Stuttering
Other namesStammering, alalia syllabaris, alalia literalis, anarthria literalis, dysphemia.[1]
SpecialtySpeech–language pathology
SymptomsInvoluntary sound repetition and disruption or blocking of speech
ComplicationsShame, bullying, social anxiety, fear of public speaking
Usual onset2–5 years
DurationLong term
CausesUnknown
Differential diagnosisDysphonia[1]
TreatmentSpeech therapy
MedicationDopamine antagonists
PrognosisUsually resolves by late childhood; 20% of cases last into adulthood
FrequencyAbout 1%

Stuttering, also known as stammering, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.[2][3] The term stuttering is most commonly associated with involuntary sound repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by people who stutter as blocks, and the prolongation of certain sounds, usually vowels or semivowels. According to Watkins et al., stuttering is a disorder of "selection, initiation, and execution of motor sequences necessary for fluent speech production".[4] For many people who stutter, repetition is the main concern. The term "stuttering" covers a wide range of severity, from barely perceptible impediments that are largely cosmetic to severe symptoms that effectively prevent oral communication. Almost 70 million people worldwide stutter,[5] about 1% of the world's population.[4]

The impact of discrimination against stuttering on a dysfluent person's functioning and emotional state can be severe. This may include fears of having to enunciate specific vowels or consonants, fears of being caught stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being a possible target of bullying (especially in children), having to use word substitution and rearrange words in a sentence to hide stuttering, or a feeling of "loss of control" during speech. Stuttering is sometimes popularly seen as a symptom of anxiety, but there is no direct correlation in that direction.[6][7]

Stuttering is generally not a problem with the physical production of speech sounds or putting thoughts into words. Acute nervousness and stress are not thought to cause stuttering, but they can trigger stuttering in people who have the speech disorder, and living with a stigmatized disability can result in anxiety and high allostatic stress load (chronic nervousness and stress) that increase the amount of acute stress necessary to trigger stuttering in any given person who stutters, worsening the situation in the manner of a positive feedback system; the name 'stuttered speech syndrome' has been proposed for this condition.[8][9] Neither acute nor chronic stress, however, itself creates any predisposition to stuttering.

The disorder is also variable, which means that in certain situations, such as talking on the telephone or in a large group, the stuttering might be more severe or less, depending on whether or not the person who stutters is self-conscious about their stuttering. People who stutter often find that their stuttering fluctuates and that they have "good" days, "bad" days and "stutter-free" days. The times in which their stuttering fluctuates can be random.[10] Although the exact etiology, or cause, of stuttering is unknown, both genetics and neurophysiology are thought to contribute. There are many treatments and speech therapy techniques available that may help decrease speech disfluency in some people who stutter, to the point where an untrained ear cannot identify a problem; however, there is essentially no cure for the disorder. The severity of the person's stuttering would correspond to the amount of speech therapy needed to decrease disfluency. For severe stuttering, long-term therapy and hard work is required to decrease disfluency.[11]

Characteristics

Common behaviors

Common stuttering behaviors are observable signs of speech disfluencies, for example: repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. These differ from the normal disfluencies found in all speakers in that stuttering disfluencies may last longer, occur more frequently, and are produced with more effort and strain.[12] Stuttering disfluencies also vary in quality: common disfluencies tend to be repeated movements, fixed postures, or superfluous behaviors. Each of these three categories is composed of subgroups of stutters and disfluencies.[13]

  • Repeated movements[13]
    • Syllable repetition—a single syllable word is repeated (for example: on—on—on a chair) or a part of a word which is still a full syllable such as "un—un—under the ..." and "o—o—open".
    • Incomplete syllable repetition—an incomplete syllable is repeated, such as a consonant without a vowel, for example, "c—c—c—cold".
    • Multi-syllable repetition—more than one syllable such as a whole word, or more than one word is repeated, such as "I know—I know—I know a lot of information."
  • Fixed postures[13]
    • With audible airflow—prolongation of a sound occurs such as "mmmmmmmmmom".
    • Without audible airflow—such as a block of speech or a tense pause where nothing is said despite efforts.
  • Superfluous behaviors[13]
    • Verbal—this includes an interjection such as an unnecessary uh or um as well as revisions, such as going back and correcting one's initial statements such as "I—My girlfriend ...", where the I has been corrected to the word my.
    • Nonverbal—these are visible or audible speech behaviors, such as lip smacking, throat clearing, head thrusting, etc., usually representing an effort to break through or circumvent a block or stuttering loop.

Variability

The severity of a stutter is often not constant even for people who severely stutter. Stutterers commonly report dramatically increased fluency when talking in unison with another speaker, copying another's speech, whispering, singing, and acting or when talking to pets, young children, or themselves.[14] Other situations, such as public speaking and speaking on the telephone, are often greatly feared, and increased stuttering is reported.[15]

Feelings and attitudes

Stuttering could have a significant negative cognitive and affective impact on the person who stutters. It has been described in terms of the analogy to an iceberg, with the immediately visible and audible symptoms of stuttering above the waterline and a broader set of symptoms such as negative emotions hidden below the surface.[16] Feelings of embarrassment, shame, frustration, fear, anger, and guilt are frequent in people who stutter,[17] and may actually increase tension and effort, leading to increased stuttering.[18] With time, continued exposure to difficult speaking experiences may crystallize into a negative self-concept and self-image. Many perceive stutterers as less intelligent due to their disfluency; however, as a group, individuals who stutter tend to be of above average intelligence.[19] People who stutter may project their attitudes onto others, believing that the others think them nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program.[18]

Many people who stutter report a high emotional cost, including jobs or promotions not received, as well as relationships broken or not pursued.[20]

Others have developed Stuttering pride and encourage other stutterers to take pride in their stutter and to find how it has been beneficial for them.

Fluency and disfluency

Linguistic tasks can invoke speech disfluency. People who stutter may experience varying disfluency.[21] Tasks that trigger disfluency usually require a controlled-language processing, which involves linguistic planning. In stuttering, it is seen that many individuals do not demonstrate disfluencies when it comes to tasks that allow for automatic processing without substantial planning. For example, singing "Happy Birthday" or other relatively common, repeated linguistic discourses, could be fluid in people who stutter. Tasks like this reduce semantic, syntactic, and prosodic planning, whereas spontaneous, "controlled" speech or reading aloud requires thoughts to transform into linguistic material and thereafter syntax and prosody. Some researchers hypothesize that controlled-language activated circuitry consistently does not function properly in people who stutter, whereas people who do not stutter only sometimes display disfluent speech and abnormal circuitry.[21]

Associated conditions

Stuttering can co-occur with other learning disorders. These associated disabilities include:

Causes

No single, exclusive cause of developmental stuttering is known. A variety of hypotheses and theories suggest multiple factors contributing to stuttering.[36] Among these is the strong evidence that stuttering has a genetic basis.[37] Children who have first-degree relatives who stutter are three times as likely to develop a stutter.[38] However, twin and adoption studies suggest that genetic factors interact with environmental factors for stuttering to occur,[39] and many stutterers have no family history of the disorder.[40] There is evidence that stuttering is more common in children who also have concurrent speech, language, learning or motor difficulties.[41] Robert West, a pioneer of genetic studies in stuttering, has suggested that the presence of stuttering is connected to the fact that articulated speech is the last major acquisition in human evolution.[42]

Another view is that a stutter or stammer is a complex tic. This view is held for the following reasons. It always arises from repetition of sounds or words. Young children like repetition and the more tense they are feeling, the more they like this outlet for their tension – an understandable and quite normal reaction. They are capable of repeating all types of behaviour. The more tension that is felt, the less one likes change. The more change, the greater can be the repetition. So, when a three-year-old finds he has a new baby brother or sister he may start repeating sounds. The repetitions can become conditioned and automatic and ensuing struggles against the repetitions result in prolongations and blocks in his speech. More boys stammer than girls, in the ratio of 3–4 boys : 1 girl. This is because the male hypothalamic-pituitary-adrenal (HPA) axis is more active. As males produce more cortisol than females under the same provocation, they can be tense or anxious and become repetitive.[43]

In a 2010 article, three genes were found by Dennis Drayna and team to correlate with stuttering: GNPTAB, GNPTG, and NAGPA. Researchers estimated that alterations in these three genes were present in 9% of those who have a family history of stuttering.[44][45]

For some people who stutter, congenital factors may play a role. These may include physical trauma at or around birth, learning disabilities, and cerebral palsy. In others, there could be added impact due to stressful situations such as the birth of a sibling, moving, or a sudden growth in linguistic ability.[37][39]

There is clear empirical evidence for structural and functional differences in the brains of stutterers. Research is complicated somewhat by the possibility that such differences could be the consequences of stuttering rather than a cause, but recent research on older children confirms structural differences thereby giving strength to the argument that at least some of the differences are not a consequence of stuttering.[46][47]

Auditory processing deficits have also been proposed as a cause of stuttering. Stuttering is less prevalent in deaf and hard-of-hearing individuals,[48] and stuttering may be reduced when auditory feedback is altered, such as by masking, delayed auditory feedback (DAF), or frequency altered feedback.[36][49] There is some evidence that the functional organization of the auditory cortex may be different in people who stutter.[36]

There is evidence of differences in linguistic processing between people who stutter and people who do not.[50] Brain scans of adult stutterers have found greater activation of the right hemisphere, which is associated with emotions, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed.[36][39]

The capacities and demands model has been proposed to account for the heterogeneity of the disorder. In this approach, speech performance varies depending on the capacity that the individual has for producing fluent speech, and the demands placed upon the person by the speaking situation. Capacity for fluent speech may be affected by a predisposition to the disorder, auditory processing or motor speech deficits, and cognitive or affective issues. Demands may be increased by internal factors such as lack of confidence or self esteem or inadequate language skills or external factors such as peer pressure, time pressure, stressful speaking situations, insistence on perfect speech, and the like. In stuttering, the severity of the disorder is seen as likely to increase when demands placed on the person's speech and language system exceed their capacity to deal with these pressures.[51] However, the precise nature of the capacity or incapacity has not been delineated.

