Relapse In Stuttering: Causes, Signs, And Tips To Avoid It
Author: Roselyn Mathew, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, January 15, 2025
Table of Contents
Differences between disfluencies and stuttering
According to Wingate in 1990, “Stuttering is a disruption in the fluency of verbal expression characterized by involuntary audible or silent repetitions or prolongations of sounds or syllables. There is not one cause of stuttering. These are not readily controllable and may be accompanied by other movements and by emotions of negative nature such as fear, embarrassment or irritation.”
Much of the research and studies in the earlier times were completely focused on the disorder rather than the person. Later, studies and research started focusing on impacts of stuttering on a person’s life.
Yaruss and Quesal in 2004 described stuttering as “Stuttering is more than just speech disruptions; it includes the impact on a person’s ability to communicate, their emotional experiences, and their quality of life”.
Disfluencies are minor interruptions in the fluency of a person’s speech and are non- pathological. It is very common to have disfluencies when we speak. People sometimes confuse disfluencies as stuttering and vice versa. Given below are certain differences between disfluencies and stuttering. These are:
Difficulties with certain words or sounds
A person with stuttering finds certain sounds or words to be more difficult than other sounds and words in general.
People with disfluencies will show interrupted fluency equally for all sounds and words.
Secondary behaviours
People with stuttering typically show secondaries or secondary behaviours like tensing muscles in the face, clenching of jaw, blinking of eyes, abnormal hand and leg movements as a means to reduce their stress while saying a sound or a word. These are not observed in people with disfluencies.
Excessive anxiety and stress
Although a person with disfluencies might feel anxious about their speech in certain situations, people with stuttering have higher amounts of anxiety about their speech most of the time.
Speaking in-person vs over the phone or virtually
A person with disfluencies usually has the same number of disfluencies while speaking in- person or over the phone or virtually. Some people with stuttering feel an increase or decrease in their dysfluencies while speaking over the phone or virtually vs in- person.
Reading
People with disfluencies generally do not have disfluencies while reading whereas a person with stuttering usually has dysfluencies while reading.
If you feel that your speech is not fluent and is accompanied by anxiety to speak or other behaviours like facial grimaces, tapping of hands or feet, feeling tension on throat, jaw or tongue, excessive eye blinking etc., it is recommended to get your speech assessed by a speech pathologist to rule out stuttering. There are different approaches to treat stuttering depending on the type, severity and the person’s situation. It is important to understand, learn and practice the techniques in order to improve fluency.
Relapse in stuttering
Relapse in stuttering means going back to the previous level of stuttering or sometimes to a higher level of stuttering after achieving a reduction in stuttering. It happens usually after the end of therapy sessions. Along with dysfluencies a person with stuttering might also experience other issues associated with stuttering like secondary behaviours, anxiety and a tendency to avoid speech and speaking situations. It is extremely frustrating for people with stuttering to experience a relapse especially after spending a lot of time and effort to improve their fluency. It becomes even more frustrating to achieve a good fluency and confidence and then to have a decline in fluency and feel other issues like secondary behaviours and anxiety come back within days. Relapse in stuttering may or may not be temporary depending on the factors that caused the relapse.
Causes of relapse in stuttering
Reduced confidence
A relapse would make a person less confident and would make them think that they might stutter even if they use the techniques.
Increased dysfluencies and secondary behaviours
The rate of dysfluencies might go to a level that is equal to, higher or sometimes, even lower than the initial level of dysfluencies that the person had before they started therapy. They might also start showing secondary behaviours that they had before.
Experiencing frustration during speaking situations
Being aware of an increase in stuttering and secondary behaviours would result in increased frustration whenever they need to speak, especially if it is with unfamiliar people or higher authorities.
Avoiding speech and speaking situations
Lack of confidence, dysfluencies, secondary behaviours and frustrations might make them avoid speech and speaking situations as much as possible.
Common signs of relapse in stuttering
Not practicing the techniques consistently
It is important to practice all the techniques that have been taught during the sessions. Even if someone feels that they have normal or near normal fluency in speech, they still have to practice the techniques every day.
Lack of interest or motivation
It is true that it takes a lot of effort and time to attain a normal or near normal speech level. Once a person reaches this level, practicing again would be less appealing or less interesting to them. They could lose the motivation to devote some time to practice or use these techniques whenever they communicate with others. This could result in not being used to the modified method of speaking which could lead to a relapse in stuttering.
Lack of monitoring and self-feedback
During sessions, a person gets continuously monitored and feedback is given to them about their performance. They also get frequently reminded to use the techniques whenever they forget to do so. Even though the therapist makes sure that their client gets feedback when they make an error, after the sessions, the client might not pay attention to their speech which could lead to them not having adequate or sufficient feedback. Therefore, it is important for the client to make sure that they are aware of their speech during sessions and to try to get self-feedback outside sessions.
Even though a person makes sure that they do all the above-mentioned points correctly, there could be some other factors which could lead to a relapse in stuttering. They are:
Gender
Studies have shown that relapse of stuttering occurred more in males compared to females.
Genetics
It has also been observed that people with a family history of stuttering had more chance of having relapse compared to people who have no family history of stuttering.
Relationship with the therapist and support group
It has also been seen that clients who do not have a good relationship with their speech language pathologist or do not have a support group tend to have a relapse in stuttering.
Neural load
Some people have a lot of other issues with stuttering like depression, anxiety, trying hard to meet everyone's expectations and doing their other activities related to work or studies. It has been seen that people with other issues along with stuttering had a greater chance of relapse.
Environmental causes
Unusual situations like starting a new job, living in a new city, receiving a promotion with increased pressure or receiving a different role at work etc. are initially challenging for everyone. These unexpected changes in speaking situations might cause a relapse in stuttering especially if there is a lack of confidence or support from others.
Unrealistic self-expectations
It is sometimes observed that certain people during and after therapy are extremely self-conscious of even minor disfluencies in their speech. It is completely natural to have minor disfluencies while speaking which is hardly noticed by speakers as well as listeners. When people with stuttering have high expectations of not making any disfluencies, they tend to always feel high amounts of stress and pressure while speaking, which might cause a relapse in stuttering.
Tips to avoid relapse in stuttering
It is important to practice the techniques everyday even if you feel that your speech has become fluent.
Have a follow up session with your speech pathologist once in every 3 or 6 months as per their recommendation.
Do not keep extremely high expectations such as not to have any disfluency while speaking. Remember that everyone would have some minor disfluencies while speaking and make sure to not overthink about it. Talk to your speech pathologist if you feel that you tend to overthink about your speech.
If you feel that you have a lot of stress, try to reduce them by practicing various relaxation techniques.
Try to find a support group that you are comfortable with, to discuss your everyday challenges in speech. Even if you cannot find an external support group, you can have discussions about your speech with your family, close friends and others who are supportive.
Conclusion
Relapse in stuttering means an increase in stuttering after a period of improvement in fluency. It can be caused due to various reasons. It is important to be aware if you are experiencing a relapse in order to not allow it to happen. It would be helpful to follow certain practices to reduce the chances of getting a relapse.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
