Stuttering

Abstract

Stuttering is a multi-dimensional problem involving a particular kind of speech behavior, feelings, beliefs, self- concepts, and social interactions. Stutterers have "good days"? with less stuttering? and "bad days"? when they can't get a word out. Current research suggests that it is caused by a complex interaction between a person's physical makeup and the environment. Stutterers are, on average, psychologically normal, except for fears and anxieties around talking. Stress and anxiety may aggravate stuttering. On the other hand, most stutterers speak fluently when relaxed, but stutter under stress. Stuttering affects people from all levels of the socioeconomic scale and is found in all parts of the world. The frequency of stuttered words, the type of speech disruption, and the presence of, and type of associated behavior varies from person to person. In terms of prognosis, early detection is important. The aim of this article, is to examine the persons who stutter, within the light of the etiology, frequency, definition, differential diagnosis, and comorbid psychiatric symptoms.

Keywords

• stuttering, epidemiology, etiology, clinical features

Kekemelik

Abstract

Kekemelik konuşma davranışında değişiklikler, duygular, inançlar, benlik kavramı ve sosyal etkileşim gibi özellikleriyle çok yönlü bir problemdir. Kekemeler daha az kekeledikleri zaman "iyi gün" ve kelimeleri söyleyemedikleri zaman ise "kötü gün"dedirler. Son zamanlardaki araştırmalar, kekemeliğin bir kişi de fiziksel yapı ile çevresel etkenler arasındaki karmaşık ilişkiden kaynaklandığını göstermiştir. Kekemeler, konuşma esnasındaki korku ve kaygı haricinde, psikolojik olarak normal sayılabilirler. Stres ve kaygı kekemeliği artırabilir. Öte yandan, stres altındayken kekelemelerine rağmen kekemelerin çoğu rahat olduklarında akıcı konuşurlar. Kekemelik farklı ekonomik düzeyleri olan insanları etkileyebilir ve bütün dünya da görülebilir. Kekeleme sıklığı, konuşma bozukluğunun çeşidi ve kekemelik ile ilişkili davranış değişiklikleri ya da bunların tipi kişiden kişiye değişir. Sonlanım açısından erken tespit önemlidir. Bu çalışmanın amacı, kekemeliğin nedenleri, yaygınlık, tanı ölçütleri, ayırıcı tanı ve eşlik eden psikiyatrik belirtiler ışığında incelenmesidir.

Keywords

• kekemelik, epidemiyoloji, etyoloji, klinik özellikler

References

1. Konrot A. Sözel dil ve konuşma sorunları (Lisans tamamlama programı tezi). Eskişe- hir, Anadolu Üniversitesi, 1998.
2. Shames GH, Wiig EH, Secord WA. Human Communication Disorders: An Introduction. Boston, Allyn & Bacon, 1998.
3. Cangi ME. Kekemeliği olan ve olmayan ergenlerin çok boyutlu mükemmeliyetçilik düzeylerinin karşılaştırılması (Yüksek lisans tezi). Eskişehir, Anadolu Üniversitesi, 2008.
4. Özgür İ. Konuşma Bozukluğu ve Sağaltımı. Adana, Nobel Kitabevi, 2003.
5. Öztürk MO. Ruh Sağlığı ve Bozuklukları, 8.Baskı. Ankara, Nobel Tıp Kitabevi, 2002.
6. Silverman FH. Stuttering and Other Fluency Disorders. Illinois, Waveland Press,
7. Starkweather CW. Fluency and Stuttering: Introduction. New Jersey, Prentice Hall, 1987.
8. Karacan E. Bebeklerde ve çocuklarda dil gelişimi. Klinik Psikiyatri Dergisi 2000; 3:263-268.

