Out of the mouths of babes

Stammering cannot be completely cured, but it can be treated to improve the quality of life in most sufferers.

Dr. Cahtia Adelman 370 (photo credit: Judy Siegel-Itzkovich)
Dr. Cahtia Adelman 370
(photo credit: Judy Siegel-Itzkovich)
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 it.
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 can handle.”
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.
Working at 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 suppliers.
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 insurers.
Years ago, it used to be thought that parents were to blame for children’s stuttering.
“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 it.”
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.”
STUTTERING 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.
Most 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.
Schoolchildren who 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 Stutterers.
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 organs.
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 them.
Around the world support groups such as those organized by AMBI can provide sufferers with more confidence and improve their quality of life.
“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 reduced.
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 can stutter.”