Stuttering from anxiety

Stuttering in relation to anxiety, temperament, and personality: review and analysis with focus on causality

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Elsevier Science

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Review

. 2014 Jun;40:5-21.

doi: 10.1016/j.jfludis.2014.01.004. Epub 2014 Feb 8.

Per A Alm¹

Affiliations

Affiliation

¹ Department of Neuroscience, Speech and Language Pathology, Uppsala University, Sweden. Electronic address: [email protected].

PMID: 24929463
DOI: 10.1016/j.jfludis.2014.01.004

Review

Per A Alm. J Fluency Disord. 2014 Jun.

. 2014 Jun;40:5-21.

doi: 10.1016/j.jfludis.2014.01.004. Epub 2014 Feb 8.

Author

Per A Alm¹

Affiliation

¹ Department of Neuroscience, Speech and Language Pathology, Uppsala University, Sweden. Electronic address: [email protected].

PMID: 24929463
DOI: 10.1016/j.jfludis.2014.01.004

Abstract

Anxiety and emotional reactions have a central role in many theories of stuttering, for example that persons who stutter would tend to have an emotionally sensitive temperament. The possible relation between stuttering and certain traits of temperament or personality were reviewed and analyzed, with focus on temporal relations (i.e., what comes first). It was consistently found that preschool children who stutter (as a group) do not show any tendencies toward elevated temperamental traits of shyness or social anxiety compared with children who do not stutter. Significant group differences were, however, repeatedly reported for traits associated with inattention and hyperactivity/impulsivity, which is likely to reflect a subgroup of children who stutter. Available data is not consistent with the proposal that the risk for persistent stuttering is increased by an emotionally reactive temperament in children who stutter. Speech-related social anxiety develops in many cases of stuttering, before adulthood. Reduction of social anxiety in adults who stutter does not in itself appear to result in significant improvement of speech fluency. Studies have not revealed any relation between the severity of the motor symptoms of stuttering and temperamental traits. It is proposed that situational variability of stuttering, related to social complexity, is an effect of interference from social cognition and not directly from the emotions of social anxiety. In summary, the studies in this review provide strong evidence that persons who stutter are not characterized by constitutional traits of anxiety or similar constructs.

Educational objectives: This paper provides a review and analysis of studies of anxiety, temperament, and personality, organized with the objective to clarify cause and effect relations. Readers will be able to (a) understand the importance of effect size and distribution of data for interpretation of group differences; (b) understand the role of temporal relations for interpretation of cause and effect; (c) discuss the results of studies of anxiety, temperament and personality in relation to stuttering; and (d) discuss situational variations of stuttering and the possible role of social cognition.

Keywords: ADHD; Anxiety; Social cognition; Stuttering; Temperament.

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The Link Between Social Anxiety and Stuttering | Heuser Hearing Institute

Posted on April 29, 2020 by Heuser Hearing Institute

Recent research has shown a link between social anxiety disorder (SAD) and childhood-onset fluency disorder (stuttering), with a rate of overlap as high as 75 percent.

What Is Social Anxiety Disorder?

Social anxiety disorder is more than simply being nervous or shy. SAD, also known as a social phobia, causes people to avoid all social contact because certain aspects of everyday interactions, like small talk and eye contact, make them so uncomfortable.

Symptoms of SAD are triggered by social interactions, and may include:

Fear of being judged, embarrassed, humiliated or offending someone
Rapid heartbeat
Muscle tension
Dizziness
Gastrointestinal problems
Shortness of breath

Symptoms may occur when thinking about social interactions, during social interactions or even after social interactions have passed.

What Is Childhood-Onset Fluency Disorder?

Stuttering is a speech disorder that causes problems with fluency and speech flow. People who stutter know what they are trying to say but have a difficult time getting the words out. While common in young children learning how to speak, the condition can persist into adulthood without early intervention.

Symptoms of stuttering include:

Trouble starting a word, phrase or sentence
Prolonging sounds within a word
Repetition of a sound, syllable or word
Silence between syllables or words
Addition of filler words
Tension or tightness in the face

While less common, stuttering can be accompanied by:

Rapid eye blinks
Tremors of the lips or jaw
Facial tics
Head jerks
Clenched fists

The Link Between Stuttering & SAD

It is important to note that, while feelings of stress, anxiety or embarrassment are common for people who stutter, SAD is not diagnosed unless these symptoms are debilitating to some degree and occur for reasons beyond the stutter.

While the nature of the link between these conditions is unclear, studies have shown that the neurotransmitter dopamine plays a role in both stuttering and SAD. In fact, a higher rate of SAD has been found in people with Parkinson’s disease, a disorder involving dopamine production.