9. Topbaş S, Konrot A, Ege P. Dil ve Konuşma Terapistliği: Türkiye’de Gelişmekte Olan Bir Bilim Dalı. Eskişehir, Anadolu Üniversitesi Yayınları, 2002.
10. American Speech-Language-Hearing Association. Definitions of communication disorders and variations. http://www.asha.org/docs/html/RP1993-00208.html (06.07.2011 tarhinde ulaşıldı).
11. American Speech-Language-Hearing Association. Terminology pertaining to fluency and fluency disorders: Guidelines. http://www.asha.org/docs/html/GL1999- 00063.html (06.07.2011 tarhinde ulaşıldı).
12. Hicks PL. Opportunities in Speech-Language Pathology Careers. New York, McGraw-Hill, 2007.
13. Abalı O, Beşikçi H, Kınalı G, Tüzün ÜD. Kekeme çocuk ve ergenlerin anne babala- rının psikiyatrik semptomlarının değerlendirilmesi. Düşünen Adam: Psikiyatri ve Nö- rolojik Bilimler Dergisi 2003; 16:144-146.
14. Bloodstein O. Stuttering: The Search for a Cause and Cure. Boston, Allyn & Bacon,
15. Bloodstein O, Ratner NB. A Handbook on Stuttering. New York, Delmar Gengage Learning, 2008.
16. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed. Philadelphia, Lippincott Williams & Wilkins, 2009.
17. Guitar B. Stuttering: An Integrated Approach to Its Nature and Treatment, 3rd ed. Baltimore, Lippincott Williams & Wilkins, 2006.
18. Schwartz HD, Zebrowski PM, Conture EG. Behaviors at the onset of stuttering. J Fluency Disord 1990; 15:77-86.
19. Manning WH. Clinical Decision Making in Fluency Disorders, 3rd ed. New York, Delmar Gengage Learning, 2010.
20. Perkins WH. What is Stuttering? J Speech Hear Disord 1990; 55:370-382.
21. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, WHO, 1992.
22. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
23. Wingate ME. A Standard Definition of Stuttering. J Speech Hear Disord 1964; 29:484-489.
24. Zebrowski PM, Kelly EM. Manual of Stuttering Intervention. Canada, Singular/ Thomson Learning, 2002.
25. Zebrowski PM, Conture EG. Judgements of disfluency by mothers of stuttering and normal non fluency children. J Speech Hear Res 1989; 32:625-634.
26. Boey RA, Wuyts FL, Van de Heyning PH, De Bodt MS, Heylen L. Characteristics of stuttering-like disfluencies in Dutch-speaking children. J Fluency Disord 2007; 32:310-329.
27. Packman A, Code C, Onslow M. On the cause of stuttering: Integrating theory with brain and behavioral research. J Neurolinguistics 2007; 20:353-362.
28. Pedersen MP, Jorgensen SH, Nakayama H, Raaschou OH, Olsen ST. Aphasia in acute stroke: Incidence, determinants and recovery. Ann Neurology 1995; 38:659- 666.
29. Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis 2004; 17:35-43.
30. Avcı A, Uğuz Ş, Toros F. Çocuklarda kekemelik: Karşılaştırmalı bir izleme çalışması. Klinik Psikiyatri Dergisi 2002; 5:16-21.
31. Bayramkaya E, Toros F, Özge C. Ergenlerde sosyal fobi ile depresyon, öz kavram, sigara alışkanlığı arasındaki ilişki. Klinik Psikofarmakoloji Bülteni 2005; 15:165-173.
32. İnceer BB, Akseki P. Kekemelikte bilişsel çarpıtmalar. Ege Tıp Dergisi 1999; 38:187- 190.
33. İnceer B, Day A. Kekemelik Nedir? 28. Ulusal Psikiyatri Kongresi, 1992, Ankara, Türkiye. Bildiri Özetleri Kitabı sayfa:18.
34. Topbaş S, Maviş İ, Özdemir S, Tuncer M, Ünal Ö, Güven S, Altınsoy A, Topbaş O, St. Louis K. Proje: e-ÖZYARDEP: Kekemelik İçin Internet Ortamında Topluluk Temelli Öz-Yardım Destek Grupları Oluşturma Programı. Eskişehir, Tübitak, 2009.
35. Shapiro DA. Stuttering Intervention: A Collaborative Journey To Fluency Freedom. Austin, Texas, PRO-ED, 1999.
36. Tamam L, Öztanrıöver S, Özpoyraz N. Erişkin çağda başlayan bir kekemelik olgusu. Turk Psikiyatri Derg 1998; 9:64-67.
