The Destruction Of A Stuttering Asian

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From Wikipedia, the free encyclopedia
"Stutter" redirects here. For other uses, see Stutter (disambiguation).
"Stammer" redirects here. For other uses, see Stammer (disambiguation).
"Stammerer" redirects here. For people with the epithet "the Stammerer", see List of people known as the Stammerer.
"Stutterer" redirects here. For the short film, see Stutterer (film).
Stammering, alalia syllabaris, alalia literalis, anarthria literalis, dysphemia.[1]
Stuttering (/ˈstʌtərɪŋ/), stammering (/ˈstæmərɪŋ/
Involuntary sound repetition and disruption or blocking of speech
Usually resolves by late childhood; 20% of cases last into adulthood
Stuttering, also known as stammering and dysphemia, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.[2] The term stuttering is most commonly associated with involuntary sound repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by people who stutter as blocks, and the prolongation of certain sounds, usually vowels or semivowels. According to Watkins et al., stuttering is a disorder of "selection, initiation, and execution of motor sequences necessary for fluent speech production".[3] For many people who stutter, repetition is the main concern. The term "stuttering" covers a wide range of severity, from barely perceptible impediments that are largely cosmetic to severe symptoms that effectively prevent oral communication. Almost 70 million people worldwide stutter,[4] about 1% of the world's population.[3]
The impact of stuttering on a person's functioning and emotional state can be severe. This may include fears of having to enunciate specific vowels or consonants, fears of being caught stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being a possible target of bullying (especially in children), having to use word substitution and rearrange words in a sentence to hide stuttering, or a feeling of "loss of control" during speech. Stuttering is sometimes popularly seen as a symptom of anxiety, but there is no direct correlation in that direction.[5]
Stuttering is generally not a problem with the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress are not thought to cause stuttering, but they can trigger stuttering in people who have the speech disorder, and living with a stigmatized disability can result in anxiety and high allostatic stress load (chronic nervousness and stress) that reduce the amount of acute stress necessary to trigger stuttering in any given person who stutters, worsening the situation in the manner of a positive feedback system; the name 'stuttered speech syndrome' has been proposed for this condition.[6][7] Neither acute nor chronic stress, however, itself creates any predisposition to stuttering.
The disorder is also variable, which means that in certain situations, such as talking on the telephone or in a large group, the stuttering might be more severe or less, depending on whether or not the person who stutters is self-conscious about their stuttering. People who stutter often find that their stuttering fluctuates and that they have "good" days, "bad" days and "stutter-free" days. The times in which their stuttering fluctuates can be random.[8] Although the exact etiology, or cause, of stuttering is unknown, both genetics and neurophysiology are thought to contribute. There are many treatments and speech therapy techniques available that may help decrease speech disfluency in some people who stutter to the point where an untrained ear cannot identify a problem; however, there is essentially no cure for the disorder at present. The severity of the person's stuttering would correspond to the amount of speech therapy needed to decrease disfluency. For severe stuttering, long-term therapy and hard work is required to decrease disfluency.[9]
Common stuttering behaviors are observable signs of speech disfluencies, for example: repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. These differ from the normal disfluencies found in all speakers in that stuttering disfluencies may last longer, occur more frequently, and are produced with more effort and strain.[10] Stuttering disfluencies also vary in quality: common disfluencies tend to be repeated movements, fixed postures, or superfluous behaviors. Each of these three categories is composed of subgroups of stutters and disfluencies.[11]
The severity of a stutter is often not constant even for people who severely stutter. Stutterers commonly report dramatically increased fluency when talking in unison with another speaker, copying another's speech, whispering, singing, and acting or when talking to pets, young children, or themselves.[12] Other situations, such as public speaking and speaking on the telephone, are often greatly feared, and increased stuttering is reported.[13]
Stuttering could have a significant negative cognitive and affective impact on the person who stutters. It has been described in terms of the analogy to an iceberg, with the immediately visible and audible symptoms of stuttering above the waterline and a broader set of symptoms such as negative emotions hidden below the surface.[14] Feelings of embarrassment, shame, frustration, fear, anger, and guilt are frequent in people who stutter,[15] and may actually increase tension and effort, leading to increased stuttering.[16] With time, continued exposure to difficult speaking experiences may crystallize into a negative self-concept and self-image. Many perceive stutterers as less intelligent due to their disfluency; however, as a group, individuals who stutter tend to be of above average intelligence.[17] People who stutter may project their attitudes onto others, believing that the others think them nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program.[16]
