Photo: AP Photo/Andrew Harnik
On a pre-COVID-19 stop in New Hampshire during his campaign for the Democratic presidential nomination, Joe Biden met 13-year-old Braydon Harrington, who, like Biden, stutters. During the Democratic National Convention several months later, Harrington spoke of that meeting and told a national audience how Biden told him they were members of the same club.
Roughly 3 million people in the United States — including President Joe Biden — stutter. They are among the more than 70 million people around the world with the speech disorder, which is characterized by the repetition of sounds, syllables or words; prolongation of and fluency. “Many people think if you tell someone who stutters to ‘just relax’ or ‘slow down’ or to ‘think about what you want to say before you say it,’ that this is somehow going to help them,” says Nicole Schussel, a UCLA Health speech-language pathologist. “But most sounds; and interruptions in speech known as blocks. While on the campaign trail, Biden talked about his lifelong struggle with stuttering — “It’s a debilitation situation,” he said — and his connection with a New Hampshire teen who also stutters made national news after the Democratic National Convention.
The precise cause of stuttering is unclear, and while there is no cure, speech therapy can help many who stutter to gain greater control people who stutter are thinking about what they want to say. It’s an issue of being able to get it out fluently or in a smooth way.”
Stuttering behaviors typically surface around age 3 or 4, Schussel says. “There’s some preschool-age stuttering that we expect. Children start to gain all of this new vocabulary, and they don’t really know what to do with it,” Schussel says. “They’re trying to figure out what order to put the words in while trying to keep their place in the conversation.”
Children who begin stuttering before the age of 3½ are most likely to outgrow it, she says, but those who start to stutter later or who stutter for six-to-12 months or longer may be at greater risk of continuing. “The indicators that suggest this may not be typical preschool-age stuttering are if a parent observes that a high percentage of a child’s syllables are stuttered, or if they notice the child avoiding certain speaking opportunities or becoming frustrated with their own speech,” Schussel says. Another tell-tale sign is what is called physical concomitants — physical behaviors that are associated with a stuttering moment, such as eye blinking or head nodding. “Children don’t realize they’re doing it, and sometimes adults don’t realize they’re doing it, but it’s an attempt to break out of the stuttering moment,” she says.
The foundations for some of the therapies used to treat stuttering were established decades ago at UCLA by Joseph and Vivian Sheehan. Joseph Sheehan, a clinical psychologist who ran UCLA’s stuttering clinic for more than 30 years, compared stuttering to an iceberg: Its characteristic behaviors are just a small percentage of what stuttering is, like the visible part of an iceberg above the water. Below the surface often lie fear, shame, guilt, anxiety, isolation, denial and hopelessness, which exacerbate the condition. He encouraged people who stutter to accept the condition and stutter openly — an approach now known as acceptance therapy — thus eliminating the fear and shame associated with stuttering. His wife Vivian Sheehan, a speech pathologist, continued sharing his therapeutic approach after his death in 1983.
Acceptance therapy is still effectively used with adolescents and adults who stutter. With younger children, Schussel employs an approach called the Lidcombe program, a parent-driven modality that identifies “smooth” speech and “bumpy” speech. “We’re not addressing the fear and anxiety below the surface of their stuttering because they’re still so young,” she says.
With school-age children, treatment typically focuses on “fluency shaping” — how to create less tension in the jaw, throat and other facial muscles so that speech comes more easily. “They may still stutter,” Schussel says, “but they’re not doing it in a way that is affecting how well other people can understand them or that is impeding their willingness to raise their hand to talk in class.”