Mechanism

Physiology

Though neuroimaging studies have not yet found specific neural correlates, there is much evidence that the brains of adults who stutter differ from the brains of adults who do not stutter. Several neuroimaging studies have emerged to identify areas associated with stuttering. In general, during stuttering, cerebral activities change dramatically in comparison to silent rest or fluent speech between people who stutter and people who do not. There is evidence that people who stutter activate motor programs before the articulatory or linguistic processing is initiated. Brain imaging studies have primarily been focused on adults. However, the neurological abnormalities found in adults does not determine whether childhood stuttering caused these abnormalities or whether the abnormalities cause stuttering.[46]

Studies utilizing positron emission tomography (PET) have found during tasks that invoke disfluent speech, people who stutter show hypoactivity in cortical areas associated with language processing, such as Broca's area, but hyperactivity in areas associated with motor function.[21] One such study that evaluated the stutter period found that there was overactivation in the cerebrum and cerebellum, and relative deactivation of the left hemisphere auditory areas and frontal temporal regions.[52]

Functional magnetic resonance imaging (fMRI) has found abnormal activation in the right frontal operculum (RFO), which is an area associated with time-estimation tasks, occasionally incorporated in complex speech.[21]

Researchers have explored temporal cortical activations by utilizing magnetoencephalography (MEG). In single-word-recognition tasks, people who did not stutter showed cortical activation first in occipital areas, then in left inferior-frontal regions such as Broca's area, and finally, in motor and premotor cortices. The stutterers also first had cortical activation in the occipital areas but the left inferior-frontal regions were activated only after the motor and premotor cortices were activated.[21][52]

During speech production, people who stutter show overactivity in the anterior insula, cerebellum and bilateral midbrain. They show underactivity in the ventral premotor, Rolandic opercular and sensorimotor cortex bilaterally and Heschl's gyrus in the left hemisphere.[46] Additionally, speech production yields underactivity in cortical motor and premotor areas.[46]

Abnormal lateralization

Much evidence from neuroimaging techniques has supported the theory that the right hemisphere of people who stutter interferes with left-hemisphere speech production.

In 2008, it was shown that adults who stutter have anatomical differences in gyri within the perisylvian cortex, in frontotemporal areas. A large amount of white matter is found in the right hemisphere of the brain, including the region of the superior temporal gyrus. This was discovered using voxel-based morphometry. On the other hand, lesser amounts of white matter are found in the left inferior arcuate fasciculus connecting the temporal and frontal areas in stuttering adults.[53]

As of 2011 it was known that the corpus callosum, which transfers information between the left and right cerebral hemispheres. rostrum, and the anterior mid-body sections were larger in adults who stutter as compared to normally fluent adults. This difference was thought to be due to unusual functions of brain organization in stuttering adults or a result of how the stuttering adults performed language-relevant tasks. Furthermore, previous research had found that adults who stutter show cerebral hemispheres that contain uncommon brain proportions and allocations of gray and white matter tissue.[54] There is less coordination between the speech motor and planning regions in the brain's left hemisphere of men and women who stutter, when compared to a non-stuttering control group.[55] Anatomical connectivity of the speech motor and planning regions is less vigorous in adults who stutter, especially women. Men who stutter seem to have more right-sided motor connectivity. On the other hand, stuttering women have less connectivity with the right motor regions.[55]

In non-stuttering, normal speech, PET scans have shown that both hemispheres are active but that the left hemisphere may be more active. By contrast, people who stutter yield more activity on the right hemisphere, suggesting that it might be interfering with left-hemisphere speech production. Another comparison of scans anterior forebrain regions are disproportionately active in stuttering subjects, while post-rolandic regions are relatively inactive.[56]

Bilateral increases and unusual right-left asymmetry has been found in the planum temporale when comparing people who stutter and people who do not.[52] These studies have also found that there are anatomical differences in the Rolandic operculum and arcuate fasciculus.[4]

In 2019, Denis Drayna suggested that brain imaging studies of people who stutter do not tell if the differences in the brain anatomy caused stuttering or if they are the effect of stuttering; in the mouse model for stuttering created by Drayna and team, they noticed significant similarities between the vocalizations in mice (carrying GNPTAB mutation) and human stuttering.[57]

In 2021, researchers investigated the brain tissue from the mice mutants and reported a significant decrease in the number and density of astrocytes in their corpus callosum.[58] Astrocyte is a star-shaped cell in the brain that supports the nerve cells by supplying oxygen and nutrients, and taking away the waste. The corpus callosum enables the communication between the left and right hemispheres of the brain.[59] As of 2020 follow-up experiments with the GNPTAB mutation introduced to brain cell types showed that the vocalization defects in mice were specific to the loss of astrocytes,[60] and mice did not show stuttering-like vocalization defects when the mutation was engineered to other brain cell types.[61]

Dopamine

Recent studies have found that adults who stutter have elevated levels of the neurotransmitter dopamine, and have thus found dopamine antagonists that reduce stuttering (see anti-stuttering medication below).[52] Overactivity of the midbrain has been found at the level of the substantia nigra extended to the red nucleus and subthalamic nucleus, which all contribute to the production of dopamine.[46] However, increased dopamine does not imply increased excitatory function since dopamine's effect can be both excitatory or inhibitory depending upon which dopamine receptors (labelled D1–D5) have been stimulated.

Diagnosis

Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a certified speech–language pathologist (SLP). Diagnosis of stuttering employs information both from direct observation of the individual and information about the individual's background, through a case history.[62] Information from both sources should consider things such as age, the various times it has occurred, and other impediments.[63] The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents.[64] The overall goal of assessment for the SLP will be (1) to determine whether a speech disfluency exists, and (2) assess if its severity warrants concern for further treatment.

During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech (Riley's Stuttering Severity Instrument Fourth Edition (SSI-4)).[64] They might also employ a test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, part-word repetitions and prolongations, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future.[65]

Stuttering is a multifaceted, complex disorder that can impact an individual's life in a variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of the speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)).[66]

Clinical psychologists with adequate expertise can also diagnose Stuttering per the DSM-5 diagnostic codes.[67] The DSM-5 describes Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However, the specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms "fluency" and "disfluency".

Normal disfluency

Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies").[68] This type of disfluency is a normal part of speech development and temporarily present in preschool aged children who are learning to speak.[68] These normal disfluencies can present as interjections ("Um"), multisyllable repetitions ("I want I want to do that"), or revised or abandoned utterances ("I want—hey what's that?").[68] Normal disfluency should be ruled out before diagnosing stuttering.[69]

Classification

Developmental stuttering (also known as childhood onset fluency disorder) is stuttering that originates when a child is learning to speak and may persist as the child matures into adulthood. Stuttering that persists after the age of seven is classified as persistent stuttering.[68]

Other much less common causes of stuttering include neurogenic stuttering (stuttering that occurs secondary to brain damage, such as after a stroke) and psychogenic stuttering (stuttering related to a psychological condition).[68]

Developmental

Stuttering is typically a developmental disorder beginning in early childhood and continuing into adulthood in at least 20% of affected children.[36][70] The mean onset of stuttering is 30 months.[71] Although there is variability, early stuttering behaviours usually consist of word or syllable repetitions, while secondary behaviours such as tension, avoidance or escape behaviours are absent.[72] Most young children are unaware of the interruptions in their speech.[72] With young stutterers, disfluency may be episodic, and periods of stuttering are followed by periods of relatively decreased disfluency.[73]

Though the rate of early recovery is very high,[36] with time a young person who stutters may transition from easy, relaxed repetition to more tense and effortful stuttering, including blocks and prolongations.[72] Some propose that parental reactions may affect the development of a chronic stutter. Recommendations to "slow down", "take a breath", "say it again", etc., may increase the child's anxiety and fear, leading to more difficulties with speaking and, in the "cycle of stuttering," to yet more fear, anxiety and expectation of stuttering.[74] With time secondary stuttering, including escape behaviours such as eye blinking and lip movements, may be used, as well as fear and avoidance of sounds, words, people, or speaking situations. Eventually, many become fully aware of their disorder and begin to identify themselves as stutterers. With this may come deeper frustration, embarrassment and shame.[75] Other, rarer patterns of stuttering development have been described, including sudden onset with the child being unable to speak, despite attempts to do so.[76] The child usually is unable to utter the first sound of a sentence, and shows high levels of awareness and frustration. Another variety also begins suddenly with frequent word and phrase repetition, and does not include the development of secondary stuttering behaviours.[76]