37. Jordan LC, Hillis AE. Disorders of speech and language: Aphasia, apraxia and dysarthria. Curr Opin Neurol 2006; 19:580-585.
38. Andrews G, Craig A, Feyer A, Hoddinott S, Hoiwe P, Neilson M. Stuttering: A review of research findings and theories circa 1982. J Speech Hear Disord. 1983; 48:226-246.
39. Healey EC. Readings on Research in Stuttering. New York, Longman, 1991.
40. Guitar B, McCauley R. Treatment of Stuttering: Established and Emerging Approaches. Baltimore, Lippincott Williams & Wilkins, 2010.
41. Peters HFM, Boves L. Coordination of aerodynamic and phonatory processes in fluent speech utterances of stutterers. J Speech Hear Res 1988; 31:352-361.
42. Van Riper C. The Nature of Stuttering. New Jersey, Prentice-Hall, 1971.
43. Sercan M, Sercan YK. Kekemeliğin yapısal etmenleri. Nöropsikiyatri Arşivi 1991; 28:11-20.
44. Vilkman E, Sonninen A, Hurme P, Körkkö P. External laryngeal frame function in voice production revisited: A review. J Voice 1996; 10:78-92.
45. Ezrati-Vinacour R, Levin I. The relationship between anxiety and stuttering: a multidimensional approach. J Fluency Disord 2004; 29:135-148.
46. Alm PA. Copper in developmental stuttering. Folia Phoniatr Logop 2005; 57:216- 222.
47. Johnson W. Stuttering in Children and Adults. Minneapolis, University of Minnesota Press, 1955.
48. Johnson W. The Children With Speech Handicaps in Forty-ninth Yearbook of National Society for the Study of Education, Part II. Chicago, University of Chicago Press, 1963.
49. Johnson W. Speech Handicapped School Children. New York, Harpers, 1956.
50. Büchel C, Sommer M. What Causes Stuttering? PLoS Biol 2004; 2:46.
51. Kızıltan G, Akalın MA. Stuttering may be a type of action dystonia. Mov Disord 1996; 11:278-282.
52. Costa D, Antoniac M, Berghianu S, Marinescu R, Boeru L, Bruja N et al. Clinical and paraclinical aspects of tetany in stuttering. Act Nerv Super (Praha) 1986; 28:156- 158.
53. Steidl L, Pesák J, Chytilová H. Stuttering and tetanic syndrome. Folia Phoniatr (Basel) 1991; 43:7-12.
54. Comings DE, Wu S, Chiu C, Ring RH, Gade R, Ahn C et al. Polygenic inheritance of Tourette syndrome, stuttering, attention deficit hyperactivity, conduct, and oppositional defiant disorder: the additive and subtractive effect of the three dopaminergic genes-DRD2, D beta H, and DAT1. Am J Med Genet 1996; 67:264
55. Kidd KK. Recent progress on the genetics of stuttering. In Genetic Aspects of Speech and Language Disorders (Eds CL Ludlow, JA Cooper):197-203. New York, Academic Press, 1983.
56. Felsenfeld S, Kirk KM, Zhu G, Statham DJ, Neale MC, Martin NG. A study of the genetic and environmental etiology of stuttering in a selected twin sample. Behav Genet 2000; 30:359-366.
57. Ambrose N, Yairi E, Cox N. Early childhood stuttering: Genetic aspects. J Speech Hear Res 1993; 36:701-706.
58. Howell P, Davis S, Williams R. Late childhood stuttering. J Speech Lang Hear Res 2008; 51:669-687.
59. Yairi E. Subtyping stuttering I: A review. J Fluency Disord 2007; 32:165-196.
60. Klompas M, Ross E. Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: Personal accounts of South African individuals. J Fluency Disord 2004; 29:275-305.
61. Lask J, Lask B. Child Psychiatry and Social Work. London, Tavistock, 1981.
62. Öztürk M, Tüzün Ü. Kekeme çocuklarda sosyal fobi. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2002; 7:12-16.
63. Bandura A. A social cognitive theory of personality. In Handbook of personality, 2nd ed. (Eds L Pervin, O John):154-196. New York, Guilford, 1999.
64. Leung KC. Stuttering. Clin Pediatr 1990; 29:498-502.
65. Lawrence M, Barclay DM. Stuttering: A brief review. Am Fam Physician 1998; 57:2175-2178.
