Moses, Aristotle, Demosthenes, Aesop, Isaac Newton and Winston Churchill were
only a few of the personalities who suffered from stuttering – but the speech
impediment didn’t seem to get in their way.
Still, an estimated 80,000
Israelis – or one percent of the population – stammer, and the embarrassing
defect affects five percent at some time in their lives. While they cannot be
cured of it, stutterers can be helped to learn how to overcome
International Stuttering Awareness Week and its counterpart week in
Israel were marked late last month to help sufferers and non-stammerers to react
with patience and understanding.
Stuttering occurs in every culture, in
women and men,`` says Dr. Cahtia Adelman, the new director of the speech and
hearing clinics at Hadassah University Medical Centers in Jerusalem’s Ein Kerem
and on Mount Scopus, who is also a senior lecturer at the department of
communications disorders in the capital’s Hadassah Academic College. “It may be
that people who stutter are speaking too fast for what their motor coordination
Adelman, who came on aliya with her American family as a
teen before the Yom Kippur War, says in an interview with The Jerusalem Post
that awareness among parents about the possibility of speech and hearing
problems and the fact that treatment is included in the basket of health
services is growing. That is important, she says, because it’s vital to get
children to therapists as early as possible.
Adelman was chosen by a
tender earlier this year to replace at Hadassah the veteran and esteemed head of
the department, Haya Levi, who decided to retire early.
Hadassah since 1981, the new director has noted the growth in the number of
schools of speech and hearing therapy from the first at Tel Aviv University to a
total of five – including the Hadassah Academic College (which has a branch at
Jerusalem’s Haredi College), the University of Haifa, Ariel University and the
Kiryat Ono Academic College.
All four public health funds offer the
services of speech pathologists/audiologists, as do child development centers,
schools, old-age homes, special education programs, hospitals and hearing-aid
Currently there are 3,500 such therapists registered with the
Health Ministry. Israel is one of the more advanced countries providing speech
and hearing therapy, she adds. Unlike the US, where students usually learn
either hearing or speech therapy, in Israel, they are required to study both at
a high level.
Besides treating stuttering and other speech problems, the
Hadassah clinics treat patients with swallowing disorders, aphasia and cleft
palate; diagnose and treat voice disorders; screen newborns’ hearing; assess
hearing of people at all ages; and diagnose and habilitate patients who need
hearing aids or cochlear implants.
As for stammering, the four public
health funds usually cover the costs of the number of lessons that patients
need. Sometimes, says Adelman, getting approval for children is easier than for
adults. But in children, while treatment is covered, the cost of the initial
evaluation for children over the age of six is not paid for by the
Years ago, it used to be thought that parents were to blame for
“It was kind of a Freudian approach. But now we
know that parents are not to blame.
In fact, they can help the child.
Since treatment in children should come to speech pathologists as early as
possible. We try to see youngsters within weeks of hearing from parents that
there is a stuttering problem,” says Adelman.
“This way, we can give the
parents the first tools to help the child. Parents who work with their children
can really help. We start off with indirect therapy through parental counseling
to create a fluency-enhancing environment for the child by creating a home
environment of good communications. In that way, the affected child can
communicate and will be listened to.”
If direct therapy becomes
necessary, it’s more successful if parents get counseling before. Parents are
also vital to the success of direct therapy, as they practice with the child
daily. They are taught to make the exercises fun; if not, the child will not do
Speech pathologists/audiologists “get a lot of satisfaction from
their work. They can see their patients improve. When deaf people get a cochlear
implant that can help them to hear, it’s like magic. When working with people
who stutter, we have to work very hard. We can’t cure it, but we can raise the
quality of their lives by helping them to communicate better.”
INVOLVES disruptions in the production of speech sounds. Most people add “um” or
“ah” to their sentences as they think, but when extra sounds or syllables are
used too often, they become a stutter. It is not uniform: Some people stammer
only when they are doing certain things, like speaking before a group, and then
try to avoid such activities to escape embarrassment.
Others try to
obscure their stammering by rearranging or changing words they intend to use to
make their problem less prominent.
Although one would think that
stuttering is always easily identifiable, there are some people who stammer
whose speech defect can be diagnosed only by a speech therapist.
cases of stuttering are developmental, beginning in young children. However, in
rare cases, stuttering may be acquired in adulthood following a head injury,
stroke, brain tumor or the use of drugs. This type of stuttering has different
characteristics from its developmental equivalent. It tends to be limited to
partial-word or -sound repetitions, and is connected to a relative lack of
anxiety and secondary stuttering behaviors.
“Some treatment techniques
can help people with developmental stuttering but not with the acquired kind. We
can also help people with the acquired kind, but they need neurological and
psychological evaluation first,” Adelman says.