Neurogenic stuttering

Some stuttering is also believed to be caused by neurophysiology. Neurogenic stuttering is a type of fluency disorder in which a person has difficulty in producing speech in a normal, smooth fashion. Individuals with fluency disorders may have speech that sounds fragmented or halting, with frequent interruptions and difficulty producing words without effort or struggle. Neurogenic stuttering typically appears following some sort of injury or disease to the central nervous system. Injuries to the brain and spinal cord, including cortex, subcortex, cerebellum, and even the neural pathway regions.[4]

Acquired stuttering

In rare cases, stuttering may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. The stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback (see below), which may promote decreasing disfluency in those with the developmental condition, are not effective with the acquired type.[36][70][77]

Psychogenic stuttering may also arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker.[78]

Differential diagnosis

Other disorders with symptoms resembling stuttering, or associated disorders include autism, cluttering, Parkinson's disease, essential tremor, palilalia, spasmodic dysphonia, selective mutism, and social anxiety.

Treatment

Before beginning treatment, an assessment is needed, as diagnosing stuttering requires the skills of a certified speech–language pathologist (SLP).[79] While there is no complete cure for stuttering, several treatment options exist that help individuals to better control their speech. Many of the available treatments focus on learning strategies to minimize stuttering through speed reduction, breathing regulation, and gradual progression from single-syllable responses to longer words, and eventually more complex sentences. Furthermore, some stuttering therapies help to address the anxiety that is often caused by stuttering, and consequently worsens stuttering symptoms.[80] This method of treatment is referred to as a comprehensive approach, in which the main emphasis of treatment is directed toward improving the speaker's attitudes toward communication and minimizing the negative impact stuttering can have on the speaker's life.[81] Treatment from a qualified S-LP can benefit stutterers of any age.[82]

Speech language pathologists teach people who stutter to control and monitor the rate at which they speak. In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practising smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. When treating stuttering in children, some researchers recommend that an evaluation be conducted every three months in order to determine whether or not the selected treatment option is working effectively. "Follow-up" or "maintenance" sessions are often necessary after completion of formal intervention to prevent relapse.[83]

Fluency shaping therapy

Fluency shaping therapy, also known as "speak more fluently", "prolonged speech", or "connected speech", trains people who stutter to speak less disfluently by controlling their breathing, phonation, and articulation (lips, jaw, and tongue). It is based on operant conditioning techniques.[84]

People who stutter are trained to reduce their speaking rate by stretching vowels and consonants, and using other disfluency-reducing techniques such as continuous airflow and soft speech contacts. The result is very slow, monotonic, but fluent speech, used only in the speech clinic. After the person who stutters masters these skills, the speaking rate and intonation are increased gradually. This more normal-sounding, fluent speech is then transferred to daily life outside the speech clinic, though lack of speech naturalness at the end of treatment remains a frequent criticism. Fluency shaping approaches are often taught in intensive group therapy programs, which may take two to three weeks to complete.

Modification therapy

The goal of stuttering modification therapy is not to eliminate stuttering but to modify it so that stuttering is easier and less effortful.[85] The rationale is that, since fear and anxiety cause increased stuttering, using easier stuttering and with less fear and avoidance, stuttering will decrease. The most widely known approach was published by Charles Van Riper in 1973 and is also known as block modification therapy.[86] However, depending on the patient, speech therapy may be ineffective.[87]

Electronic fluency device

Altered auditory feedback, so that people who stutter hear their voice differently, has been used for over 50 years in the treatment of stuttering.[88] Altered auditory feedback effect can be produced by speaking in chorus with another person, by blocking out the voice of the person who stutters while they are talking (masking), by delaying slightly the voice of the person who stutters (delayed auditory feedback) or by altering the frequency of the feedback (frequency altered feedback). Studies of these techniques have had mixed results, with some people who stutter showing substantial reductions in stuttering, while others improved only slightly or not at all.[88] In a 2006 review of the efficacy of stuttering treatments, none of the studies on altered auditory feedback met the criteria for experimental quality, such as the presence of control groups.[89]

Mobile applications

Stuttering treatment using mobile application

There are specialized mobile applications and PC programs for stutter treatment. The goal pursued by the applications of this kind is speech cycle restoration: I say, I hear, I build a phrase, I say, and so on, using various methods of stutter correction.[90]

The user interacts with the application through altered auditory feedback: they say something into the headset's microphone and listen to their own voice in the headphones processed by a certain method.[90]

The following stutter correction methods are typically used in applications:

  • MAF (masking auditory feedback). It is basically masking by white noise or sinus noises of the user's own speech. Scientists believe that people who stutter can speak more smoothly when they do not hear their own speech. This method is considered old-fashioned and ineffective.[91][92][93]
  • DAF (delayed auditory feedback). This method involves sending the user's voice from a microphone to headphones with a delay of fractions of a second. The goal of this method is to teach people who stutter to prolong vowels and reduce their speech rate. After speech correction with long delays, the application is adjusted at shorter delays which increase the speech rate until it becomes normal.[94][95]
  • FAF (frequency-shifted auditory feedback). This method involves shifting the user's voice tone frequency that they are listening to compared to their own voice. The shift range can be different: from several semitones to half an octave.[96][97][98]
  • Using metronomes and tempo correctors. Rhythmic metronome strikes are used in this method. The effectiveness of the method is related to the fact that rhythm has positive effect on someone who stutters, especially when pronouncing slowly.[99]
  • Using visual feedback. This method determines the user's speech parameters (for instance, speech tempo) and their representation on screen as visual information. The principal goal of the method is allowing the user to effectively manage their voice through achieving the defined targeted parameters. It is supposed that the user sees visual representation of both current and targeted parameters (such as speech tempo) on the screen while pronouncing.[100][101]

Medications

Although no medication is FDA approved for stuttering, several studies have shown certain medications to have beneficial effects on reducing the severity of stuttering symptoms. Although different classes of medications have been investigated, those with dopamine blocking activity have been shown in numerous trials to have positive effects on stuttering. These medications are FDA approved in the United States and hold similar approval in most countries for other conditions and their safety profiles are well established in these disorders.

The best studied medication in stuttering is olanzapine, whose effectiveness as of 2004[102] had been established in replicated trials. Olanzapine acts as a dopamine antagonist to D2 receptors in the mesolimbic pathway, and works similarly on serotonin 5HT2A receptors in the frontal cortex.[103] At doses between 2.5 and 5 mg, olanzapine has been shown to be more effective than placebo at reducing stuttering symptoms, and may serve as a first-line pharmacological treatment for stuttering based on the preponderance of its efficacy data.[104] However, other medications are generally better tolerated with less weight gain and less risk of metabolic effects than olanzapine.

As of 2000, Risperidone[105] and haloperidol had also shown effectiveness in the treatment of stuttering. However, haloperidol in particular often result in poor long-term compliance due to concerning side effects such as movement disorders and prolactin elevation, which can also occur with risperidone.[104] Other dopamine active medications reported to positively treat stuttering include aripiprazole, asenapine, lurasidone, which tend to be better tolerated than olanzapine with less weight gain. All these medications as well as olanzapine can carry the potential risk of a long-term movement disorder known as tardive dyskinesia.

The investigational compound, ecopipam, is unique from other dopamine antagonists in that it acts on D1 receptors instead of D2, owing little, if any risk, of movement disorders. A 2019 open label study of ecopipam in adults demonstrated significantly improved stuttering symptoms with no reports of parkinsonian-like movement disorders or tardive dyskinesia which can be seen with D2 antagonists.[106] In addition, ecopipam had no reported weight gain, but instead has been reported to lead to weight loss.[106] In a preliminary study, it was well tolerated in subjects, effectively reduced stuttering severity, and was even associated in a short-term study with improved quality of life in persons who stutter.[106] Further research is still warranted, but this novel mechanism is showing promise in the pharmacologic treatment of stuttering.

Support

With existing behavioral and prosthetic treatments providing limited relief and pharmacologic treatments in need of FDA approval for widespread use, support groups and the self-help movement continue to gain popularity and support from professionals and from people who stutter. Self-help groups provide people who stutter a shared forum within which they can access resources and support from others facing the same challenges of stuttering.[80] One of the basic tenets behind the self-help movement is that since a cure does not exist, quality of life can be improved by not thinking about the stammer for prolonged periods. Psychoanalysis has claimed success in the treatment of stuttering.[107] Hypnotherapy has also been explored as a management alternative.[108][109][110] Support groups further focus on the fact that stuttering is not a physical impediment but a psychological one.[111]

Psychological approach

Cognitive behavior therapy has been used to treat stuttering.[112] Also sociological approaches has been explored regarding how social groups maintain stuttering through social norms.[113]

Diaphragmatic breathing

Several treatment initiatives, for example the McGuire programme[114] and the Starfish Project, advocate diaphragmatic breathing (or costal breathing) as a means by which stuttering can be controlled.