66. Morley ME. The development and disorders of speech in childhood, Livingstone,
67. İnceer B, Kocadere M. Kekemelik ve Kekelemek Üzerine. İzmir, Ege Üniversitesi Basımevi, 1999.
68. Fransella F. Personal Change and Reconstruction: Research on a Treatment of Stuttering. New York, Academic Press, 1972.
69. Ryan BP. Programmed Therapy for Stuttering in Children and Adults. Springfield, Thomas Publishing, 1974.
70. Conture EG. Treatment efficacy: Stuttering. J Speech Hear Res 1996; 39:18-26.
71. Hurst MI, Cooper EB. Employer attitudes toward stuttering. J Fluency Disord 1983; 8:1-12.
72. Klein JF, Hood SB. The impact of stuttering on employment opportunities and job performance. J Fluency Disord 2004; 29:255-273.
73. Atkins CP. Perceptions of speakers with minimal eye contact: Implications for stutterers. J Fluency Disord 1988; 13:429-436.
74. Bieling PJ, Summerfeldt LJ, Israeli AL, Antony MM. Perfectionism as an explanatory construct in comorbidity of axis I disorders. J Psychopathol Behav Assess 2004; 26:193-201.
75. Hewitt PL, Flett GL. Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psycho-pathology. J Pers Soc Psychol 1991; 60:456- 470.
76. Hewitt PL, Flett GL. Dimensions of perfectionism in unipolar depression. J Abnorm Psychol 1991; 100:98-101.
77. Wyatt R, Gilbert P. Dimensions of perfectionism: A study exploring their relationship with perceived social rank and status. Pers Individ Dif 1998; 24:71-79.
78. Enns MW, Cox BJ. Perfectionism and depression symptom severity in major depressive disorder. Behav Res Ther 1999; 37:783-794.
79. Frost RO, Steketee G. Perfectionism in obsessive compulsive disorder patients. Behav Res Ther 1997; 35:291-296.
80. Pişgin İ, Özen DŞ. Çocukluktan erişkinliğe obsesif kompulsif bozuklukta hatalı değerlendirme ve inanç alanları. Psikiyatride Güncel Yaklaşımlar 2010; 2:117-131.
81. Mitzman PF, Slade P, Dewey ME. Preliminary development of a questionnaire designed to measure neurotic perfectionism in the eating disorders. J Clin Psychol 1994; 50:516-522.
82. Atasoy Z, Şenol S. İletişim bozuklukları. In Psikiyatri Temel Kitabı, (Eds C Güleç, E Köroğlu):1069-1078. Ankara, Hekimler Yayın Birliği, 1998.
83. Cooper EB. Red herrings, dead horses, straw men, and blind alleys: Escaping the stuttering conundrum. J Fluency Disord 1993; 18:375-387.
84. Karrass J, Walden TA, Conture EG, Graham CG, Arnold HS, Hartfield KN, Schwenk KA. Relation of emotional reactivity and regulation to childhood stuttering. J Commun Disord 2006; 39:402-423.
85. Vinacour RE, Levin R. The relationship between anxiety and Stuttering: A multidimensional approach. J Fluency Disord 2004; 29:135-148.
86. Hearne A, Packman A, Onslow M, Quine S. Stuttering and its treatment in adolescence: The perceptions of people who stutter. J Fluency Disord 2008; 33:81- 98.
87. Miller S, Watson BC. The relationship between communication attitude, anxiety and depression in stutterers and nonstutterers. J Speech Hear Res 1992; 35:789-798.
88. Ashby JS, Rice KG. Perfectionism, dysfunctional, attitudes and self-esteem: a structural equations analysis. J Couns Dev 2002; 80:197-203.
89. Cheng SK, Chong GH, Wong CW. Chinese frost multidimensional perfectionism scale: A validation and prediction of self-esteem and psychological distress. J Clin Psychol 1999; 55:1051-1061.
90. Polvan Ö. Çocuk ve Ergen Psikiyatrisi. İstanbul, Nobel Tıp Kitabevleri, 2001.
91. Sarp A, Kurt BB, Kınay D, Gökyiğit A, Çalışkan A. Gilles De La Tourette Sendro- munda EEG bulgularının kekemelik ve enürezis nokturna gruplarıyla karşılaştırılması. Nöropsikiyatri Arşivi 1996; 33:85-88.