UW and the community

January 12, 2011

‘The Kings Speech mostly true to life, UW expert on stuttering says

“Just form your words carefully.”

“Relax!”

“Just take your time.”

“Get it out, boy!”

These are all cringe-worthy, exasperating and ultimately unhelpful advice dreaded by most people who stutter, says a UW expert on the speech disorder.

The new movie, The Kings Speech, documents Britain’s King George VI as he struggles with stuttering, or stammering, as the Brits call it. A stutterer since childhood, Bertie – the kings nickname – feared becoming king because of the roles public speaking requirements.

Ludo Max, UW associate professor of speech and hearing sciences, says that the movie is an accurate portrayal of stuttering and of the techniques used to overcome the speech disorder during the 1930s and 1940s. But there are some inconsistencies with what is known today about stuttering. And the stuttering of many children and adults is more severe than that of the king.

A common ailment, stuttering afflicts about 1 percent – one out of 100 – of the population. The statistic holds across culture and language, indicating that no particular language is more or less vulnerable. Unlike the depiction in The Kings Speech, being left- or right-handed does not affect the chance of developing a stuttering problem.

But gender does matter. Though equal numbers of boys and girls start to stutter, girls are more likely to overcome it without treatment. As adults, three to four times as many men as women stutter.

In the movie, the king, played by actor Colin Firth, tries various tricks to stop stammering: inserting large marbles in his mouth while trying to speak, singing, speaking out loud while listening to music.

As ridiculous as some of the tricks sound, they might have worked, Max said. Since King George VIs time, research has revealed that when people who stutter change how they speak, their stuttering can diminish.

While the movie may lead audiences to believe that anxiety, fear or childhood trauma cause stuttering in adulthood, Max said that psychological factors are just part of the problem. “The essence of the problem lies in the brains motor areas that produce speech, and these areas are  affected by stress,” he said. “Psychological factors dont cause stuttering; theyre a result.”

In Maxs research, he finds that motor deficits can explain stuttering. Speaking requires precise planning of fast movements by the jaw, tongue, lips, and vocal folds. Max has found that in stuttering, the brain has difficulty with using incoming information – hearing our own speech sounds and feeling our own movements – to plan and adjust those movements correctly.

Its differences on the order of milliseconds and millimeters, but it could be enough to disrupt speech. Once these motor difficulties are better understood, it may become possible to develop better treatments to reduce stuttering.

For more on Maxs research, watch a video of his lab or check out his website.

While motor deficits are the root cause, stress exacerbates stuttering. Imagine: every time you open your mouth to speak in class or in a meeting or place a phone call, you feel gut-wrenching fear of halting, hesitating, stumbling speech.

“People who stutter often worry about how bad their speech will be,” Max said. “Theyll have good days and bad days, good and bad situations.”

The anxiety is enough to provoke some people to avoid difficult speaking situations altogether and replace hard to say words with easier ones, which can influence what meal they order in a restaurant, what they name their children, where they live and if they ever use the telephone.

For adults, treatment options include speech therapy, medication or electronic devices. Stuttering can run in families, and genetic testing may eventually yield new treatments.

Meanwhile, some people who stutter rely on devices that look like hearing aids and that help reduce stuttering by playing a slightly-delayed, high-pitched playback of what the person says.

Similarly, in The Kings Speech, the king did not stutter if he listened to music on headphones while reading aloud a Hamlet soliloquy.

But these devices are controversial, Max said. Their usefulness can wear off over time.

Another trick: no one who stutters will stutter while singing. But how useful is that? “I dont mind listening to stuttering, but listening to singing may be just too weird,” Max said.

One strategy that can temporarily help adults who stutter is to change how they talk. “Anything they do thats different from how they normally speak will help them be more fluent for a while,” Max said. This may explain, for instance, why actors with a stuttering problem – including James Earl Jones and Marilyn Monroe – didnt stutter when playing a role.

Speech therapy can help adults find easier ways to speak so that they dont get hung up on words as often and for as long a time. Therapy can also help with the psychological components of stuttering. “Speech therapy for adults can make stuttering easier to handle, though its highly unlikely for their stuttering to go away completely,” Max said.

The best way to nix stuttering for good is to stop it once it begins, usually around ages 2 to 4. Children who stutter at this age are able to do simple language tasks, such as naming objects. But they run into trouble when they attempt to combine words into sentences.

Speech therapy can eliminate stuttering if the therapy begins soon after the child starts stuttering, Max said. In the Lidcombe Programme, parents learn to calmly and gently correct their childs speech. “An experienced speech-language pathologist can teach parents exactly how and when to say to their child ‘I heard a bumpy word, did you hear that?” Max said. At the same time, the parents learn how and when to praise their child for fluent speech.

As depicted in The Kings Speech, King George VI, with speech therapy, was able to give frequent liv
e radio speeches that helped encourage citizens through the war.

Max hopes that the movie will help people who stutter feel less isolated and misunderstood. He also hopes the movie helps people who do not stutter ”better understand the daily difficulties encountered by a stuttering family member, friend, colleague or random person on the street.”

Saying “take your time,” “take a deep breath” or other encouragements, while well-intentioned, do not ease stuttering, Max said. Guessing or filling in words that the person may be trying to say can make things worse, too.

“The best thing to do is to patiently wait and give the person time to finish the word or sentence,” he said.  “Show the person that their stuttering is okay, that it doesnt pose a problem with communication. This may help the person become less anxious about the situation and less worried about the stuttering.”