Prognosis

Among preschoolers with stuttering, the prognosis for recovery is good. Based on research, about 65% to 87.5% of preschoolers who stutter recover spontaneously by 7 years of age or within the first 2 years of stuttering,[68][71][115] and about 74% recover by their early teens.[116] In particular, girls seem to recover well.[116][117] For others, early intervention is effective in helping the child overcome disfluency.[118]

Prognosis is guarded with later age of onset: children who start stuttering at age 3½ years or later,[119] and duration of greater than 6–12 months since onset, that is, once stuttering has become established, and the child has developed secondary behaviors;[118] only 18% of children who stutter after five years recover spontaneously.[120] Stuttering that persists after the age of seven is classified as persistent stuttering, and is associated with a much lower chance of recovery.[68] However, with treatment young children may be left with little evidence of stuttering.[118]

For adults who stutter, there is no known cure,[116] though they may make partial recovery or even complete recovery with intervention. People who stutter often learn to stutter less severely, though others may make no progress with therapy.[118]

Emotional sequelae associated with stuttering primarily relates to state-dependent anxiety related to the speech disorder itself. However, this is typically isolated to social contexts that require speaking, is not a trait anxiety, and this anxiety does not persist if stuttering remits spontaneously. Research attempting to correlate stuttering with generalized or state anxiety, personality profiles, trauma history, or decreased IQ have failed to find adequate empirical support for any of these claims.

Epidemiology

The lifetime prevalence, or the proportion of individuals expected to stutter at one time in their lives, is about 5%,[121] and overall males are affected two to five times more often than females.[70][122][123] However, there is not much information known about the underlying cause for such a skewed sex ratio.[55] Most stuttering begins in early childhood, and studies suggest that 2.5% of children under the age of 5 stutter.[124][119] As seen in children who have just begun stuttering, there is an equivalent number of boys and girls who stutter. Still, the sex ratio appears to widen as children grow: among preschoolers, boys who stutter outnumber girls who stutter by about a two to one ratio, or less.[123][119] This ratio widens to three to one during first grade, and five to one during fifth grade,[125] as girls have higher recovery rates.[116] Due to high (approximately 65–75%) rates of early recovery,[122][126] the overall prevalence of stuttering is generally considered to be approximately 1%.[70][127]

Cross cultural

Cross-cultural studies of stuttering prevalence were very active in early and mid-20th century, particularly under the influence of the works of Wendell Johnson, who claimed that the onset of stuttering was connected to the cultural expectations and the pressure put on young children by anxious parents. Johnson claimed there were cultures where stuttering, and even the word "stutterer", were absent (for example, among some tribes of American Indians). Later studies found that this claim was not supported by the facts, so the influence of cultural factors in stuttering research declined. It is generally accepted by contemporary scholars that stuttering is present in every culture and in every race, although the attitude towards the actual prevalence differs. Some believe stuttering occurs in all cultures and races[37] at similar rates,[70] about 1% of general population (and is about 5% among young children) all around the world. A US-based study indicated that there were no racial or ethnic differences in the incidence of stuttering in preschool children.[124][119] At the same time, there are cross-cultural studies indicating that the difference between cultures may exist. For example, summarizing prevalence studies, E. Cooper and C. Cooper conclude: "On the basis of the data currently available, it appears the prevalence of fluency disorders varies among the cultures of the world, with some indications that the prevalence of fluency disorders labeled as stuttering is higher among black populations than white or Asian populations" (Cooper & Cooper, 1993:197). In his "Stuttering and its Treatment: Eleven lectures" Mark Onslow remarked that "one recent study with many participants (N=119,367)[128] convincingly reported more stuttering among African Americans than other Americans. Why this could be the case is challenging to explain ..."[129]

Different regions of the world are researched very unevenly. The largest number of studies has been conducted in European countries and in North America, where the experts agree on the mean estimate to be about 1% of the general population (Bloodtein, 1995. A Handbook on Stuttering). African populations, particularly from West Africa, might have the highest stuttering prevalence in the world—reaching in some populations 5%, 6% and even over 9%.[130] Many regions of the world are not researched sufficiently, and for some major regions there are no prevalence studies at all (for example, in China). Some claim the reason for this might be a lower incidence in the general population in China.[131]

History

Lewis Carroll, the well-known author of Alice's Adventures in Wonderland, had a stammer, as did his siblings.

Because of the unusual-sounding speech that is produced and the behaviors and attitudes that accompany a stutter, it has long been a subject of scientific interest and speculation as well as discrimination and ridicule. People who stutter can be traced back centuries to the likes of Demosthenes, who tried to control his disfluency by speaking with pebbles in his mouth.[132] The Talmud interprets Bible passages to indicate that Moses also stuttered, and that placing a burning coal in his mouth had caused him to be "slow and hesitant of speech" (Exodus 4, v.10).[132]

Galen's humoral theories were influential in Europe in the Middle Ages for centuries afterward. In this theory, stuttering was attributed to an imbalance of the four bodily humors—yellow bile, blood, black bile, and phlegm. Hieronymus Mercurialis, writing in the sixteenth century, proposed to redress the imbalance by changes in diet, reduced libido (in men only), and purging. Believing that fear aggravated stuttering, he suggested techniques to overcome this. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century.[133] Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman emperor Claudius was initially shunned from the public eye and excluded from public office.[132]

In and around eighteenth and nineteenth century Europe, surgical interventions for stuttering were recommended, including cutting the tongue with scissors, removing a triangular wedge from the posterior tongue, and cutting nerves, or neck and lip muscles. Others recommended shortening the uvula or removing the tonsils. All were abandoned due to the danger of bleeding to death and their failure to stop stuttering. Less drastically, Jean Marc Gaspard Itard placed a small forked golden plate under the tongue in order to support "weak" muscles.[132]

Notker Balbulus, from a medieval manuscript

Italian pathologist Giovanni Morgagni attributed stuttering to deviations in the hyoid bone, a conclusion he came to via autopsy.[133] Blessed Notker of St. Gall (c. 840 – 912), called Balbulus ("The Stutterer") and described by his biographer as being "delicate of body but not of mind, stuttering of tongue but not of intellect, pushing boldly forward in things Divine," was invoked against stammering.

A royal Briton who stammered was King George VI. He went through years of speech therapy, most successfully under Australian speech therapist Lionel Logue, for his stammer. The Academy Award-winning film The King's Speech (2010) in which Colin Firth plays George VI, tells his story. The film is based on an original screenplay by David Seidler, who also stuttered until age 16.

Another British case was that of Prime Minister Winston Churchill. Churchill claimed, perhaps not directly discussing himself, that "[s]ometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience ..."[134] However, those who knew Churchill and commented on his stutter believed that it was or had been a significant problem for him.[135] His secretary Phyllis Moir commented that "Winston Churchill was born and grew up with a stutter" in her 1941 book I was Winston Churchill's Private Secretary. She related one example, "'It's s-s-simply s-s-splendid,' he stuttered—as he always did when excited." Louis J. Alber, who helped to arrange a lecture tour of the United States, wrote in Volume 55 of The American Mercury (1942) that "Churchill struggled to express his feelings but his stutter caught him in the throat and his face turned purple" and that "born with a stutter and a lisp, both caused in large measure by a defect in his palate, Churchill was at first seriously hampered in his public speaking. It is characteristic of the man's perseverance that, despite his staggering handicap, he made himself one of the greatest orators of our time."

For centuries "cures" such as consistently drinking water from a snail shell for the rest of one's life, "hitting a stutterer in the face when the weather is cloudy", strengthening the tongue as a muscle, and various herbal remedies were tried.[136] Similarly, in the past people subscribed to odd theories about the causes of stuttering, such as tickling an infant too much, eating improperly during breastfeeding, allowing an infant to look in the mirror, cutting a child's hair before the child spoke his or her first words, having too small a tongue, or the "work of the devil".[136]

Some people who stutter, and are part of the disability rights movement, have begun to embrace their stuttering voices as an important part of their identity.[137][138] In July 2015 the UK Ministry of Defence (MOD) announced the launch of the Defence Stammering Network to support and champion the interests of British military personnel and MOD civil servants who stammer and to raise awareness of the condition.[139]

Bilingual stuttering

Identification

Bilingualism is the ability to speak two languages. Many bilingual people have been exposed to more than one language since birth and throughout childhood. Since language and culture are relatively fluid factors in a person's understanding and production of language, bilingualism may be a feature that impacts speech fluency. There are several ways during which stuttering may be noticed in bilingual children including the following.

