27 Feb 2011
Stammering is treatable if it is discovered before a child reaches the age of six, say speech therapists
The highly acclaimed movie The King's Speech chronicles King George VI's lifelong struggle with stammering.
Approximately 1 per cent of the world's population, or about 70 million people, have the same affliction as the deceased British monarch.
In Singapore, it is estimated that more than 1 per cent of the population stammers.
The Singapore General Hospital's (SGH) speech therapy department, one of the main facilities for treating speech impediments here, has since 2003 treated 150 patients for stammering.
Stammering, or stuttering, is defined as a physical disorder where there is a disruption to the rhythm of speech due to the involuntary lack of coordination of speech muscles.
It appears in early childhood from about the ages of three to five and can carry on into adulthood.
While its exact cause is unknown, SGH's speech therapist Kristl Alphonso says there is a genetic link – about 60 per cent of people who stutter have a family history of stuttering. It affects boys more than girls at a ratio of 4:1.
Stuttering can also develop in adults as a result of a stroke or head trauma.
"Stuttering is not caused by anxiety or nervousness or any other psychological causes.
"Such emotions can exacerbate the stutter but they do not cause it," notes Ms Alphonso. The stutter manifests itself in different ways, such as repeating sounds or words as in "m-m-mummy" and stretching sounds as in "ssssnake".
Mr Zhou Xinzi, 21, who stammers, says, "My first memory of stuttering is at six years old, when my mum told me not to stomp my foot when I wanted to say a word. Stammerers tend to do that when they want to force out a word."
Mr Zhou, who has just finished his national service, recalls: "If a teacher asked a question and suddenly pointed at me to reply when I was totally unprepared, the stuttering would usually be quite terrible. The whole class would have to wait for me to say what I wanted to say. Friends would make fun of me because they didn't understand why I spoke that way."
IT consultant Lionel, 31, who declined to give his full name, also developed a stutter in primary school: "It was especially challenging for me to communicate with people in noisy places as I would need to raise my voice. Somehow, that made me stutter more."
Speech therapists told LifeStyle that stammering is more treatable if it is caught before a child turns six.
"Stuttering is very treatable in its early years. The benefits of treatment in early years outweigh that of the wait-and-see approach," says SGH's senior speech therapist Gwyneth Lee.
Currently, the gold standard for treating children who stammer is the Lidcombe programme.
Ms Lee cited a 2000 medical study in the American publication Journal Of Speech, Language And Hearing Research, which showed that out of 261 children who were treated, 250 children completed the first stage of the two-stage treatment with near-zero stuttering or no stuttering.
A behavioural treatment developed by a team of Australian researchers, it involves the parent being trained to tease out and listen for stutter-free and stuttered speech.
Positive reinforcement and gentle correction are emphasised. Treatment continues until the child has reached a very low level of stuttering or none at all.
Ms Lee says: "Parent and child come in for weekly therapy sessions with a clinician. The parent learns how to carry out the treatment and monitor the progress of the child."
It takes an average of four weeks of treatment before the child begins to show significant progress, and 16 weeks before speech is normalised.
But for the likes of Mr Zhou and Lionel, the condition is considered chronic. Mr Zhou sought treatment only when he was 15, while Lionel did so in his 20s. Both of them were previously unaware of treatment options.
"There is no cure for stuttering in adults as the disorder becomes more entrenched with age," says Ms Lee.
Adult patients need to learn a new speech pattern, which is a "fairly laborious" process since it is like learning a new way of talking.
The standard treatment, called smooth or prolonged speech, requires a lot of motivation on the individual's part to maintain fluent speech by practising daily on their own.
Exercises and techniques include starting gently on a sound and gradually joining the syllables of every word together.
It took three days of intensive treatment at SGH for Mr Zhou to improve, while Lionel also learnt to manage after 10 weekly sessions at SGH. Mr Zhou still stammers occasionally when he is feeling anxious but it is not as bad as before.
Besides practising the techniques every day, Lionel also attends a monthly support group at SGH for teenage and adult stutterers.
Its members practise speech techniques together and challenge themselves with situations such as public speaking.
Lionel says: "There are always challenging situations such as giving presentations or talking to strangers. I find that I am in much less control when I am physically tired or stressed.
"But I think I have accepted stuttering as a part of my life and as long as I can manage it, I should be happy."
"If a teacher asked a question and suddenly pointed at me to reply when I was totally unprepared, the stuttering would be terrible... Friends would make fun of me because they didn't understand why I spoke that way."
MR ZHOU XINZI recalling a stammering incident
Click here for jpeg format
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