- The Washington Times - Sunday, August 6, 2000

For Vasu Parameswaran, even ordering food in a restaurant was a challenge. He might have preferred pasta but would scan the menu searching for something that he could say easily.
Mr. Parameswaran, a 28-year-old engineer, stutters. He is one of an estimated 3 million Amer-icans who do so, according to the Stuttering Foundation of America, a nonprofit group that works toward stuttering education and treatment. About 80 percent of people with the speech disorder outgrow it or are able to work through it in speech therapy. For the other 20 percent, it becomes a lifelong problem that can affect everything from relationships to career choices.
The best way to cope with adult stuttering is to face it, not avoid it, Mr. Parameswaran, of Germantown, has found. He has learned to order the pasta, make the phone call, not substitute one word for another.
"The more you hold back and don't accept it, the harder it is to cope with it," he says.
Vivian Sisskin, a Northern Virginia speech pathologist who specializes in treating stuttering, helps adults like Mr. Parameswaran reduce use of avoidance techniques.
"So much of the struggle is learned behavior," she says . "In adulthood, part of the problem is the tension process stutterers feel by anticipating a situation. It becomes a debilitating process of fear of speaking and avoidance."

Speaking through frustration

Simply put, stuttering is the condition in which the flow of speech is disrupted by stoppages, such as the struggle to get words out, or repetitions, such as pronouncing "hello" as "h-h-h-h-hello" or prolongation ("hhhhhhhhhello").
It is a condition that typically appears between ages 2 and 5, and the earlier a stutterer gets speech therapy, the better chance he or she has of managing the condition, says Diane Paul-Brown, director of clinical issues for the American Speech-Language-Hearing Association.
"The earlier it is treated, the better," Ms. Paul-Brown says. "You are not going to see spontaneous recovery from a stutterer in his or her teens, particularly if the child has had a consistent stutter. By then, he may need intense, focused treatment [called fluency training]. If it continues into adulthood, we don't speak about cures, we speak about management."
Management is possible. The Stuttering Foundation of America points out in its literature that famous former stutterers include James Earl Jones; Carly Simon; Marilyn Monroe; Winston Churchill; and Rep. Frank Wolf, Virginia Republican.
They dealt with their stuttering in a variety of ways: through speech therapy, fluency training or simply outgrowing it.
It is still something of a mystery why some people develop a stutter, but most research points toward a neurological miscommunication between the brain and the 100 or more muscles used to produce speech, says Jane Fraser, president of the Stuttering Foundation of America. The problem is made worse by environmental and psychological factors, such as the tension a stutterer feels when he or she has to speak.
"Anticipatory fear is 80 percent of the problem," says Mary Weadon, a Herndon woman in her 40s who stutters. "Growing up, I would ask permission to exempt myself from all oral reports and book reports in school. I was basically able to surround myself with a substantial portion of denial. Finally, in seventh grade, a teacher insisted I give a report on Pablo Picasso. It was difficult, but it may have been a mini turning point for me."
At the National Institutes of Health, research is being conducted to try to gain an understanding of the genetic link to stuttering. Many stutterers, including Mr. Parameswaran, have a parent who also stuttered.
Unlocking the genetic link may lead eventually to a drug to control the problem, Ms. Fraser says. No drug therapy exists to control the stutter, but some stutterers have taken anti-anxiety drugs to cope with the tension they feel when trying to speak.
Researchers at the University of Toronto are conducting research to understand brain activity patterns in people as they undergo intensive treatment for the disorder. The researchers have been comparing brain scans of stuttering adults to scans of non-stuttering adults. They are measuring blood flow and other physiological changes as the stutterers undergo speech therapy.
These tests should help scientists understand more about the neurological basis of stuttering. That, in turn, may lead to changes in the way the disorder is treated, such as including cognitive therapy in a treatment plan, says lead researcher Robert Kroll.

Therapy and coping

Adult stutterers have two primary options for dealing with the disorder: to get intensive therapy to correct the stutter or to accept it to the point where they no longer feel anxiety because of it.
Therapy or "fluency shaping" is similar to the mechanics-based speech therapy a child would undergo. It focuses on the mechanics of breathing and the movements of the vocal cords, tongue, lips and jaw.
Some fluency-shaping programs are intensive inpatient programs that last about three weeks. Many well-known former stutterers, such as John Glenn's wife, Annie, a spokeswoman for the Stuttering Foundation of America, have dealt successfully with the problem in this way.
Others have chosen to cope with their speech the way it is. Ms. Sisskin, for instance, runs a therapy group that meets weekly. Its members, including Mr. Parameswaran and Ms. Weadon, put themselves in mock situations that ordinarily would cause tension and exacerbate stuttering.
One recent exercise was a group trip to Rehoboth Beach. Group members put themselves in real situations such as stopping strangers to ask for directions or going into a bookstore to ask for a book on stuttering.
"I would say the confidence level of my stuttering has risen dramatically since I started going to therapy five years ago," Ms. Weadon says.
She and Mr. Parameswaran both say they have abandoned most of the tricks that used to get them through social and business situations. Mr. Parameswaran introduces himself (one's own name is often one of the hardest words for a stutterer) rather than waiting for someone to introduce him. Ms. Weadon says she no longer substitutes "safe" words for words she may stutter.
"Without even realizing it, I developed a different vocabulary and way of phrasing things to accommodate my stutter," Ms. Weadon says. "For instance, I would answer the phone with 'yes' rather than 'hello' Some of the substitutions were not even conscious to me."
In the past several years, Ms. Weadon has embraced speaking opportunities rather than avoided them. She joined Toastmasters, a public-speaking group. As a Fairfax County special-education teacher, she runs the meetings for her department and introduces guest speakers.
Stuttering is so much a part of her, Ms. Weadon's license plate reads "MMMMARY."
"I think I have come to understand the biggest problem is we try to avoid it," she says. "When we do that, the problem gets bigger and bigger. It is like running down a hill. You have to go faster and faster."

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