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TO THE PEDIATRICIANS AND FAMILY PHYSICIANS

THE CHILD WHO STUTTERS:

The term “disfluency” means a hesitation, interruption, or disruption of the flow of a speech utterance. It may be normal or, as in the case of stuttering it may be abnormal. Most children go through periods of disfluency as they learn to speak and try to keep up with adult speakers. Some will experience mild stuttering, and for others the difficulty will become severe. Early intervention by the pediatrician or family physician can help parents understand and thus minimize the problem.

ETIOLOGY

Although the etiology of stuttering is not fully understood, there is strong evidence to suggest that it emerges from a combination of constitutional and environmental factors. Geneticists have found indications that susceptibility to stuttering maybe inherited and that is most likely to occur in boys. Further support for inheritance comes from twin studies that have demonstrated a higher concordance for stuttering among both members of identical twin pairs than fraternal twin pairs. Congenital brain damage is also suspected to be a predisposing factor in some cases. For a large number of children who stutter, however, there is neither family history of the disorder nor clear evidence of brain damage.

Brain imaging studies conducted in many laboratories throughout the world indicate that adults who stutter show distinct anomalies in brain function (ref the Lancet, Nature, and Brain publications). In contrast with normal speaker individuals who stutter show deactivation of left-hemisphere sensorimotor centers and over-activation of homologous right-hemisphere structures during both stuttered and non-stuttered speech. The essential defect is hypothesized to be lack of sensorimotor integration necessary to regulate the rapid movements of fluent speech. Both temporary fluency (induced through singing or choral reading) and more permanent fluency (as result of behavioral treatments) appear to normalize the activation patterns.