Many people who stutter report a high emotional cost, including jobs or promotions not received, as well as relationships broken or not pursued.[18]
Linguistic tasks can invoke speech disfluency. People who stutter may experience varying disfluency.[19] Tasks that trigger disfluency usually require a controlled-language processing, which involves linguistic planning. In stuttering, it is seen that many individuals do not demonstrate disfluencies when it comes to tasks that allow for automatic processing without substantial planning. For example, singing "Happy Birthday" or other relatively common, repeated linguistic discourses, could be fluid in people who stutter. Tasks like this reduce semantic, syntactic, and prosodic planning, whereas spontaneous, "controlled" speech or reading aloud requires thoughts to transform into linguistic material and thereafter syntax and prosody. Some researchers hypothesize that controlled-language activated circuitry consistently does not function properly in people who stutter, whereas people who do not stutter only sometimes display disfluent speech and abnormal circuitry.[19]
No single, exclusive cause of developmental stuttering is known. A variety of hypotheses and theories suggests multiple factors contributing to stuttering.[20] Among these is the strong evidence that stuttering has a genetic basis.[21] Children who have first-degree relatives who stutter are three times as likely to develop a stutter.[22] However, twin and adoption studies suggest that genetic factors interact with environmental factors for stuttering to occur,[23] and many stutterers have no family history of the disorder.[24] There is evidence that stuttering is more common in children who also have concurrent speech, language, learning or motor difficulties.[25] Robert West, a pioneer of genetic studies in stuttering, has suggested that the presence of stuttering is connected to the fact that articulated speech is the last major acquisition in human evolution.[26]
Another view is that a stutter or stammer is a complex tic. This view is held for the following reasons. It always arises from repetition of sounds or words. Young children like repetition and the more tense they are feeling, the more they like this outlet for their tension – an understandable and quite normal reaction. They are capable of repeating all types of behaviour. The more tension that is felt, the less one likes change. The more change, the greater can be the repetition. So, when a 3 year old finds he has a new baby brother or sister he may start repeating sounds. The repetitions can become conditioned and automatic and ensuing struggles against the repetitions result in prolongations and blocks in his speech. More boys stammer than girls, in the ratio of 3–4 boys : 1 girl. This is because the male Hypothalamic-Pituitary-Adrenal (HPA) Axis is more active. As males produce more cortisol than females under the same provocation, they can be tense or anxious and become repetitive.[27]
In a 2010 article, three genes were found by Dennis Drayna and team to correlate with stuttering: GNPTAB, GNPTG, and NAGPA. Researchers estimated that alterations in these three genes were present in 9% of those who have a family history of stuttering.[28][29]
For some people who stutter, congenital factors may play a role. These may include physical trauma at or around birth, learning disabilities, as well as cerebral palsy. In others, there could be added impact due to stressful situations such as the birth of a sibling, moving, or a sudden growth in linguistic ability.[21][23]
There is clear empirical evidence for structural and functional differences in the brains of stutterers. Research is complicated somewhat by the possibility that such differences could be the consequences of stuttering rather than a cause, but recent research on older children confirms structural differences thereby giving strength to the argument that at least some of the differences are not a consequence of stuttering.[30][31]
Auditory processing deficits have also been proposed as a cause of stuttering. Stuttering is less prevalent in deaf and hard-of-hearing individuals,[32] and stuttering may be reduced when auditory feedback is altered, such as by masking, delayed auditory feedback (DAF), or frequency altered feedback.[20][33] There is some evidence that the functional organization of the auditory cortex may be different in people who stutter.[20]
There is evidence of differences in linguistic processing between people who stutter and people who do not.[34] Brain scans of adult stutterers have found greater activation of the right hemisphere, which is associated with emotions, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed.[20][23]
The capacities and demands model has been proposed to account for the heterogeneity of the disorder. In this approach, speech performance varies depending on the capacity that the individual has for producing fluent speech, and the demands placed upon the person by the speaking situation. Capacity for fluent speech may be affected by a predisposition to the disorder, auditory processing or motor speech deficits, and cognitive or affective issues. Demands may be increased by internal factors such as lack of confidence or self esteem or inadequate language skills or external factors such as peer pressure, time pressure, stressful speaking situations, insistence on perfect speech, and the like. In stuttering, the severity of the disorder is seen as likely to increase when demands placed on the person's speech and language system exceed their capacity to deal with these pressures.[35] However, the precise nature of the capacity or incapacity has not been delineated.