  • The child is mixing vocabulary (code mixing) from both languages in one sentence. This is a normal process that helps the child increase their skills in the weaker language, but may trigger a temporary increase in disfluency.[140]
  • The child is having difficulty finding the correct word to express ideas resulting in an increase in normal speech disfluency.[140]
  • The child is having difficulty using grammatically complex sentences in one or both languages as compared to other children of the same age. Also, the child may make grammatical mistakes. Developing proficiency in both languages may be gradual, so development may be uneven between the two languages.[140]
  • Adding a second or third language between the ages of three and five years of age may cause stuttering to increase (become more severe). However, this may be the case only when: (1) the child's first language is not strong or the child is experiencing difficulties in their first language, (2) One language is used more than the other or, (3) the child resists speaking the additional language.

Stuttering may present differently depending on the languages the individual uses. For example, morphological and other linguistic differences between languages may make presentation of disfluency appear to be more or less of a problem depending on the individual case.[141]

Research

Much research is being conducted to look at the prevalence of stuttering in bilingual populations and the differences between languages. For instance, one study concluded that bilingual children who spoke English and another language had an increased risk of stuttering and a lower chance of recovery from stuttering than monolingual speakers and speakers who spoke solely a language other than English.[142] Another study, though methodologically weak, showed relatively indistinguishable percentages of monolingual and bilingual people who stutter.[143] Due to so much conflicting data, the relationship between bilingualism and stuttering has been called enigmatic,[144] which can demonstrate the intricacies of the topic and encourages more research to be conducted in order to sway the belief of impact the relationship between bilingualism and stuttering has.

Jazz and Eurodance musician Scatman John wrote the song "Scatman (Ski Ba Bop Ba Dop Bop)" to help children who stutter overcome adversity. Born John Paul Larkin, Scatman spoke with a stutter himself and won the American Speech-Language-Hearing Association's Annie Glenn Award for outstanding service to the stuttering community.[145]

Arkwright, the main protagonist in the BBC sitcom Open All Hours, had a severe stutter that was used for comic effect.[146] Laxman, a supporting character in Indian comedy film Golmaal (2010), had stammering problem.[147]

Stuttering Community

Many counties have regular events and activities to get people who stutter together in mutual support. These events take place at regional, national, and international level. At a regional level, there are often stuttering support or chapter groups that look to provide a place for people who stutter in the local area to meet, discuss and learn from each other.[148][149]

At a national level, stuttering charities or groups host conferences. Conferences can vary in their focus and scope, some focus on the latest research developments, some on stuttering and the arts and others still look to provide a space for stutterers simply to come together.

There are two different international meetings of stutterers. The International Stuttering Association World Congress is primarily focused on people who stutter. There is also Joint World Congress on Stuttering and Cluttering that brings together academics, researchers, speech-language pathologists, people who stutter, and people who clutter for a focus more on research, viewpoints, and treatments for stuttering.

Historic advocacy and self-help

Self-help and advocacy organisations for people who stammer have reportedly been in existence since the 1920s. In 1921, a Philadelphia-based attorney who stammered, J Stanley Smith established the Kingsley Club. [150] Designed to support people with a stammer in the Philadelphia area the club took inspiration for its name from Charles Kingsley. Kingsley, a nineteenth century English social reformer and author of Westward Ho! and The Water Babies had a stammer himself.[151]  

Whilst Kingsley himself did not appear to recommend self-help or advocacy groups for people who stammer the Kingsley Club promoted a positive mental attitude to support its members in becoming confident speakers, in a similar way discussed by Charles Kingsley in Irrationale of Speech.

Other support groups for people who stammer began to emerge in the first half of the twentieth century. In 1935 a Stammerer’s Club was established in Melbourne, Australia by a Mr H Collin of Thornbury.[152] At the time of its formation it had 68 members. The club was formed in response to the tragic case of a man from Sydney who “sought relief from the effects of stammering in suicide”. As well as providing self-help this club adopted an advocacy role with the intention of appealing to the Government to provide special education and to fund research into the causes of stammering (Bermuda Reporter).[153]

Stuttering Pride

The Stuttering Pride flag symbolises the waves of stuttering pride rippling through the community.

Stuttering pride (or stuttering advocacy) is a social movement repositioning stuttering as a valuable and respectable way of speaking. The movement seeks to counter the societal narratives in which temporal and societal expectations dictate how communication takes place.[154] In this sense, the stuttering pride movement challenges the pervasive societal narrative of stuttering as a defect and instead positions stuttering as a valuable and respectable way of speaking in its own right. The movement encourages stutterers to take pride in their unique speech patterns and in what stuttering can tell us about the world. It also advocates for societal adjustments to allow stutterers equal access to education and employment opportunities, and addresses how this may impact Stuttering therapy.[154]

