Stuttering 47that stuttering is caused by a prob lem with auditory feedback when the person speaks. There is also
mounting evidence of a gene for stuttering. According to Owens, Metz, and Haas (2000), 50% of
persons who stutter have a relative who stuttered. This high rate of stuttering within families may
support a ge ne tic link to the disorder, or it may simply suggest similar child- rearing practices
among generations of these families. Most authorities on stuttering acknowledge that if there is a
gene for stuttering, it predisposes the person to stutter and that environmental factors play a role in
precipitating and perpetuating the disorder. There are several other organic theories of stuttering
linking the disorder to brain abnormalities and neurological impairments. Brain scanning tech-
nologies, such as positron emission tomography, have provided evidence of a neurological basis
for stuttering (Kroll & DeNil, 1998). However, with regard to the organic theories of stuttering, it
should be noted that even if stuttering is a physically based disorder, currently there are no surger-
ies or medi cations to eliminate it; therapeutic prevention and management are required. Clinicians
should focus on promoting resilience in young children (Nelson, 2012).
The psychological theories focus on two aspects of stuttering. First, some theories propose
that stuttering is directly caused by psychological catalysts. These range from repressed needs,
to conf licts between the id and superego, to unspeakable feelings and conversion reactions such
as oral fixations and repressed hostility. The purely psychological etiology of stuttering has been
generally discounted, except for those persons with late onset of the disorder. When stuttering
begins in adults, it is likely to be hysterically based and a result of psychological trauma. The most
frequent psychiatric prob lems observed in psychogenic stuttering include conversion reactions,
anxiety, and hysterical neurosis (Duffy & Baumgartner, 1997). Van Riper (1973, 1992) believes that
late- onset hysterical stuttering is fundamentally dif fer ent from childhood stuttering.
The second aspect of the psychological theories involves the role of stuttering in shaping
personality. This, too, is a controversial aspect. Does stuttering affect a person psychologically?
Is there a stuttering personality? De cades of research on this subject have not provided a clear
consensus, but it is logical that stuttering, like many disabilities, affects a person’s social interac-
tions, self- concept, and interpersonal relationships. Crichton- Smith (2002) found that stuttering
can have a limiting effect on the individual’s life, especially in the areas of employment, education,
and self- esteem. However, few studies have shown that stuttering causes the person to be dramati-
cally affected psychologically. Most persons who stutter report anxiety and embarrassment while
speaking, and dealing with frequent trepidation and other negative emotions creates psychological
challenges. Of course, not all persons who stutter have anxiety while stuttering, and they also have
the anxiety- free normal nonf luencies seen in nonstutterers. Stuttering can be troublesome, but it is
not psychologically and socially devastating to most individuals. However, rarely is psychotherapy
alone able to cure or significantly decrease stuttering.
The two primary learning theories of stuttering, summarized next, propose that the disorder
is the result of (1) the reinforcement and subsequent increase in the number of normal nonf luen-
cies or (2) the disruptive effects of negative emotional learning on speech fluency. Both learning
theories suggest the etiology of the disorder and provide for therapeutic intervention.
The operant conditioning theory suggests that persons develop stuttering because the normal
nonf luencies that every one displays are rewarded and thus increase in frequency and duration.
Children, particularly between the ages of 3 and 7 years, display frequent normal nonf luencies
during speech, especially when excited. Environmental rewards are pres ent for the nonf luencies,
thus increasing the likelihood of their recurrence. Environmental rewards for the child include
attention from parents and teachers, noninterruption, special status among peers, and other indi-
vidually dependent factors. The more dysf luencies the child displays, the more frequent are the
rewards for the be hav ior. Over time, the dysf luencies are shaped into unique patterns of stuttering.