Though neuroimaging studies have not yet found specific neural correlates, there is much evidence that the brains of adults who stutter differ from the brains of adults who do not stutter. Several neuroimaging studies have emerged to identify areas associated with stuttering. In general, during stuttering, cerebral activities change dramatically in comparison to silent rest or fluent speech between people who stutter and people who do not. There is evidence that people who stutter activate motor programs before the articulatory or linguistic processing is initiated. Brain imaging studies have primarily been focused on adults. However, the neurological abnormalities found in adults does not determine whether childhood stuttering caused these abnormalities or whether the abnormalities cause stuttering.[30]
Studies utilizing positron emission tomography (PET) have found during tasks that invoke disfluent speech, people who stutter show hypoactivity in cortical areas associated with language processing, such as Broca's area, but hyperactivity in areas associated with motor function.[19] One such study that evaluated the stutter period found that there was overactivation in the cerebrum and cerebellum, and relative deactivation of the left hemisphere auditory areas and frontal temporal regions.[36]
Functional magnetic resonance imaging (fMRI) has found abnormal activation in the right frontal operculum (RFO), which is an area associated with time-estimation tasks, occasionally incorporated in complex speech.[19]
Researchers have explored temporal cortical activations by utilizing magnetoencephalography (MEG). In single-word-recognition tasks, people who did not stutter showed cortical activation first in occipital areas, then in left inferior-frontal regions such as Broca's area, and finally, in motor and premotor cortices. The stutterers also first had cortical activation in the occipital areas but the left inferior-frontal regions were activated only after the motor and premotor cortices were activated.[19][36]
During speech production, people who stutter show overactivity in the anterior insula, cerebellum and bilateral midbrain. They show underactivity in the ventral premotor, Rolandic opercular and sensorimotor cortex bilaterally and Heschl's gyrus in the left hemisphere.[30] Additionally, speech production yields underactivity in cortical motor and premotor areas.[30]
Much evidence from neuroimaging techniques has supported the theory that the right hemisphere of people who stutter interferes with left-hemisphere speech production.
Adults who stutter have anatomical differences in gyri within the perisylvian frontotemporal areas. A large amount of white matter is found in the right hemisphere of the brain, including the region of the superior temporal gyrus. This was discovered using voxel-based morphometry (VBM). On the other hand, lesser amounts of white matter are found in the left inferior arcuate fasciculus connecting the temporal and frontal areas in stuttering adults.[37]
Results have shown that there is less coordination between the speech motor and planning regions in the brain's left hemisphere of men and women who stutter, when compared to a non-stuttering control group.[38] Anatomical connectivity of the speech motor and planning regions is less vigorous in adults who stutter, especially women. Men who stutter seem to have more right-sided motor connectivity. On the other hand, stuttering women have less connectivity with the right motor regions.[38]
In non-stuttering, normal speech, PET scans show that both hemispheres are active but that the left hemisphere may be more active. By contrast, people who stutter yield more activity on the right hemisphere, suggesting that it might be interfering with left-hemisphere speech production. Another comparison of scans anterior forebrain regions are disproportionately active in stuttering subjects, while post-rolandic regions are relatively inactive.[39]
Bilateral increases and unusual right-left asymmetry has been found in the planum temporale when comparing people who stutter and people who do not.[36] These studies have also found that there are anatomical differences in the Rolandic operculum and arcuate fasciculus.[3]
The corpus callosum transfers information between the left and right cerebral hemispheres. The corpus callosum, rostrum, and the anterior mid-body sections are larger in adults who stutter as compared to normally fluent adults. This difference may be due to unusual functions of brain organization in stuttering adults and may be a result of how the stuttering adults performed language-relevant tasks. Furthermore, previous research has found that adults who stutter show cerebral hemispheres that contain uncommon brain proportions and allocations of gray and white matter tissue.[40]
Recent studies have found that adults who stutter have elevated levels of the neurotransmitter dopamine, and have thus found dopamine antagonists that reduce stuttering (see anti-stuttering medication below).[36] Overactivity of the midbrain has been found at the level of the substantia nigra extended to the red nucleus and subthalamic nucleus, which all contribute to the production of dopamine.[30] However, increased dopamine does not imply increased excitatory function since dopamine's effect can be both excitatory or inhibitory depending upon which dopamine receptors (labelled D1 – D5) have been stimulated.
Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a certified speech-language pathologist (SLP). Diagnosis of stuttering employs information both from direct observation of the individual and information about the individual's background, through a case history.[41] Information from both sources should consider things such as age, the various times it has occurred, and other impediments.[42] The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents.[43] The overall goal of assessment for the SLP will be (1) to determine whether a speech disfluency exists, and (2) assess if its severity warrants concern for further treatment.
During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech (Riley’s Stuttering Severity Instrument Fourth Edition (SSI-4)).[43] They might also employ a test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, part-word repetitions and prolongations, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future.[44]
Stuttering is a multifaceted, complex disorder that can impact an individual's life in a variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), qual
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The Destruction Of A Stuttering Asian

The Destruction Of A Stuttering Asian

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