Therapy for children

Treatment of stuttering in children younger than six years of age focuses on the prevention or elimination of stuttering. Families play an important role in the management of stuttering in children: therapy is usually characterized providing an environment that encourages slow speech, affording the child time to talk, and modeling slowed and relaxed speech.

Fluency shaping

Fluency shaping therapy focuses on changing all of the speech of the person who stutters. This type of therapy involves teaching the stutterer to use a speaking style that requires careful and prominent self-monitoring; examples of such therapy include one in which the stutterer slows his speech down or speaks in a controlled tone. This type of approach can reduce stuttering, although in children its effectiveness decreases if stuttering persists after eight years of age.

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.

Stuttering modification

Stuttering modification therapy, also known as traditional stuttering therapy,^[2] was developed by Charles Van Riper between 1936 and 1958.^[13] It focuses on reducing the severity of stuttering by changing only the portions of speech in which a person stutters, to make them smoother, shorter, less tense and hard, and less penalizing. This approach attempts to reduce the severity and fear of stuttering, and strives to teach stutterers to stutter with control, and not to make the stutterer fluent. Therapy using this approach tends to recognize the fear and avoidance of stuttering.

Contemporary devices

Contemporary devices used to reduce stuttering alters the frequency of the speaker's voice to mimic the "choral effect", a phenomenon in which person's stutter decreases or ceases completely when she is speaking with a group of others, or slows the rate of speech through delayed auditory feedback.

Delayed auditory feedback devices, such as Speech Easy encourage the slowing down of speech by replaying the speaker's words into their ears. The stutterer is then forced to slow their rate of speech to prevent distortions in the speech that is heard through the device. This is not effective for all people who stutter, and is shown to wear off over time.^[14] 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.^[15]

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.^[16]

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.^[16]

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.^[17][18][19]
• 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.^[20][21]
• 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.^[22][23][24]
• 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.^[25]
• 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.^[26][27]

Diaphragmatic breathing

Several treatment initiatives use diaphragmatic breathing (or costal breathing) as a means by which stuttering can be controlled.^[32]

Psychological approach

Cognitive behavior therapy has been used to treat stuttering.^[33] Also sociological approaches has been explored regarding how social groups maintain stuttering through social norms.^[34]

Self-therapy and community groups

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) may be used to help people who stutter. CBT may be partially effective in helping clients reduce their secondary behaviors, anxiety, and cognitive distortion.^[40][41] Cognitive behavioral therapy is a collaborative process that requires the client and the therapist working together to explore the buried feelings of frustration, avoidance, anger, and self-doubt. Younger children who stutter are more benefited by CBT as compared to adults who stutter. Research at the Michael Palin Center has shown that CBT is a powerful tool for children who stutter.^[42]

Pharmacologic therapy

Several pharmacologic, i.e. drug-based, methods to control or alleviate stuttering events have been studied, but each has either proved ineffective or have had adverse effects. A comprehensive review of pharmacologic interventions for stuttering showed that no agent leads to valid improvement in stuttering or in secondary social and emotional consequences.