Neuroimaging has also shown that people with SAD and a stutter have abnormalities in their dopamine D2 receptor and process dopamine differently than people without these disorders. The amygdala may also play a role in SAD and stuttering.

Treatment Options

Speech therapy with a speech-language pathologist (SLP) is the standard treatment for stuttering and other speech disorders. SAD is often treated with medications such as selective serotonin reuptake inhibitors (SSRIs). People with both conditions benefit greatly from cognitive-behavioral therapy (CBT).

For more information about the link between stuttering and social anxiety disorder, contact the experts at Heuser Hearing Institute today at (502) 584-3573.

Learn More About Speech Disorders

What is a Speech Disorder?
Breaking Down the Different Speech Disorders
When Should You See a Speech Pathologist?

Contact Us

What is stuttering? | Centrum Słuchu i Mowy MEDINCUS

What is stuttering?

Yawning is a speech impediment that affects almost 1% of the population and usually occurs by 3-5 years of age. The disorder is manifested by impaired verbal communication, difficulty maintaining fluent speech due to excessive respiratory, vocal and articulatory muscle spasms.

The most common form of stuttering is:

repetition of words (daddy daddy bought me me),0012
chanting the word (for the time being meeeenya naaaasmork),
pauses between words (….. I want to….. watch……… TV),
phrase delay (allows for a minute of rest),
sound additions (I yyyy buy this yyyy bread),
breathing problems (frequent breaths, gasping for air),
"movements" (touching the eyes, lips, legs and other parts of the body),
avoiding eye contact.

We usually define stuttering as loss of control over pronunciation. This is a persistent attempt to express words with insufficiency on the part of the articulatory organs. People who stutter avoid difficult words, withdraw from various social assignments, do not keep up the conversation in society, so we often may not notice that a person has this kind of speech impairment. Initially, stuttering is mild and the person who stutters is not always aware that his speech is not fluent. As a result of adverse conditions or misbehavior on the part of others (friends, acquaintances, parents), the speech defect is fixed and becomes a serious problem in which a stuttering person begins to experience constant fear when communicating. Frustration arises (a mental state that occurs in a situation of real or perceived impossibility to satisfy certain needs, manifests itself in a number of emotional processes, such as disappointment, anxiety, irritation, and even despair).

The clinical picture of stuttering varies and depends on many factors. Signs of speech disorders can disappear, soften, and also intensify with obsessive fear, in situations and moments of strong mental stress (when communicating in a large group of people, while talking on the phone).

Most people who stutter share the opinion that the hidden aspects of stuttering (fear, embarrassment, shame, tension) contribute to the loss of self-confidence and belief in one's own abilities. The most difficult thing for a stuttering person is the fear that he will suddenly start to stutter and how others will react to it.

The level of fear is influenced by how a stutterer perceives himself. The more pronounced the signs of stuttering are, the more ambitious and dependent on the opinions of others is a person with stuttering, while his self-esteem decreases. The lack of response to the problem of stuttering when communicating with the second party does not eliminate it, but even makes it even more difficult.

How to help a stuttering person?

Required:

treat a stuttering person as a partner in communication and listen to him carefully.
accept the way people stutter.
do not interrupt or speak for a person with a stutter (this is a sign of impatience and recognition of his incapacity).
do not express excitement, regret and anger, allow the phrase to be completed.
Maintain eye contact while talking.

For parents and teachers of stuttering children:

Required:

speak slowly and calmly with your child so as not to create an atmosphere of "race".
do not interrupt the child, do not help finish a word or phrase, ask him to speak slowly, breathe calmly and not worry.
draw the attention of the child himself to how he speaks, especially if there are great difficulties. Allow him to finish the statement and then focus on things that don't bother him.
accept episodes of stuttering as something natural. We should listen to what the child says, not how he says it. This will help the stuttering child and will be an example for other children.
Do not exclude a stuttering child from a process that requires talking. For good health, attach to general recitation, choral singing and reading (with such forms of communication, stuttering disappears).
help the child develop self-esteem by not taking into account his missteps when speaking, but by emphasizing other actions that he does well.
Encourage even the slightest success of a student with slurred speech and positively set them up for more difficult activities.
protect the psyche of a child with rough speech, but at the same time temper it, helping to get out of difficult situations, if the child cannot cope on his own.

For stutterers:

You must:

define your problem exactly: what you do when you stutter, how you behave, what are your thoughts and feelings.
try to always speak thoroughly, whether stuttering occurs or not.
implement all changes in your life gradually.
do not hide stuttering is a non-contagious disease.
keep up the conversation.
stutter freely and do not try to hide the fact that you are a stutterer.
try to talk as much and as often as possible.