Both inheried and
environmental factors are responsible for developmental stuttering, Adelman
says. Among the contributory factors are genetics (about six out of 10
stutterers have a first-degree relative who stammers); the processing of
language in different parts of the brain; high activity levels; and a too-fast
rate of speech. “It apparently starts off with a genetic predisposition and then
environmental factors take effect,” she says.
The average age at which
children begin to stutter, says Adelman, is 30 months, but the onset is very
variable and can begin as early as a year and a half. It is quite natural for
young children begin to form words to stutter, so parents should not be unduly
worried, but they should be alert and as patient with the child as possible. If
the stammering gets worse and is accompanied by facial or body movements, a
speech and language therapist should be consulted around the age of three or
even earlier, if the child shows discomfort, the parents are concerned or there
is a family history of stuttering.
Adelman notes that boys have more
speech problems. “I don’t know if all speech problems are sex linked. But they
seem to develop speech at a slightly slower rate than girls. The prevalence of
stuttering in boys is about four time that of girls.”
FORTUNATELY , IN
about three-quarters of preschool children who stutter, the condition disappears
by itself by the time they go into first grade. Try not to call attention to
stammers in a child, as this embarrasses him and can make it worse. But it is
not recommended to ignore stuttering in a child. Parents and teachers must learn
how to talk about it to help them. Adelman says it’s impossible for her to
predict with certainty whether stuttering in a young child will pass by itself,
but a speech pathologist can use predictive factors to estimate the risk of it
becoming chronic and then decide how to proceed.
stutter are too-often ridiculed or singled out by their peers; if this happens
to your child, speak to the teacher, who should discuss it gently in the
classroom. At home, don’t correct or interrupt a stuttering child all the time.
Speak slowly to him. Family meals with calm conversation can be a good place for
the child to feel relaxed. In addition to consulting a speech pathologist, more
tips can be obtained from the AMBI (www.ambi.org.il), the Israel Association of
As Adelman states, there is no complete cure for stuttering,
but speech pathologists can nevertheless treat the condition in a comprehensive
way by helping sufferers to control their speech better. Trying to get them to
calm down is not effective. “We’re careful to stay away from that, as that is
‘advice’ they get from people around them, and it is not helpful.” The
professionals teach them to speak more slowly, control their breathing, stretch
their consonants and vowels and slowly progress from speaking in single
syllables to longer words and more complicated sentences.
About a third
of her clinic’s patients are young children, a third older children and teens
and the rest adults. For adults, she says, “we have conducted intensive,
threeweek treatment and, with follow-ups at lessening frequency. We are now in
the process of exploring the possibility of follow- up through various Internet
technologies so that patients won’t need so many follow-up visits in person. We
have found that some learning is better done in a group and some with only the
patient and the therapist alone.”
AT THE Hadassah clinic, Adelman does
not use biofeedback as treatment, as it has proved effect, but it can be tried
for speaking more softly, putting less pressure on speech
Hypnotism has been tried for the treatment of stuttering, but the
Hadassah expert says that it was disappointing. “Hypnotism in general doesn’t
work on everyone. For stuttering, even if people’s speech improves initially, it
fades away. Every time it’s done, the effect lessens. It’s very sad that it
doesn’t have a significant, long-term effect.”
One naturally thinks of
the possibility that medications can improve the speaking of those who stutter.
So far, no drug has been registered by the US Food and Drug Administration
specifically for treating stuttering. But a variety of psychoactive and other
prescription drugs have been given in centers around the world to people who
stutter. They include drugs for hypertension, depression and psychosis as well
as dopamine antagonists.
The drugs come with side effects, some of them
serious, and their efficacy has not really been proven; the option of
medications is not regarded as promising now. Yet pharmaceutical companies are
conducting research on potential drugs for stammering, as they are gambling on
products that would bring major profits. The Stuttering Foundation of America is
a force behind finding such a pharmaceutical cure.
Adelman says that to
get her clinical communications students – who may have to treat stuttering one
day – more aware of the condition, she asks them to stutter intentionally as
practice and see reactions of others. This definitely instills empathy in
Around the world support groups such as those organized by AMBI can
provide sufferers with more confidence and improve their quality of
“It’s harder to treat Arab patients, as while there are some
Arab-speaking speech pathologists, there aren’t enough,” Adelman says. “With the
increasing number of schools for training professionals, this problem should be
Young people who stutter are considered for enlistment into the
Israel Defense Service, but it depends on their profile. “If someone wants to be
in a combat position, this could be a problem, as he has to warn clearly and
immediately if there is danger.
This could be difficult for someone who
stutters. But others are inducted without any problem.
As for adults, the
Hadassah expert insists that treatment is “never too late. We have had good
results with people who first seek treatment after the age of 50. Among them,”
says Adelman, have been businessmen, lawyers, teachers and lecturers. Anybody