Nervousness. Stress. Shyness. Speaking more than one language. Thinking too quickly.
None of these are reasons why people stutter.
Yet, these misconceptions remain all too prevalent, says Angela Medina. For the estimated 80 million people worldwide who stutter, they can be hurtful and even sometimes give rise to stigma.
For International Stuttering Awareness Day on Oct. 22, Medina — an associate professor of Communication Sciences and Disorders in FIU’s Nicole Wertheim College of Nursing & Health Sciences — shines a light on this oftentimes misunderstood and complex speech disorder, how there’s often hidden emotional impacts, as well as what she's learned through her recent research on a mindfulness meditation program for adults who stutter.
First, tell us a little bit about stuttering. What is it?
Stuttering is a speech disorder that is comprised of behavioral, cognitive and affective (feelings, thoughts) components that can be evaluated, diagnosed and managed by a speech-language pathologist.
I think what comes to mind for many people first is the speech behaviors. Clinically speaking, these include repetitions of sounds and syllables (mo-mo-mo-mo-mommy), blockages of air (… mommy) and prolongation of speech sounds (mmmmmommy).
Over time, these speech behaviors may also be accompanied by other visible behaviors that show signs of tension or struggle such as grimacing, straining of the neck muscles and blinking hard. Stuttering doesn’t start out with these other behaviors. They are learned.
What many people do not consider, though, are the “invisible” aspects of stuttering, such as the feelings and attitudes people who stutter hold toward themselves and their stuttering. How these affective and cognitive components are managed has implications for the stutterer’s quality of life and well-being.
How are they managed?
It is different for everyone. For some, it might mean using clinical and/or self-taught speech strategies to lessen the severity of their stuttering as needed.
For others, it may be a matter of working on not letting stuttering negatively impact their lives by going ahead and saying the exact words they want to say when they want to say them — whether they know they are going to stutter on those words or not.
What are the biggest myths surrounding stuttering?
There are so many still floating around out there about the causes of stuttering! The ones I have heard most frequently are that stuttering is caused by nervousness, the brain thinking faster than the stutterer can talk, not breathing correctly or bilingualism.
Many of these incorrect beliefs about the causes of stuttering place blame on the stutterer as if they are doing something wrong. I think this plants the seeds for people’s well-intentioned but unhelpful advice for “curing” the stutter like telling the stutterer to “slow down,” “take a deep breath,” or “think about what you want to say before you say it."
"The fact of the matter is that stuttering is caused by differences in the way stutterers’ brains are structured and function. It cannot be cured."
As you said, stuttering cannot be cured. So, how do speech-language pathologists help?
About 75% of children who begin stuttering around the ages of 2-4 years old will grow out of stuttering early in their school-age years without therapy. The other 25% who continue stuttering past the age of puberty will stutter for the rest of their lives.
For children, teens, and adults who stutter, speech-language pathologists may work on a number of aspects related to stuttering, including self-advocacy, acceptance, stuttering with less tension and overall communication skills.
Your recent study explores how mindfulness can help people who stutter. Did it help with acceptance?
In this eight-week study, we had five adults who stutter participate in our once-a-week hybrid mindfulness program where they could join us live or watch a recording of that week’s live session. The sessions consisted of guided exploration of mindfulness topics (intention, acceptance, gratitude), breathing techniques for relaxation, guided meditation, and chair yoga.
After completing the program, three of our five participants showed improvement in their quality of life. However, participants reported they planned to apply mindfulness knowledge in their personal lives and that they noticed positive changes within themselves.
What does a mindfulness practice look like for someone who stutters?
As we saw in our study, mindfulness practice for a person who stutters can look the same as, if not identical to, the practice of a person who does not stutter. Everyone — regardless of the way they speak — can benefit from gentle stretches throughout their day, as well as breathing exercises designed to calm the nervous system.
Some ways a person who stutters may want to tailor their practice to fit their individual needs may be to do a body scan exercise, for example, and notice and then release tension that they may experience during stuttering moments, for instance in the throat, mouth, face and shoulders.
Similarly, studying and reflecting on concepts within mindfulness, such as acceptance, self-compassion and living in the present moment may promote improved feelings and attitudes about stuttering. Many people who stutter live with the uncertainty and challenges that come with not having control of their own speech as well as the subsequent negative reactions their listeners may have to their stuttering.
The concept of staying in the present moment can be life-changing for a person who stutters because, if they are staying in the present, they cannot ruminate on past negative social interactions nor can they worry about what might happen in future conversations. They can just “be” and there is so much freedom in that.
In addition, you also have researched the bilingual stuttering experience. What has been the biggest takeaway from that work?
Over the past several years of working with this population, the thing that has left a lasting impression on me is how detrimental it can be to strip a child of their native language.
I have worked with participants who stutter who cannot communicate with their grandparents and other family members because they never gained proficiency in their native language due to the misconception that stuttering is caused by bilingualism. Aside from the lack of connection with family members, stutterers have also reported feeling a lack of connection with their cultural communities and part of who they are because they cannot communicate in their native language.
Unfortunately, there are still professionals out there advising families to speak only one language in the household to avoid the risk of stuttering. To date, research does not support the idea that bilingualism causes stuttering. On the contrary, it shows the cognitive benefits of bilingualism.
Angela Medina is Research Director of the Mindfulness Research Lab and helps design and test the efficacy of mindfulness meditation programs for people who stutter as well as speech-language pathology students. Her research interests include the adults' stuttering experiences, culturally and linguistically diverse populations, mindfulness and qualitative research methods. She's published work on the Spanish-English bilingual stuttering experience, fluency-inducing strategies used by Spanish-English-speaking bilinguals who stutter, and stigma experienced by Hispanics who stutter. Medina has published and presented her research nationally and internationally. She is also the Research Chair of the National Stuttering Association’s Board of Directors. Medina's love of studying languages started here FIU, where she earned her master's in Linguistics.