cannot easily interrupt. The abnormality involves throat-clearing and other vocalizations, similar to what is seen in tic disorders.
Treatment The therapy of stuttering is difficult to evaluate and, on the whole, the therapy of speech-fluency disorders has been a frustrating effort. As remarked earlier, all these disturbances are modifiable by environmental circumstances. Thus a certain proportion of stutterers will become more fluent under certain conditions, such as reading aloud; others will stutter more severely at this time. Again, a majority of stutterers will be adversely affected by talking on the telephone; a minority are helped by this device. Some stutterers are more fluent under conditions of mild alcohol intoxication. Nearly every stutterer is fluent while singing. Schemes such as the encouragement of associated muscular movements (“penciling,” etc.) and the adoption of a “theatrical” approach to speaking have been advocated. Common to all such efforts has been the difficulty of achieving carryover into the natural speaking environment. Progressive relaxation, hypnosis, delayed auditory feedback, loud noise that masks speech sounds, and many other ancillary measures may help, but only temporarily. Canevini and colleagues have made the interesting observation that stuttering improved in an epileptic treated with levetiracetam, and Rosenberger has commented on other drug therapies.
Cluttering, or Cluttered Speech