Associations

See also

Notes

  1. 1 2 GREENE, J. S. (1937-07-01). "Dysphemia and Dysphonia: Cardinal Features of Three Types of Functional Syndrome: Stuttering, Aphonia and Falsetto (Male)". Archives of Otolaryngology–Head & Neck Surgery. American Medical Association (AMA). 26 (1): 74–82. doi:10.1001/archotol.1937.00650020080011. ISSN 0886-4470.
  2. ↑ World Health Organization ICD-10 F95.8 – Stuttering Archived 2014-11-02 at the Wayback Machine.
  3. ↑ Sheikh, Shakeel; Sahidullah, Md; Hirsch, Fabrice; Ouni, Slim (July 2021). "Machine Learning for Stuttering Identification: Review, Challenges & Future Directions". arXiv:2107.04057 [cs.SD].
  4. 1 2 3 4 [Carlson, N. (2013). Human Communication. In Physiology of behavior (11th ed., pp. 497–500). Boston: Allyn and Bacon.]
  5. ↑ "11 Facts About Stuttering". Archived from the original on 19 July 2014. Retrieved 15 July 2014.
  6. ↑ "What is the relationship between stuttering and anxiety? | British Stammering Association". www.stammering.org. Archived from the original on 2017-04-23. Retrieved 2019-03-20.
  7. ↑ Constantino CD, Campbell P, Simpson S (March–April 2022). "Stuttering and the social model". Journal of Communication Disorders. 96: 106200. doi:10.1016/j.jcomdis.2022.106200. ISSN 0021-9924. PMID 35248920. S2CID 247096437.
  8. ↑ http://www.stutteredspeechsyndrome.com Archived 2011-02-08 at the Wayback Machine
  9. ↑ Irwin, M. (2006). Au-Yeung, J.; Leahy, M. M. (eds.). Terminology – How should stuttering be defined? And why? – Research, Treatment, and Self-Help in Fluency Disorders: New Horizons. The International Fluency Association. pp. 41–45. ISBN 978-0-9555700-1-8. Archived from the original on 2015-09-28.
  10. ↑ Bowen, Caroline. "Information for Families: Stuttering- What can be done about it?". speech-language-therapy dot com. Archived from the original on April 2, 2015. Retrieved June 19, 2013.
  11. ↑ Ashurst JV, Wasson MN (October 2011). "Developmental and persistent developmental stuttering: an overview for primary care physicians". The Journal of the American Osteopathic Association. 111 (10): 576–80. PMID 22065298.
  12. ↑ Ward 2006, pp. 5–6
  13. 1 2 3 4 Teesson K, Packman A, Onslow M (August 2003). "The Lidcombe Behavioral Data Language of stuttering". Journal of Speech, Language, and Hearing Research. 46 (4): 1009–15. doi:10.1044/1092-4388(2003/078). PMID 12959476. Archived from the original on 2014-08-05.
  14. ↑ Ward 2006, pp. 13–14
  15. ↑ Ward 2006, p. 14
  16. ↑ Kalinowski & Saltuklaroglu 2006, p. 17
  17. ↑ Ward 2006, p. 179
  18. 1 2 Guitar 2005, pp. 16–7
  19. ↑ "Stuttering Children More Intelligent According to New Study [Video]". 2013-08-26. Archived from the original on 2014-10-24.
  20. ↑ Pollack, Andrew. "To Fight Stuttering, Doctors Look at the Brain Archived 2016-11-09 at the Wayback Machine", New York Times, September 12, 2006.
  21. 1 2 3 4 5 Sandak, R (2000). "Stuttering: a view from neuroimaging". The Lancet. 356 (9228): 445–446. doi:10.1016/s0140-6736(00)02547-2. PMID 10981883. S2CID 28135568.
  22. ↑ Sroubek, Ariane; Kelly, Mary; Li, Xiaobo (2013-02-01). "Inattentiveness in attention-deficit/hyperactivity disorder". Neuroscience Bulletin. 29 (1): 103–110. doi:10.1007/s12264-012-1295-6. ISSN 1995-8218. PMC 4440572. PMID 23299717.
  23. ↑ Druker, Kerianne; Hennessey, Neville; Mazzucchelli, Trevor; Beilby, Janet (2019-03-01). "Elevated attention deficit hyperactivity disorder symptoms in children who stutter". Journal of Fluency Disorders. 59: 80–90. doi:10.1016/j.jfludis.2018.11.002. ISSN 0094-730X. PMID 30477807. S2CID 53733731.
  24. ↑ Donaher, Joseph; Richels, Corrin (2012-12-01). "Traits of attention deficit/hyperactivity disorder in school-age children who stutter". Journal of Fluency Disorders. Special Issue: 9th Oxford Dysfluency Conference. 37 (4): 242–252. doi:10.1016/j.jfludis.2012.08.002. ISSN 0094-730X. PMID 23218208.
  25. ↑ Arndt Jennifer; Healey E. Charles (2001-04-01). "Concomitant Disorders in School-Age Children Who Stutter". Language, Speech, and Hearing Services in Schools. 32 (2): 68–78. doi:10.1044/0161-1461(2001/006). PMID 27764357.
  26. ↑ Riley Jeanna; Riley Johnetta G. (2000-10-01). "A Revised Component Model for diagnosing and Treating Children Who Stutter". Contemporary Issues in Communication Science and Disorders. 27 (Fall): 188–199. doi:10.1044/cicsd_27_F_188.
  27. ↑ Peterson, Robin L; Pennington, Bruce F (May 2012). "Developmental dyslexia". The Lancet. 379 (9830): 1997–2007. doi:10.1016/s0140-6736(12)60198-6. ISSN 0140-6736. PMC 3465717. PMID 22513218.
  28. ↑ Blood, Gordon W; Ridenour, Victor J; Qualls, Constance Dean; Hammer, Carol Scheffner (November 2003). "Co-occurring disorders in children who stutter". Journal of Communication Disorders. 36 (6): 427–448. doi:10.1016/S0021-9924(03)00023-6. PMID 12967738.
  29. ↑ Arndt, Jennifer; Healey, E. Charles (April 2001). "Concomitant Disorders in School-Age Children Who Stutter". Language, Speech, and Hearing Services in Schools. 32 (2): 68–78. doi:10.1044/0161-1461(2001/006). ISSN 0161-1461. PMID 27764357.
  30. ↑ Elsherif, Mahmoud M.; Wheeldon, Linda R.; Frisson, Steven (2021-03-01). "Do dyslexia and stuttering share a processing deficit?". Journal of Fluency Disorders. 67: 105827. doi:10.1016/j.jfludis.2020.105827. ISSN 0094-730X. PMID 33444937. S2CID 231611179.
  31. 1 2 3 Briley, Patrick M.; Ellis, Charles (2018-12-10). "The Coexistence of Disabling Conditions in Children Who Stutter: Evidence From the National Health Interview Survey". Journal of Speech, Language, and Hearing Research. 61 (12): 2895–2905. doi:10.1044/2018_JSLHR-S-17-0378. ISSN 1092-4388. PMID 30458520. S2CID 53946065.
  32. ↑ Healey, E. C., Reid, R., & Donaher, J. (2005). Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges. In R. Lees & C. Stark (Eds.), The treatment of stuttering in the young school-aged child (pp. 178–196). Whurr Publishers.
  33. ↑ Ntourou, Katerina; Conture, Edward G.; Lipsey, Mark W. (August 2011). "Language Abilities of Children Who Stutter: A Meta-Analytical Review". American Journal of Speech-Language Pathology. 20 (3): 163–179. doi:10.1044/1058-0360(2011/09-0102). ISSN 1058-0360. PMC 3738062. PMID 21478281.
  34. ↑ Iverach, Lisa; Rapee, Ronald M. (June 2014). "Social anxiety disorder and stuttering: Current status and future directions". Journal of Fluency Disorders. 40: 69–82. doi:10.1016/j.jfludis.2013.08.003. PMID 24929468.
  35. ↑ St. Louis, Kenneth O.; Hinzman, Audrey R. (October 1988). "A descriptive study of speech, language, and hearing characteristics of school-aged stutterers". Journal of Fluency Disorders. 13 (5): 331–355. doi:10.1016/0094-730X(88)90003-4.
  36. 1 2 3 4 5 6 7 Gordon, N. (2002). "Stuttering: incidence and causes". Developmental Medicine & Child Neurology. 44 (4): 278–81. doi:10.1017/S0012162201002067. PMID 11995897.
  37. 1 2 3 Guitar 2005, pp. 5–6
  38. ↑ Ward 2006, p. 11
  39. 1 2 3 Guitar 2005, p. 66
  40. ↑ Guitar 2005, p. 39
  41. ↑ Ward 2006, p. 12
  42. ↑ West, R.; Nelson, S.; Berry, M. (1939). "The heredity of stuttering". Quarterly Journal of Speech. 25 (1): 23–30. doi:10.1080/00335633909380434.
  43. ↑ Stammering (Stuttering) A Complex Vocal Tic, Patricia Sims, Kindle version 2014
  44. ↑ Kang, Changsoo; Riazuddin, Sheikh; Mundorff, Jennifer; Krasnewich, Donna; Friedman, Penelope; Mullikin, James C.; Drayna, Dennis (2010-02-25). "Mutations in the Lysosomal Enzyme–Targeting Pathway and Persistent Stuttering". New England Journal of Medicine. 362 (8): 677–685. doi:10.1056/nejmoa0902630. ISSN 0028-4793. PMC 2936507. PMID 20147709.
  45. ↑ "Genetic Mutations Linked to Stuttering". Children.webmd.com. February 10, 2010. Archived from the original on November 12, 2012. Retrieved August 13, 2012.
  46. 1 2 3 4 5 Watkins KE, Smith SM, Davis S, Howell P (January 2008). "Structural and functional abnormalities of the motor system in developmental stuttering". Brain. 131 (Pt 1): 50–9. doi:10.1093/brain/awm241. PMC 2492392. PMID 17928317.
  47. ↑ Soo-Eun, Chang (2007). "Brain anatomy differences in childhood stuttering". NeuroImage.
  48. ↑ Ward 2006, pp. 46–7
  49. ↑ Ward 2006, p. 58
  50. ↑ Ward 2006, p. 43
  51. ↑ Ward 2006, pp. 16–21
  52. 1 2 3 4 Bloodstein, Oliver; Ratner, Nan Bernstein (2007). A handbook on stuttering. Cengage Learning. p. 142. ISBN 978-1418042035.
  53. ↑ Chang SE, Erickson KI, Ambrose NG, Hasegawa-Johnson MA, Ludlow CL (February 2008). "Brain anatomy differences in childhood stuttering". NeuroImage. 39 (3): 1333–44. doi:10.1016/j.neuroimage.2007.09.067. PMC 2731627. PMID 18023366.
  54. ↑ McGaughey, Steve (2011-12-16). "Stuttering starts in the brain". Futurity. Archived from the original on 2013-04-24. Retrieved 2014-05-12.
