Characteristics of stuttering in adults are typically very different from those in children. While adults who stutter also exhibit repetitions, blocks and prolongations, these core behaviours are often longer. The blocks are more tense often accompanied by tremors of the lips, jaw or/and tongue.
Secondary behaviours in adults are much more complex through years of acquired expertise. Avoidance of feared words and escaping difficult to pronounce words are much more difficult to detect in adults who have been stuttering for more than a decade or two. In some cases, adults may even successfully suppress their stammering by using avoidance behaviours extensively. While these are common among adults who stutter, they might not be doing these intentionally.
The negative emotions (fear, shame and embarrassment) are much stronger in adults who stutter than in children. That might lead someone with a speech disorder like stuttering to display introvert-like qualities, lack of confidence in social situations and harm their concept of “Self”.
Hence the process of treating an adult, who stutters is quite intensive. Advanced stuttering not only requires the attention of a good speech-language pathologist (SLP) but also a cognitive behavioural therapist (CBT) or counsellor. Therefore, therapy for advanced stuttering needs to directly deal with the aspects of avoidance behaviour along. The therapist must understand that the adult with advanced stuttering may not fear the situations and words only, but also the stuttering itself.
Here are a few facts about the treatment of advanced stuttering every adolescent and adult must remember –
- It can be a very lengthy process – The treatment of adolescent and adults who stutter can take a long time since it needs to focus on many aspects including the emotions of the individual, integral beliefs associated with stuttering, and the secondary behaviours. While preschool children may take only a couple of months or a year to show marked improvement in fluency, adults must remember that patience and persistence are going to be their only friends in the long journey towards fluency. Thus, it is of utmost importance for adults to work with their SPLs to set realistic goals before they begin working on his/her speech. An integrated approach that includes exploring their nature and severity of stuttering, learning controlled fluency and increasing approach behaviour. An adult has to unlearn a significant amount of coping behaviour they have learned over the years they have been stuttering. It requires hard work on the part of the therapist, counsellor and their client.
- There is no one-size-fits-all treatment – Each client comes with different levels of stuttering severity, emotional blocks and stuttering related beliefs. Therefore, it is impossible to stretch one treatment to every adult with a stutter. The treatments vary according to their experience related to stuttering, their upbringing, traumas related to stuttering and even their perception of the listener when they stutter. Of all treatment processes, controlled fluency is the most important, and the performance of the patient during controlled stuttering sessions will dictate the future of their treatment.
- Integrated treatment should always include an increase in approach behaviour and reduction in avoidance – Over the years, SPLs have associated low levels of avoidance and increase in approach behaviour with an improvement in the fluency of speech. An integrated approach pays attention to the negative emotions, attitudes and avoidances of the adult. The use of controlled fluency or superfluency can positively influence the attitude and emotions via recurring experiences of fluency. Neurologically speaking, it can kindle speech regulation and emotional regulation by the left hemisphere. At the same time, it can dampen avoidance behaviour in the same person. The skills acquired after integrated therapy can include slowed speech rate, easy phonation onset, proprioception, pausing and light articulatory contact.
- Treatment may not remove speech-processing deficits completely – Adults who stutter may continue to possess speech-processing deficits even after the completion of successful treatment. Brain imaging studies show that adults with stuttering may continue to display lower-than-average left-brain activity, despite receiving complete speech therapy sessions by an expert. Dealing with residual stuttering is a long-term commitment and it can be a continuing task for the person and his/her therapist. It reflects a study conducted recently where more than 80% of the 216 participants chose fluency over freedom from stuttering as their therapy goal.
- Keeping yourself motivated – You need to keep a measure of your progress and the result of the regular therapy. Make a note of the percentage of syllables stuttered to capture the snapshot of progress before and after speech therapy. Don’t forget that speech therapy is a long journey for adolescents and adults. Therefore, it is important to stick to your exercises and attend the appointments with your therapist for continuing improvement of your speech fluency.
Adults who stutter can seek out online forums or communities near their location to share their feelings and emotions about stuttering. Finding a safe space to share life experiences that may have occurred due to stuttering can help one find confidence.
It will help you set realistic goals for your speech, as well as to measure the progress once you begin attending the therapy sessions with your SLP.