Stuttering is a fluency disorder that affects roughly three million Americans, occurring most commonly in children between the ages of 2-5 who are still developing language skills. However, stuttering can affect people of all ages. Even though 5% of children stutter for some period of their childhood, most will outgrow it; around 1% or less of adults stutter. While it does not fall into the same category as an articulation disorder, stuttering and articulation disorders can coexist making speech and communication even more difficult.
Before we can understand the connection between an articulation disorder and stuttering, we have to understand their differences.
What Is Articulation Disorder?
The focus of articulation disorders is on speech production and is sometimes referred to as a functional speech disorder that makes a person's speech difficult to understand. Variations of articulation disorders include omitting, distorting, substituting, or adding speech sounds while speaking. The causes of an articulation disorder are not known, but it can co-occur with medical disorders such as down syndrome or cerebral palsy due to the muscular difficulty in the face with these disorders.
This differs from stuttering because a fluency disorder is not about speech production, but a disruption in the normal flow of speech or the smoothness of the sounds, which is characterized by traits like prolonged or repetitious speech. Other warning signs for stuttering include voice tremors, changes in pitch while speaking, the schwa (uh sound) vowel, and either a moment of fear while speaking or avoidance of speech entirely. There is an emotional component to fluency disorders that cause them to worsen when the person is nervous, scared, excited, or anxious.
How Does It Affect Speech?
Normal speech is produced through coordinated muscle movements involving breathing, voice production (phonation), and articulation, which is comprised of the movement of the throat, palate, tongue, and lips. These movements are controlled by the brain and monitored through our hearing and touch senses.
An articulation disorder affects the way speech is articulated or spoken aloud, specifically changing the way a word sounds. Rather than struggling to speak words like with a fluency disorder, people afflicted by an articulation disorder alter their speech as they speak. Below we'll examine closely each way a sound or word can be changed by this disorder.
Omission occurs when a syllable or sound in the word has been deleted or erased during speech, such as pronouncing 'hat' as 'at.'
Distortions happen when a typically developing sound gets misused by a non-typical sound. A common example of a distortion is the lateral /s/ sound, in which air passes through the side of the mouth rather than the center creating a sloshed variation of the proper /s/ sound.
When a person changes (or substitutes) a sound in a word for a different sound, we call it substituting. An example is saying "wabbit" instead of "rabbit" or "thun" instead of "sun." This is the most common articulation disorder errors.
The addition of sounds to words is what it sounds like, adding extra sounds into a word. For example, a child saying "doga" rather than "dog."
The reason stuttering is not an articulation disorder is that the person speaking is not distorting or substituting sounds in their speech, or even adding extra random sounds. A person who stutters struggles to speak by repeating words or prolonging syllables of words such as go-go-goat. Particularly if they are using a shwa vowel such as guh-guh-goat, indicating a stutter that may be more long-lasting.
Stuttering is remarkably common in most children because their language is still developing, however, a persistent stutter does need to be addressed. If your child consistently stutters for over 3 months, then chances are they need to visit a speech-language pathologist to be evaluated and start speech therapy.
Studies have shown that boys are twice as likely to stutter than girls and three to four times more likely to continue stuttering as they get older.
There are actually 3 types of stuttering: neurogenic, developmental, and psychogenic. It was originally believed all stuttering was psychogenic, however, that's not true, and psychogenic stuttering is actually quite rare while the other two are much more common. The causes of the three types of stuttering can be found below.
TYPES OF STUTTERING
Psychogenic stuttering is caused by emotional trauma or internal problems with thought and reasoning.
Neurogenic stuttering can occur after a traumatic brain injury such as a stroke or head trauma.
Developmental stuttering is the most common form of stuttering; it occurs in children who are still developing their speech and language skills. This type of stuttering appears to run in families and in 2010, researchers from The National Institute on Deafness and Other Communication Disorders (NIDCD) isolated three genes that cause stuttering on chromosome 12 and two on chromosome 16:
These three genes work together to recycle cellular components by breaking them down. GNPTAB and GNPTG have connections with two metabolic diseases, mucolipidosis (ML) II and III, which are also caused by problems with cellular recycling leading researchers to study how this defect might lead to specific defects with speech fluency.
Therapy and self-help groups with other affected patients are shown to be very effective. Drug therapy, however, has been less successful. The FDA has not approved any drugs that specifically treat stuttering, and clinical studies are being conducted to find a drug that is successful. Drugs used for epilepsy, depression, and anxiety have shown an improvement in stuttering in some people, but researchers still think drug therapy for stuttering is largely ineffective.
There is no "cure" for stuttering, but will proper treatment and therapy, it can be managed or seemingly go away entirely as the patient becomes more comfortable speaking.
A similar disorder, known as cluttering, which is less common and often gets misdiagnosed as stuttering. Cluttering is a disorder in which the person is usually not aware when they're doing it. It develops from a young age as a child is learning to speak. They will often speak very quickly or irregularly, omit words, and get derailed from the topic. They tend to repeat phrases, interject, and often revise what they're saying. They have a lot of symptoms familiar from articulation disorder as they will leave words unfinished such as "welc" instead of "welcome," or collapse them like "elant" instead of "elephant." In some cases, the speech can sound slurred, but it is usually corrected by slower speech.
Cluttering leads us into how speech disorders can co-exist and create bigger problems for people, especially children if not treated early. Some of the disorders known to co-exist with cluttering include:
- Learning disability
- Speech motor dis-coordination
- Auditory processing disorders
- Autism spectrum disorder
- Sound-specific articulation disorders
- Language formation difficulties
- Thought organization difficulties
How Articulation Disorder Plays A Role In Stuttering
There are many types of speech disorders such as articulation disorder, stuttering, and cluttering. Sometimes these disorders co-mingle and can occur simultaneously in one person. While different, fluency and articulation do work hand in hand to allow us to communicate and each case of a speech disorder is specific to the individual and their needs.
In some cases, the stuttering will be more significant, especially if the person gets easily frustrated with their inability to communicate. Stuttering has an emotional tie to it and often worsens when a person is anxious or annoyed. While other cases, the primary issue might be the articulation disorder because of dropped syllables and substitutions. In both examples, the person cannot communicate effectively.
The role that articulation disorder plays in stuttering is that when treating a patient, a speech-language pathologist needs to know the best way to make positive progress with that patient and the fact of the matter is that each case will be different. Treatment will vary and may have to shift focus depending on how the patient is presenting symptoms.
The treatment for stuttering is a therapy that focuses on stuttering focuses on fluency; slowing down speech to make speaking smoother and identifying when the stuttering begins in conversation so that the patient can take steps to ease it. Articulation disorder is different as it focuses on language skills and speech sounds. Sometimes both take priority and have to be worked on concurrently, but most times one will take priority and therapy will adapt accordingly to the patient's needs. The goal is to have a patient who after working on preventing stuttering and boosting language skills will be able to communicate effectively, which will make them better adjusted to socialization and life.
Speech disorders, particularly stuttering, cluttering, and articulation disorder can be a major hindrance in a person's life, particularly a child who is just getting a grasp on language and who may feel shy and embarrassed by not communicating effectively. If you notice any traits of these speech disorders within your child, it's important to seek help from a speech-language pathologist, who will be able to better diagnose the disorder and start therapy to improve their speech, so they can better express themselves and their needs.