  55. 1 2 3 "Brain Development in Children Who Stutter | Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter". Stutteringhelp.org. 1955-12-04. Archived from the original on 2014-05-12. Retrieved 2014-05-12.
  56. ↑ Braun A R; Varga M; Stager S; Schulz G; Selbie S; Maisog J M; Carson R E; Ludlow C L (May 1997). "Altered patterns of cerebral activity during speech and language production in developmental stuttering. An H2(15)O positron emission tomography study". Brain. 120 (Part 5): 761–84. doi:10.1093/brain/120.5.761. PMID 9183248.
  57. ↑ "NIH study in mice identifies type of brain cell involved in stuttering". NIDCD. 2019-08-16. Retrieved 2021-05-16.
  58. ↑ "Star-shaped brain cells may be linked to stuttering: Effects of the medication risperidone on brain metabolism in stuttering examined". ScienceDaily. Retrieved 2021-05-16.
  59. ↑ Hinkley, Leighton B. N.; Marco, Elysa J.; Brown, Ethan G.; Bukshpun, Polina; Gold, Jacquelyn; Hill, Susanna; Findlay, Anne M.; Jeremy, Rita J.; Wakahiro, Mari L.; Barkovich, A. James; Mukherjee, Pratik (2016-04-20). "The Contribution of the Corpus Callosum to Language Lateralization". The Journal of Neuroscience. 36 (16): 4522–4533. doi:10.1523/JNEUROSCI.3850-14.2016. ISSN 1529-2401. PMC 4837685. PMID 27098695.
  60. ↑ "Cellular Causes of Stuttering in Adults and Children". Stamurai Blog – Stuttering Information, Advice & News. 2020-08-01. Retrieved 2021-05-16.
  61. ↑ Dance, Amber. "The mysterious cause of stuttering in the brain". www.bbc.com. Retrieved 2021-05-16.
  62. ↑ "Neurogenic Stuttering". Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. 6 May 2011. Retrieved 2020-01-29.
  63. ↑ "Stuttering". NIDCD. 2015-08-18. Archived from the original on 2018-05-20. Retrieved 2020-01-29.
  64. 1 2 http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International Archived 2013-11-10 at the Wayback Machine Fibiger S. 2009. Stuttering. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation.
  65. ↑ Encyclopedia of Rehabilitation Archived 2013-11-10 at the Wayback Machine
  66. ↑ "Trobe University School of Human Communication Disorders".
  67. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.
  68. 1 2 3 4 5 6 7 Sander, RW; Osborne, CA (1 November 2019). "Stuttering: Understanding and Treating a Common Disability". American Family Physician. 100 (9): 556–560. PMID 31674746.
  69. ↑ Ambrose, Nicoline Grinager, and Ehud Yairi. "Normative Disfluency Data for Early Childhood Stuttering." Journal of Speech, Language, and Hearing Research 42, no. 4 (1999): 895–909. https://doi.org/10.1044/jslhr.4204.895 ("Stuttering is shown to be qualitatively as well as quantitatively different from normal disfluency even at the earliest stages of stuttering.")
  70. 1 2 3 4 5 Craig, A.; Tran, Y. (2005). "The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan". Advances in Speech Language Pathology. 7 (1): 41–46. doi:10.1080/14417040500055060. S2CID 71565512.
  71. 1 2 Yairi, E.; Ambrose, N. (1992). "Onset of stuttering in preschool children: selected factors". Journal of Speech and Hearing Research. 35 (4): 782–8. doi:10.1044/jshr.3504.782. PMID 1405533.
  72. 1 2 3 Ward 2006, p. 13
  73. ↑ Ward 2006, pp. 114–5
  74. ↑ Ward 2006, pp. 13, 115
  75. ↑ Ward 2006, pp. 115–116
  76. 1 2 Ward 2006, pp. 117–119
  77. ↑ Ward 2006, pp. 4, 332–335
  78. ↑ Ward 2006, pp. 4, 332, 335–337
  79. ↑ "Stuttering". Asha.org. Archived from the original on 2013-11-20. Retrieved 2014-05-12.
  80. 1 2 "Stuttering". Nidcd.nih.gov. Archived from the original on 2014-04-04. Retrieved 2014-05-12.
  81. ↑ "Stuttering" (PDF). Archived from the original (PDF) on 2010-06-16. Retrieved 2014-05-12.
  82. ↑ "ASHA – Treatment Efficacy for Stuttering" (PDF). Archived from the original (PDF) on 2010-06-16.
  83. ↑ "Stuttering". Asha.org. Archived from the original on 2009-10-16. Retrieved 2014-05-12.
  84. ↑ Ward 2006, p. 257
  85. ↑ Ward 2006, p. 253
  86. ↑ Ward 2006, p. 245
  87. ↑ Stuttering, Stammering Archived 2012-09-10 at the Wayback Machine
  88. 1 2 Bothe, A. K.; Finn, P.; Bramlett, R. E. (2007). "Pseudoscience and the SpeechEasy: Reply to Kalinowski, Saltuklaroglu, Stuart, and Guntupalli (2007)". American Journal of Speech-Language Pathology. 16: 77–83. doi:10.1044/1058-0360(2007/010).
  89. ↑ Bothe, AK; Davidow, JH; Bramlett, RE; Ingham, RJ (2006). "Stuttering Treatment Research 1970–2005: I. Systematic Review Incorporating Trial Quality Assessment of Behavioral, Cognitive, and Related Approaches". American Journal of Speech-Language Pathology. 15 (4): 321–341. doi:10.1044/1058-0360(2006/031). PMID 17102144. S2CID 24775349.
  90. 1 2 "Electronic Devices, Software and Apps". Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. 6 May 2011. Retrieved 2019-11-21.
  91. ↑ Kalinowski, J.; Armson, J.; Roland-Mieszkowski, M.; Stuart, A.; Gracco, V. L. (1993). "Effects of alterations in auditory feedback and speech rate on stuttering frequency". Language and Speech. 36 (1): 1–16. doi:10.1177/002383099303600101. ISSN 0023-8309. PMID 8345771. S2CID 16949019.
  92. ↑ Jacks, Adam; Haley, Katarina L. (2015). "Auditory Masking Effects on Speech Fluency in Apraxia of Speech and Aphasia: Comparison to Altered Auditory Feedback". Journal of Speech, Language, and Hearing Research. 58 (6): 1670–1686. doi:10.1044/2015_JSLHR-S-14-0277. ISSN 1092-4388. PMC 4987030. PMID 26363508.
  93. ↑ Burke, Bryan D. (1969-09-01). "Reduced auditory feedback and stuttering". Behaviour Research and Therapy. 7 (3): 303–308. doi:10.1016/0005-7967(69)90011-4. ISSN 0005-7967.
  94. ↑ Bothe Anne K.; Finn Patrick; Bramlett Robin E. (2007-02-01). "Pseudoscience and the SpeechEasy: Reply to Kalinowski, Saltuklaroglu, Stuart, and Guntupalli (2007)". American Journal of Speech-Language Pathology. 16 (1): 77–83. doi:10.1044/1058-0360(2007/010).
  95. ↑ Picoloto, Luana Altran; Cardoso, Ana Cláudia Vieira; Cerqueira, Amanda Venuti; Oliveira, Cristiane Moço Canhetti de (2017-12-07). "Effect of delayed auditory feedback on stuttering with and without central auditory processing disorders". CoDAS. 29 (6): e20170038. doi:10.1590/2317-1782/201720170038. hdl:11449/179424. ISSN 2317-1782. PMID 29236907.
  96. ↑ Kalinowski, Joseph; Armson, Joy; Stuart, Andrew; Gracco, Vincent L. (1993). "Effects of Alterations in Auditory Feedback and Speech Rate on Stuttering Frequency". Language and Speech. 36 (1): 1–16. doi:10.1177/002383099303600101. ISSN 0023-8309. PMID 8345771. S2CID 16949019.
  97. ↑ Zimmerman Stephen; Kalinowski Joseph; Stuart Andrew; Rastatter Michael (1997-10-01). "Effect of Altered Auditory Feedback on People Who Stutter During Scripted Telephone Conversations". Journal of Speech, Language, and Hearing Research. 40 (5): 1130–1134. doi:10.1044/jslhr.4005.1130. PMID 9328884.
  98. ↑ Howell, Peter; Davis, Stephen; Bartrip, Jon; Wormald, Laura (2004-09-01). "Effectiveness of frequency shifted feedback at reducing disfluency for linguistically easy, and difficult, sections of speech (original audio recordings included)". Stammering Research. 1 (3): 309–315. ISSN 1742-5867. PMC 2312336. PMID 18418474.
  99. ↑ Brady, John Paul (1969-05-01). "Studies on the metronome effect on stuttering". Behaviour Research and Therapy. 7 (2): 197–204. doi:10.1016/0005-7967(69)90033-3. ISSN 0005-7967. PMID 5808691.
  100. ↑ Hudock, Daniel; Dayalu, Vikram N.; Saltuklaroglu, Tim; Stuart, Andrew; Zhang, Jianliang; Kalinowski, Joseph (2011). "Stuttering inhibition via visual feedback at normal and fast speech rates". International Journal of Language & Communication Disorders. 46 (2): 169–178. doi:10.3109/13682822.2010.490574. ISSN 1460-6984. PMID 21401815.
  101. ↑ Chesters, Jennifer; Baghai-Ravary, Ladan; Möttönen, Riikka (2015). "The effects of delayed auditory and visual feedback on speech production". The Journal of the Acoustical Society of America. 137 (2): 873–883. Bibcode:2015ASAJ..137..873C. doi:10.1121/1.4906266. ISSN 0001-4966. PMC 4477042. PMID 25698020.
  102. ↑ Maguire Gerald A., Riley Glyndon D., Franklin David L., Maguire Michael E., Nguyen Charles T., Brojeni Pedram H. (2004). "Olanzapine in the treatment of developmental stuttering: a double-blind, placebo-controlled trial". Annals of Clinical Psychiatry. 16 (2): 63–67. doi:10.1080/10401230490452834. PMID 15328899.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  103. ↑ Thomas, K., & Saadabadi, A. (2018). Olanzapine. In StatPearls [Internet]. StatPearls Publishing.
