Speech Impairment Awareness in Behavioral Health

Have you ever traveled to a foreign country and not known the local language? Ever blanked while speaking publicly? Perhaps you’ve experienced the terror of choking and not being able to yell for help? For those of us without consistent barriers to verbal communication, it’s easy to forget how integral speech is in our lives until, in a moment of dire need, we cannot access the necessary words. 

People who live with speech disorders, however, are much more attuned to barriers in verbal communication. Speech disorders are conditions that affect someone’s ability to make the speech sounds needed for verbal communication (Eske, 2019). Stuttering, a common type of speech disorder, interrupts speech-flow through involuntary stretching, repeating, and blocks in speech sounds (Eske, 2019).  It is estimated that over three million people living in the United States stutter (Quick 2017).

Developmental stuttering, resulting from genetic factors and abnormalities in speech motor control, affects children ages two to six and is the most common form of stuttering (Mayo, 2017; Quick, 2017). Twenty-five percent of children who stutter will experience persistent developmental stuttering, in which stuttering continues through development into adulthood (Quick, 2017). Traumatic brain injuries, brain disorders, and strokes can give rise to neurogenic stuttering.  (Mayo, 2017). Emotional trauma can bring about psyhogenic stuttering and other speech disturbances in the form of conversion reactions, though these can be difficult to distinguish from neurogenic stuttering (Mayo 2017; Almada, Simões, Constante, Casquinha, & Heitor, 2016).

Like many other health conditions, stuttering is among those that may not seem immediately tied to behavioral health. This is far from the truth. People who chronically stutter can experience feelings of anxiety, fear, shame, and frustration around the condition and may make effort to order their lives so as to avoid situations, words, people or activities that activate the alarming feelings associated with the stutter (Ginsberg & Wexler, 2000). For instance, one study that examined the effects of stuttering on quality of life in adults  found that stuttering negatively affects mental health, social functioning, and emotional functioning (Craig, Blumgart, & Tran, 2009). Another study found that stuttering puts adults at greater risk for anxiety disorders than non-stuttering adults (Iverach, et al., 2009).

Stuttering and Post Traumatic Stress Disorder (PTSD), a complex psychiatric condition resulting from experiencing intolerable amounts of stress, have been found to intersect on several levels. For instance, one case study examining the relationship between stuttering and PTSD found that the two conditions have similar neurobiological effects and symptoms, including slowed speech, slowed functioning, and memory loss from disassociation (Bigleveld, 2015). Starkweather and Givens (2004) in their report on stuttering as a variant of PTSD emphasized that stuttering itself has the potential to be a form of social PTSD. Both conditions, though distinguished from one another in levels of severity, are marked by cycles of hyper-arousal and distress around the hyper-aroused states.

As a result of the chronic, intrusive nature of the hyperaroused states, including feelings of terror, fear, anger, shame, and frustration, people with PTSD or stuttering may order their lives so as to avoid these states as much as possible (Starkweather & Givens, 2004). For instance, someone who stutters may feel immediate frustration and anxiety around saying certain speech sounds in front of a group and experience physical symptoms such as sweating or increased heart rate. The person may then try to avoid saying those words or sounds altogether. Someone who suffers from PTSD may similarly avoid those situations where triggers abound. This ultimately can impact the flow of short-term decisions, such as asking someone on a date or going grocery shopping, and long-term decisions, such as moving to a new place or choosing a career path. 

Disassociation serves as a complex mechanism in both PTSD and stuttering to protect a person from feeling the full intensity of hyper-aroused states. When someone disassociates, they may “leave” their body for a period of a few hours or days and lose touch with their sense of identity as well as other reality markers such as time and surroundings (Starkweather & Givens, 2004).

The therapeutic techniques for addressing PTSD and stuttering are similar in that the aim is to integrate intrusive, emotionally dysregulating experiences into the larger framework of a person’s life. Sustainable integration means that the PTSD or stuttering are no longer the defining factors in one’s life but instead become adaptable, moveable pieces in the puzzle. As the hyper-aroused states and other challenges associated with each condition become less central to a person’s life, the person can then move flexibly to and from states that are more livable (Starkweather & Givens, 2004). This may sound straightforward, but it is important to remember that the processes of integration are nonlinear, and every person’s therapeutic experience will different. What works for one person may not work for another.

Also like PTSD and many behavioral health topics, stuttering and other speech impairments are subject to societal misunderstanding and stigma. It is always best to take on a perspective of curiosity and get information from reliable, non-biased sources when delving into any of these issues. Let’s remember this especially as we celebrate Better Speech and Hearing Month!

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Almada, A., Simões, R., Constante, M., Casquinha, P., & Heitor, M. (2016). Psychogenic stuttering: A case and review. European Psychiatry, 33. doi: 10.1016/j.eurpsy.2016.01.1389

Bijleveld, H.-A. (2015). Post-traumatic Stress Disorder and Stuttering: A Diagnostic Challenge in a Case Study. Procedia – Social and Behavioral Sciences193, 37–43. doi: 10.1016/j.sbspro.2015.03.242

Craig, A., Blumgart, E., & Tran, Y. (2009). The impact of stuttering on the quality of life in adults who stutter. Journal of Fluency Disorders, 34(2), 61–71. doi: 10.1016/j.jfludis.2009.05.002

Eske, J. (2019, March 21). Speech disorders: Types, symptoms, causes, and treatment. Retrieved from https://www.medicalnewstoday.com/articles/324764#types

Ginsberg, A. P., & Wexler, K. B. (2000). Understanding Stuttering and Counseling Clients Who Stutter. Journal of Mental Health Counseling, 22(3), 228–239.

Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., … Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23(7), 928–934. doi: 10.1016/j.janxdis.2009.06.003

Starkweather, W., & Givens, J. (2004). Stuttering as A Variant of Post Traumatic Stress Disorder. Retrieved from https://www.stuttering-specialist.com/post/stuttering-as-a-variant-of-post-traumatic-stress-disorder

Mayo Clinic. Stuttering. (2017, August 1). Retrieved from https://www.mayoclinic.org/diseases-conditions/stuttering/symptoms-causes/syc-20353572

Quick Statistics About Voice, Speech, Language. (2017, December 21). Retrieved from https://www.nidcd.nih.gov/health/statistics/quick-statistics-voice-speech-language

Image credit: https://www.labourmobility.com/we-all-speak-english-dont-we/

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