Stuttered Speech Syndrome

The Definition

Stuttered Speech Syndrome: stuttering either overtly or covertly with feelings of panic associated with loss of speech control and concern over its social implications; symptoms arising from compounding interplay of the speech event of stuttering with the psychosocial pathology of Social Anxiety Disorder.

The Concept

Why is awareness of a link between stuttering and Social Anxiety Disorder (aka Social Phobia) deserving of special recognition?

  1. because so many people who stutter (at least 50%) also suffer the additional disability of SAD.
  2. because signs and symptoms of SAD include stuttering and even speech-block. Hence stuttering may be the cause of SAD as well as the consequence of it. This means these disabilities become interwoven limiting the ability to separate one from another.
  3. because “Stuttering with SAD” is a different experience for the SPEAKER than stuttering without it even though it appears the same to the OBSERVER (listener).
  4. because as a result of the phobia and associated panic of SAD, the sufferer is unable to follow logical advice (ie. someone functioning on automated emotional responses in social situations is severely restricted in their ability to follow rational advice on speech techniques of breathing and articulation etc.)

Why is a term linking Stuttering and SAD necessary?

  1. because stuttering with social anxiety disorder is a far more debilitating situation than just stuttering, and a separate name would bring greater awareness to this more serious condition
  2. because the Diagnostic and Statistical Manual of Mental Disorders prevents a diagnosis of social anxiety disorder in the presence of another primary disorder. In other words the authors of the DSM expect that people who stutter will have social anxiety disorder. However this is NOT ALWAYS the case.
  3. because alternative terms such as “stuttering with social anxiety disorder” or “social phobia associated with a communication disorder” are cumbersome.

Example. King George VI in the film “The King’s Speech”.

Film critics say the film shows how speech coach Lionel Logue cured George VI of stammering. But George, while much more fluen,t did stammer during the film’s climatic wartime address, and he continued to stutter all his adult life. Therefore if Logue the did not cure George of stuttering, then what did he cure him of?  The answer is he cured him of Stuttered Speech Syndrome. He taught George to speak with feelings of control, and therefore to manage his stuttering.

How is Stuttered Speech Syndrome Diagnosed?

By the presence of both stuttering and social anxiety disorder (SAD). This leads to the question how is Social Anxiety disorder diagnosed?

There are a number of assessment tools used to diagnose Social Anxiety Disorder. One of the most widely used for adults is the self-report questionnaire for the Leibowitz Social Anxiety Scale (LSAS -SR) . For children there exists the Social Anxiety Scale for Children (SASC-R) and its parallel version for adolescents (SASC-A) .

The Term

Why is the term Stuttered Speech Syndrome most appropriate?

  1. The word stuttered differentiates from the word stuttering which has conventional meaning.
  2. The word speech is necessary given the generalized use of stuttering in other contexts (examples from recent newspapers are “stuttering” car engine, “stuttering” run up, and “stuttering” economy).
  3. Syndrome is a medically appropriate word given its recognised use in referring to a disorder with a collection of symptoms which can vary in number and severity both between various sufferers and within the same sufferer.
  4. With the acronym SSS a perfect acroynm for s..s..stuttering is achieved.
  5. The continued use of the letter “S” means a change in stuttering association logos is not necessarily required.

Analogies

Analogy for a term referring to presence of 2 conditions

  1. Anorexia nervosa. Two conditions need be present for a diagnosis of anorexia nervosa : 1) the physical condition of low body weight (emaciation) connected to 2) the psychological condition of body dysmorhic disorder (BDD)
  2. Yips. Two conditions need be present for the correct application of the sporting term “yips” also sometimes known as “choking” :1) poor shot making connected to 2) performance anxiety.

Analogy with Other Performance Based Impairments

1. Paruresis (Shy Bladder Syndrome): Inability to urinate in presence of other people. These people have a specific Social Anxiety Disorder related to their physical ability to urinate. However there is nothing wrong with their urine passing physiology and they perform normally when they perceive themselves to be out of earshot of others.

2. Selective Mutism: Inability to produce speech in certain anxiety provoking social situations. This was formally known as elective mutism because it was assumed children were refusing to speak. However it is now generally recognised that this is a specific form of early onset Social Anxiety Disorder causing the child to be unable to speak.

Other Definitions: Covert Stuttering, Stuttering