  104. 1 2 Shaygannejad V., Khatoonabadi S. A., Shafiei B., Ghasemi M., Fatehi F., Meamar R., Dehghani L. (2013). "Olanzapine versus haloperidol: which can control stuttering better?". International Journal of Preventive Medicine. 4 (Suppl 2): S270-3. PMC 3678230. PMID 23776736.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  105. ↑ Maguire Gerald A., Riley Glyndon D., Franklin David L., Gottschalk Louis A. (2000). "Risperidone for the treatment of stuttering". Journal of Clinical Psychopharmacology. 20 (4): 479–482. doi:10.1097/00004714-200008000-00013. PMID 10917410.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  106. 1 2 3 Maguire, G.A., Lasalle L., Hoffmeyer D., Nelson M., Lochead J.D., Davis K., Burris A., Yaruss J.S., "Ecopipam as a pharmacologic treatment of stuttering." Ann Clin Psychiatry (2019 Aug), 31(3), 164-168.
  107. ↑ Messer, Stanley B. (June 1983). "Integrating psychoanalytic and behaviour therapy: Limitations, possibilities and trade-offs". British Journal of Clinical Psychology. 22 (2): 131–132. doi:10.1111/j.2044-8260.1983.tb00587.x. PMID 6871506.
  108. ↑ McCord, Hallack (1955). "Hypnotherapy and stuttering". Journal of Clinical and Experimental Hypnosis. 3 (4): 210–214. doi:10.1080/00207145508410154.
  109. ↑ Oakley, D.; Moss, G. (Spring 1996). "Stuttering modification using hypnosis: A case study". Speaking Out. 3 (4): 210–214. doi:10.1080/00207145508410154.
  110. ↑ Moore, Wilbur E. (June 1946). "Hypnosis in a system of therapy for stutterers". Journal of Speech and Hearing Disorders. 11 (2): 117–122. doi:10.1044/jshd.1102.117. PMID 20986557. Archived from the original on 2013-11-10.
  111. ↑ Fisher, Martin N. (Winter 1970). "Stuttering: A psychoanalytic view". Journal of Contemporary Psychotherapy. 2 (2): 124–127. doi:10.1007/bf02118180. S2CID 26579399.
  112. ↑ Reddy, R.P. (Spring 2017). "Cognitive Behavior Therapy for Stuttering: A Case Series". Indian Journal of Psychological Medicine. 2010 jan-jun 32(1) (1): 49–53. doi:10.4103/0253-7176.70533. PMC 3137813. PMID 21799560.
  113. ↑ "Stuttering Habits". Stuttering Habits. Archived from the original on 2017-04-18.
  114. ↑ "Stammer School: Musharaf Finds His Voice, Channel 4 | the Arts Desk". 29 August 2014. Archived from the original on 2014-09-11. Retrieved 2014-09-09.
  115. ↑ Yairi, E. (1993). "Epidemiologic and other considerations in treatment efficacy research with preschool-age children who stutter". Journal of Fluency Disorders. 18 (2–3): 197–220. doi:10.1016/0094-730X(93)90007-Q.
  116. 1 2 3 4 Ward 2006, p. 16
  117. ↑ Yairi, E (Fall 2005). "On the Gender Factor in Stuttering". Stuttering Foundation of America Newsletter: 5.
  118. 1 2 3 4 Guitar 2005, p. 7
  119. 1 2 3 4 Yairi, E.; Ambrose, N. (2005). "Early childhood stuttering". Pro-Ed.
  120. ↑ Andrews, G.; Craig, A.; Feyer, A. M.; Hoddinott, S.; Howie, P.; Neilson, M. (1983). "Stuttering: a review of research findings and theories circa 1982". The Journal of Speech and Hearing Disorders. 48 (3): 226–46. doi:10.1044/jshd.4803.226. PMID 6353066.
  121. ↑ Mansson, H. (2000). "Childhood stuttering: Incidence and development". Journal of Fluency Disorders. 25 (1): 47–57. doi:10.1016/S0094-730X(99)00023-6.
  122. 1 2 Yairi, E; Ambrose, N; Cox, N (1996). "Genetics of stuttering: a critical review". Journal of Speech, Language, and Hearing Research. 39 (4): 771–784. doi:10.1044/jshr.3904.771. PMID 8844557.
  123. 1 2 Kloth, S; Janssen, P; Kraaimaat, F; Brutten, G (1995). "Speech-motor and linguistic skills of young people who stutter prior to onset". Journal of Fluency Disorders. 20 (2): 157–70. doi:10.1016/0094-730X(94)00022-L. hdl:2066/21168. S2CID 146130424.
  124. 1 2 Proctor, A.; Duff, M.; Yairi, E. (2002). "Early childhood stuttering: African Americans and European Americans". ASHA Leader. 4 (15): 102.
  125. ↑ Guitar 2005, p. 22
  126. ↑ Yairi, E.; Ambrose, N. G. (1999). "Early childhood stuttering I: persistency and recovery rates". Journal of Speech, Language, and Hearing Research. 42 (5): 1097–112. doi:10.1044/jslhr.4205.1097. PMID 10515508.
  127. ↑ Craig, A.; Hancock, K.; Tran, Y.; Craig, M.; Peters, K. (2002). "Epidemiology of stuttering in the community across the entire life span". Journal of Speech, Language, and Hearing Research. 45 (6): 1097–105. doi:10.1044/1092-4388(2002/088). PMID 12546480.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  128. ↑ Boyle C.A., Boulet S., Schieve L.A., Cohen R.A., Blumberg S.J., Yeargin-Allsopp M., Visser S., Kogan M.D. (Jun 2011). "Trends in the prevalence of developmental disabilities in US children, 1997–2008". Pediatrics. 127 (6): 1034–42. doi:10.1542/peds.2010-2989. PMID 21606152. S2CID 21383720.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  129. ↑ Mark Onslow, "Stuttering and its Treatment: Eleven lectures", 2017, June, pg. 47.
  130. ↑ Nwokah, E (1988). "The imbalance of stuttering behavior in bilingual speakers". Journal of Fluency Disorders. 13 (5): 357–373. doi:10.1016/0094-730X(88)90004-6.
  131. ↑ Sheree Reese, Joseph Jordania (2001). "Stuttering in the Chinese population in some Southeast Asian countries: A preliminary investigation on attitude and incidence". "Stuttering Awareness Day"; Minnesota State University, Mankato. Archived from the original on 2011-06-06.
  132. 1 2 3 4 Brosch, S; Pirsig, W. (2001). "Stuttering in history and culture". Int. J. Pediatr. Otorhinolaryngol. 59 (2): 81–7. doi:10.1016/S0165-5876(01)00474-8. PMID 11378182.
  133. 1 2 Rieber, RW; Wollock, J (1977). "The historical roots of the theory and therapy of stuttering". Journal of Communication Disorders. 10 (1–2): 3–24. doi:10.1016/0021-9924(77)90009-0. PMID 325028.
  134. ↑ "Churchill: A Study in Oratory". The Churchill Centre. Archived from the original on 2005-04-19. Retrieved 2005-04-05.
  135. ↑ "Churchill Stutter". Archived from the original on 2012-01-13. Retrieved 2012-01-28.
  136. 1 2 Kuster, Judith Maginnis (2005-04-01). "Folk Myths About Stuttering". Minnesota State University. Archived from the original on 2005-04-19. Retrieved 2005-04-03.
  137. ↑ "Did I Stutter?". Did I Stutter?. Archived from the original on 2015-10-06. Retrieved 2015-10-05.
  138. ↑ "How To Stutter More". stuttermore.tumblr.com. Archived from the original on 2015-10-29. Retrieved 2015-10-05.
  139. ↑ "Defence Stammering Network launched". Archived from the original on 2015-08-25. Retrieved 2015-07-25.
  140. 1 2 3 "Stuttering and the Bilingual Child". Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter. 6 May 2011. Archived from the original on 2017-09-26. Retrieved 2017-12-18.
  141. ↑ Howell, Peter; Borsel, John Van (2011). Multilingual Aspects of Fluency Disorders. Multilingual Matters. ISBN 9781847693587.
  142. ↑ Howell, P; Davis, S; Williams, R (January 2009). "The effects of bilingualism on stuttering during late childhood". Archives of Disease in Childhood. 94 (1): 42–46. doi:10.1136/adc.2007.134114. ISSN 0003-9888. PMC 2597689. PMID 18782846.
  143. ↑ Au-Yeung, James; Howell, Peter; Davis, Steve; Charles, Nicole; Sackin, Stevie (2000-09-01). "UCL survey of bilingualism and stuttering". Journal of Fluency Disorders. 25 (3): 246. doi:10.1016/S0094-730X(00)80321-6. Archived from the original on 2017-12-23.
  144. ↑ Rachel Karniol (1992-10-01). "Stuttering out of bilingualism". First Language. 12 (36): 255–283. doi:10.1177/014272379201203604. ISSN 0142-7237. S2CID 144798976.
  145. ↑ Awards and Recognition Archived 2008-12-05 at the Wayback Machine. Retrieved 2009-12-10.
  146. ↑ Behrens, David (25 July 2020). "Where Arkwright in Open All Hours found his signature stutter". Yorkshire Post. Retrieved 23 September 2020.
  147. ↑ Nirmal, Gayatri (2017-08-09). "Due to societal pressure, Shreyas won't stammer in Golmaal 4, but has another quirk". Deccan Chronicle. Retrieved 2023-01-10.
  148. ↑ "Stammering Groups | STAMMA". stamma.org. Retrieved 2023-07-23.
  149. ↑ "Local NSA Chapters | Stuttering Support Groups". National Stuttering Association. Retrieved 2023-07-23.
  150. ↑ Thurber, James (1930-04-25). "Stammerers' Club". The New Yorker. ISSN 0028-792X. Retrieved 2023-08-01.
  151. ↑ "Fraser's Magazine for Town and Country, 1830–1882", Perceptions of the Press in Nineteenth-Century British Periodicals, Anthem Press, pp. 261–299, 2012-02-01, doi:10.7135/upo9781843317562.019, ISBN 9781843317562, retrieved 2023-08-01
  152. ↑ "STAMMERERS' CLUB". Sydney Morning Herald. 1935-05-23. Retrieved 2023-08-01.
  153. ↑ "THE STAMMERERS' CLUB OF QUEENSLAND". Cairns Post. 1936-10-10.
  154. 1 2 Stammering pride and prejudice : difference not defect. Patrick Campbell, Christopher Constantino, Sam Simpson. [Albury]. 2019. ISBN 978-1-907826-36-8. OCLC 1121135480.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)

References

Further reading

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