Your open attitude to the problem and your efforts will save you from fear.

“It is better to stutter than to be silent” Remember that you stutter in good company: Virgil, Charles Darwin, Marilyn Monroe, Winston Churchill, Anthony Quinn, Lukasz Holec, Bruce Willis, Mike Tyson, Jerzy Ovsiak, Adam Michnik.

Help for stuttering patients

We have developed and introduced into clinical practice a variety of ways to treat stuttering people. A variety of factors influencing the occurrence of stuttering necessitates a thorough diagnosis.

All stuttering people undergo phoniatric examinations, as well as speech therapy, psychological and pedagogical assessments. Based on the results of the research, taking into account the advice of specialists (test results), an individual rehabilitation program is being developed. At the same time, emphasis is placed on speech therapy, which improves the patient's speech fluency, as well as psychotherapy, physiotherapy, relaxation exercises, phoniatric rehabilitation and pharmacotherapy.

In addition, patients with abnormal auditory attention are treated with the Tomatis Method therapy (audio-psycho-linguistic stimulation). An important element of stuttering therapy is the method of stuttering correction using the Digital Speech Corrector. The results of numerous studies have confirmed the great effectiveness of the Digital Speech Corrector in the treatment of stuttering.

Stuttering - Kemma

Stuttering occurs in 4% of boys and 3% of girls of preschool age.

A certain role in the occurrence of stuttering is played by a constitutional factor or a speech, motor and communication deficiency shared with parents. Insufficiency of motor skills shared with any of the family members in children refers to poorly developed coordination of movements, stiffness, tension, or increased excitability of the muscles and ligaments of the articulatory apparatus.

Certain difficulties are observed when translating internal speech into external speech, when the child cannot freely express thoughts in words, i.e. he understands more than he speaks. This is due not so much to a lack of motor skills, but to a tendency to impressionism - the internal processing of feelings and experiences. Such children do not differ in a pronounced desire for sociability in the first years of life, preferring quiet, calm games with themselves. The most traumatic effect is the early coercion to communicate, a large number of adults, placement in a nursery and separation from parents, to whom they are very attached. Such an introverted (internal) orientation of the personality common with one of the parents gives rise to communication problems mainly in the field of establishing contacts with strangers, which, together with motor impairments, makes communication one-sided, inflexible and tense.

The opposite, extraverted orientation of the personality is also possible, when the child irresistibly strives to communicate with as many peers and adults as possible. Then the concern will be the restriction by adults of his communication with peers, which again will lead to tension and stiffness and, as an inevitable consequence, to difficulties in speech.

The next factor contributing to stuttering will be dysontogenesis, primarily a genetically disturbed rate of speech development, its unevenness. This may be indicated by a delay in the appearance of phrasal, and later articulatory, distinct or grammatically correct speech. Or, on the contrary, speech develops faster and a child at the beginning of the 2nd year of life speaks in phrases, and in the third year he reproduces by heart all the poems that he hears. In addition, the speech is distinguished by emphasized adulthood. The mixed version consists in the initial delay in speech, followed by a "breakthrough" - the pressure of words, an indomitable thirst to speak.

With regard to temperament, there is no significant predominance of extreme types.

If we are dealing with choleric temperaments, then involuntary interruptions in speech are mainly tonic in nature, such as repeated repetitions of letters at the beginning of a word. With a phlegmatic temperament, interruptions are predominantly clonic in nature: stretching out syllables and words, long pauses between them. With a sanguine type of temperament, the nature of speech convulsions will be mixed. However, the sanguine temperament in stuttering does not appear in its pure form and often represents in the process of development hardly compatible pseudo-combinations of features of choleric and phlegmatic temperaments. Such a contradiction in mental development creates a state of internal instability, which adversely affects speech. Stuttering is then distinguished by fluctuations that do not have visible causes at first glance.

In a number of cases, motor awkwardness characteristic of stuttering is a kind of rudiment of the phlegmatic character of one of the parents, while in general the child is characterized by high motor activity and swiftness - common features with another parent with a choleric temperament. This indicates an incompatible combination in children of polar opposite traits of the temperaments of their parents.

Another contributing factor to stuttering would be neuropathy. Significant fluctuations are experienced by stuttering in neuropathy due to frequent somatic diseases. The most common with stuttering is acute respiratory infections, chronic bronchitis and pneumonia, which in itself increases the excitability of such children.

Neuropathy as a general nervous and somatic weakness is a background in stuttering, preceding the appearance of psychogenically caused neurotic states.

