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Smooth talkers

Adults who stutter face daily embarrassment. Children who stutter picture themselves as having bumpy speech.

Tuesday, October 06, 1998

By Deborah Weisberg

Gary Rentschler remembers when the telephone was an instrument of terror. "I'd rush to get the phone," says the 51-year-old Upper St. Clair resident. "But then nothing would come out of my mouth. I was too panicked to say my own name or even hello."

As a child and a young adult, Rentschler stuttered. "Trying to talk in school and read aloud were impossible," he recalls. "But not being able to say my name was the worst. People look at you like, 'What's wrong? Don't you know your own name?' And the harder you struggle, the worse it gets."

Unlike at least half of all children who stutter, Rentschler did not outgrow his problem. He was 22 before he got real help.

Now, as clinical director of Duquesne University's new Stuttering Treatment and Research Center, Rentschler helps others find freedom from the same disorder.

The University of Pittsburgh and Children's Hospital also have jointly opened the Stuttering Center of Western Pennsylvania. It is based at Children's Hospital in Oakland, with satellite offices in the North Hills, Monroeville and the South Hills.

"It isn't that stuttering is on the increase," says Scott Yaruss, co-director of the Stuttering Center of Western Pennsylvania. "It's that until now treatment has been limited and ineffective."

Stuttering affects 2.5 million Americans, including an estimated 20,000 living in Allegheny County.

No one knows what causes stuttering. The disorder affects four times as many men as women and tends to runs in families, says Susan Felsenfeld, executive director and founder of Duquesne's STAR Center.

She believes the disorder has a genetic component (beyond children simply emulating their parents' speech patterns) and said research indicates the problem's origin is physiological, rather than psychological.

"Something happens in the pathway from the brain to the mouth that we don't fully understand," Felsenfeld says. "Even though the cause remains elusive, we need to manage the problem as best as we can."

Both centers treat adults who stutter by focusing on the emotional effects of the disorder as much as on the mechanics of improving their speech, a process that can take years, depending upon a client's motivation and expectations. However, their approaches to young children, who usually respond quickly to treatment, differ.

The STAR Center at Duquesne treats children "very directly," says Felsenfeld, 41, of Highland Park.

"We reward smooth speech and, in a nonjudgmental, matter-of-fact way, correct stuttering moments. The emphasis is on reward. We praise 10 times as often as we correct."

Felsenfeld teaches parents to provide the same feedback to their children at home.

The center at Children's Hospital advocates a "show, not tell" approach, says co-director Yaruss, 30, of McCandless.

"We do no direct correction," he says. "Instead we model slow, relaxed speech that children can easily process and emulate - like Mister Rogers - and we show parents how to do the same. We also help parents make changes in the child's environment, enabling him to respond appropriately to teasing, and to compete with other kids to be heard."

Felsenfeld and Yaruss agree that the sooner a child is treated, the better.

"The average age of onset is 3 or 4. That's when you want to intervene," Felsenfeld says. "Around age 10, the problem gets more complicated." Children rarely begin stuttering after age 6.

Yaruss says a child's discomfort with his own condition is reason enough for parents to seek therapeutic intervention.

"It's hard for parents to judge whether their child will outgrow stuttering or should be evaluated by a professional. But if a child even as young as 3 exhibits concern, that's a red flag. If he seems to be avoiding talking or has certain types of disfluencies, like stretching out sounds or showing signs of physical tension when he talks, he should be seen."

Using games in treatment

Ten-year-old Brittany Don of Robinson was brought to the STAR Center by her mother Loreen Iezzi, 32, because neither her pediatrician nor the school's speech therapist could adequately address the fifth-grader's stuttering.

Iezzi stuttered also when she was a child. "I was always extremely self-conscious and had the feeling I wasn't as good as other people," she says. "It kept me from going after some of the things I wanted, like certain jobs or making new friends."

Iezzi says she sees the same lack of self-confidence in Brittany. "She's more withdrawn. She keeps to herself and doesn't want to talk in front of strangers. Other kids tease her. She doesn't feel normal."

Both centers make games and art a part of treatment with children, who often find it easier to express themselves in nonverbal ways. When asked to draw pictures, some have depicted their stuttering as a dark cloud, a hovering monster or as wiggly lines coming out of their mouths. They are asked to maneuver toy cars down a bumpy road while stuttering and then down a smooth road while saying the same sentence fluently.

"We want them to acknowledge the contrast and to realize that they have some control," Felsenfeld explains, adding that children are encouraged to talk during therapy and are engaged in activities which deliberately get them excited, so they can exercise fluent speech even under the most trying conditions. "We tell them to think of themselves as athletes in training," says Felsenfeld, "and to practice their smooth speech every day."

Children who stutter need little external motivation to stop, Felsenfeld says: "I asked Brittany how much stuttering bothers her on a scale of one to 10, and she said 10."

"The hardest thing is speaking in front of a class," Brittany says. "And I have a hard time with other kids. I get so tense and nervous, I don't want to speak at all."

Brittany says she was traumatized last year when she had to get up in church and recite a prayer. "I couldn't do it without stuttering, especially when I had to say names. I knew I needed to get help."

Treating the individual

In the 1920s, people who stuttered were commonly sent to "stammer schools" where they were subjected to ridicule and periods of enforced silence. "They may have stopped stuttering," Felsenfeld says, "but they developed very unnatural patterns of speech."

In the 1950s and 1960s, a more humanistic approach prevailed. Stutterers were encouraged to relax about their problem, even if they couldn't overcome it. Treatment emphasized behavior modification. Direct correction of stuttering, called operant conditioning, became popular in the 1970s. An eclectic, client-centered approach is taken by most therapists today.

"We treat the individual, not the disorder," Yaruss says. "There's a certain amount of drill work and a certain amount of speech practice, but we are putting increasing emphasis on resolving the tension and anxiety that people who stutter find so frustrating."

While therapy may include individual and group counseling, along with speech re-patterning exercises, Yaruss says treatment is especially effective when taken into a client's environment.

"Clients can do good work in the therapy room but need to be able to transfer their fluency skills to the real world. When appropriate, I'll accompany clients to their workplace or school and help them decide how best to handle difficult situations and reflect with them about their experiences."

"If I go to a restaurant with a client, I'll sometimes pretend to stutter myself," Yaruss says, "and if the waiter laughs when I order, I'll say something like, 'I know. I have a stuttering problem. And it's really bad today.' That's to show my client how to respond appropriately to the reactions of others."

A life-shaping impediment

To avoid ridicule and rejection, people who stutter go to elaborate lengths to hide or compensate for their problem, says Rentschler, the clinical director of the STAR Center.

"They might go to a restaurant and order off a menu only the things they can say, even if they want to eat something else. Or they might wander around a big store like Hills for hours because they're too embarrassed to ask the clerk for help."

Their lives are shaped by their stuttering. Rentschler recalled a physician who was strip-searched by airport customs officials because his stuttering made him appear suspicious. In another example, a carpenter drove to different stores to check prices because he was unable to ask for quotes on the phone.

"It took hours out of his work day," Rentschler says, "It cost him a lot of jobs."

Many people who stutter are perfectionists, for example, the house painter client who works in designer clothes to ensure he won't make a mistake and the secretary who leaves her office if she misspells a word on the computer. "We looked at how stuttering and misspelling a word are pretty similar and how each can be corrected," Rentschler says.

Tim Peretich, 30, of Carrick says five years of "intense" therapy enabled him to become more fluent and bolstered his self-esteem: "I lived in a trapped world where other people did my talking for me. I felt isolated and extremely alone. I knew if I didn't get help, stuttering would rule my life. As I got more fluent, I developed more confidence. Now I live a normal life."

While determined adults can overcome their disorder, the real challenge, Yaruss says, is sustaining the success. "Relapse is the No. 1 problem for adults who have stuttered. It's like weight loss or smoking cessation. It requires constant effort."

"Now and then I have a bad day, but I don't let it get me down," says Peretich, who regularly attends support group meetings through the Pittsburgh Chapter of the National Stuttering Project. "I just keep plugging."

Deborah Weisberg is a free-lance writer who lives in Swisshelm Park.

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