Stuttering, which arose mainly under the influence of psychotraumatic factors in the first years of life, is referred to as logoneurosis. If in the future it is predetermined by fear, there are many fears, the child is timid and unsure of himself, then the diagnosis will be more correct - fear neurosis, and then it is better to regard stuttering as one of its manifestations. We can also talk about neurasthenia if stuttering is caused by an overstrain of the child's psychophysiological capabilities under the influence of excessively early, intensive training and an inadequate educational approach.

Stuttering is included in the structure of hysterical neurosis, when emotional disturbances, capriciousness, not always conscious desire to attract attention to oneself, including stuttering itself, and the desire to use it to influence others prevail. Then stuttering is overcome with difficulty, because the child is not interested in being like everyone else, and losing his exclusive influence on others.

In most cases, stuttering due to neurosis is difficult for children to experience. Often because of fear, stiffness or embarrassment, they refuse to make contact with strangers and are easily lost in a new environment. In the usual, well-established sphere of communication, they can speak quite freely, because they do not experience such a characteristic sense of responsibility for them, expressed by fears of looking funny, awkward, awkward and fear of saying something wrong, or not what is needed. Stuttering, therefore, manifests itself selectively, in certain areas of communication, and strongly depends on the psychological mood and general nervous state of the child.

The greatest difficulty for children with neuroses is not so much the speech itself, but the beginning of the conversation, because due to fear, insecurity and a mood for failure, they are unnecessarily worried, excited or inhibited at the same time (depending on temperament). Stuttering will also be characteristic of children with neuroses when a feeling of shame, an experience of what happened, appears. In this regard, such children are fundamentally different from children with residual cerebral phenomena of organic brain damage, who do not worry about their speech and do not speak worse when agitated or guilty.

Stuttering usually starts at 2 years of age. This is understandable, since at this time the child develops phrasal speech, which is in the most vulnerable position. Temperament is also clearly manifested, correlated with the speed of speech and general motor activity. It is during this period that the fundamental struggle of parents with stubbornness, self-will, slowness or restlessness often flares up, that is, with the emerging volitional qualities of the child's character and his temperament. In addition, up to 2.5 years, he is still quite strongly attached to his mother, so the affect on her absence when placed in a nursery is inevitable (especially if the child is emotionally sensitive, and the mother herself is highly anxious). And if parents "win" the confrontation with their children, then only at the cost of developing stuttering in children.

Stuttering can also start at the age of 3, the age of intensive emotional development. Three-year-olds, like two-year-olds, are afraid of injections and unexpected sounds. Therefore, pain and unexpected impact can be the reason for the onset of stuttering if they cause fear, shock, scream, which, as an affect, overstrains the child's still fragile speech system. At 3 years old, many children are afraid of the dark, fairy-tale characters and enclosed spaces. Most often, such fears are experienced by boys, which is one of the reasons for the more frequent occurrence of stuttering in them. At this age, they are easily frightened in the dark and in a limited space, where they may find themselves not of their own free will, but as a punishment or forced necessity (in a closet, isolation ward, box).

Attention is drawn to the personal characteristics of parents whose children stutter. As a rule, they are not sociable enough, they are prone to internal processing of feelings. Mothers often have high levels of anxiety. Fathers are less anxious, but more impulsive, and, as a rule, their role in the family is clearly insufficient. Both parents have an inherent desire to rush their children, to load them with various kinds of intellectual activities to the detriment of play activities. At the same time, parents themselves in most cases do not follow their own speech, and often the child does not keep up with its pace. In addition, adults are inconsistent in their demands, often change their minds, which is caused by internal instability and conflict relations in the family.

Thus, difficulties in speech as a means of communication in neuroses are of a deeper nature than speech deficiency itself, and arise as a result of a violation of the formation of interpersonal relationships, first in the family, and then when communicating with peers. Therefore, helping with stuttering is not only the elimination of a painful, neurotic state of the child, but also the restoration of his impaired, but not yet completely lost communication skills, the ability to accept and play roles and adequately express his feelings.

Learn more

Stuttering from anxiety

Stuttering in relation to anxiety, temperament, and personality: review and analysis with focus on causality

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The Link Between Social Anxiety and Stuttering | Heuser Hearing Institute

What Is Social Anxiety Disorder?

What Is Childhood-Onset Fluency Disorder?

The Link Between Stuttering & SAD

Treatment Options

Learn More About Speech Disorders

Categories

Contact Us

What is stuttering? | Centrum Słuchu i Mowy MEDINCUS

Stuttering - Kemma