Central Baptist Hospital's Fluency Clinic provides comprehensive outpatient treatment for stuttering disorders in children ages six and older and adults.

What is a stuttering disorder?

The speech disorder we call stuttering is varied in symptoms. Most people think of stuttering as sound repetitions and repetitions of words. But only some adults (and children) who stutter fit that stereotype. Many people repeat neither sounds nor words. Their stuttering blocks look and sound quite different.

Sometimes people think they have a voice or breathing disorder, because they may gasp or break off words or "choke" when they try to speak.

In fact, there are people who are so adept at covering their stuttering, that others do not identify them as stutterers at all. They may avoid or substitute words, distract their listeners with "tricks" or avoid certain situations altogether. These people are "covert stutterers" and may in fact experience even greater fear and anxiety than the person who stutters openly.

Most people who stutter begin to stutter in childhood. Some stutter as early as two years when they begin to speak. The majority begin between ages four and six, but some don't begin until puberty. In exceptional cases, stuttering can begin later in life, but usually there is some indication that the person stuttered as a child and apparently remitted for a period of years.

What causes stuttering?

Stuttering is a neuromuscular disorder, not an emotional disorder. In time, the effects of stuttering may lead to anxiety and a poor self-concept.

Research has shown that stutterers demonstrate some differences in central nervous system characteristics. Most people process language in the left half of the brain, whereas stutterers would appear to distribute language processing over both sides of the brain. Stutterers tend to perform no less accurately, but more slowly on fine motor coordination activities.

The vocal cords of stutterers function somewhat differently, too, with stutterers demonstrating delays in getting the voice started. Even the fluent speech of stutterers shows more tiny pauses in speech flow than are found in the speech of non-stutterers. Some research suggests differences in auditory functions as well. Most recently, researchers have identified actual areas of lesion in the brains of adults who stutter.

Research with stuttering adults also has shown that their respiratory patterns are different from those of non-stutterers. The combination of this respiratory and laryngeal disturbance causes disruption of the speech mechanism as the stutterer tries to begin voicing. Each pause in speech can result in repetition of this difficulty. The stutterer struggles against these blockages in speech flow, resulting in what we hear as stuttering.

Is stuttering hereditary?

Research strongly suggests that genetics may play an important role in the development of stuttering. Neither imitation nor the passing on of attitudes about speech have shown to be acceptable explanations for the high rate of stuttering in families. Up to 80 percent of all stutterers report a familial history of stuttering. Nearly four times as many males as females stutter, but this is also true for language disorders and learning disabilities. Although males appear to be more biologically susceptible to stuttering, women who stutter have a 36 percent likelihood of having family members who stutter, while men who stutter have an 18 percent likelihood.

What is CAFET?

CAFET is the acronym for "Computer-Aided Fluency Establishment Training." It is a tool developed to help speech-language pathologists treat the stuttering client in a comprehensive way, from identification of the problem through retention of fluency skills following therapy. CAFET was developed by the Annadale Fluency Clinic starting in 1983, with help from a research grant through the National Institutes of Health. It is now employed in speech clinics, hospitals and school systems throughout the U.S. and Canada.

The client wears a respiratory sensor and a tiny microphone that feed into a computer system. CAFET presents the patient's voice and breathing as visual feedback on the computer screen. Rather than trying to change only the surface behavior of stuttering, the underlying physiological microbehaviors are addressed through muscle retraining.

The computer program teaches the patient to coordinate the breathing with the onset of speech, to breathe without breath holding and to maintain the speech flow throughout the phase. Some people have called the process "therapy for the vocal cords". These aspects of coordination are practiced so thoroughly that they maintain long after the computer program is over and become part of the everyday speech of the patient.

What is the CAFET treatment program like?

The program is an individual program of "semi-intensive" therapy and includes at least four hours per week during the first four to five weeks in two-hour sessions. During each session, the "targets" of monitored speech are practiced with the computer program and molded with the help of the clinician in a "normalization" procedure. Nearly all patients are able to establish normal-sounding fluent speech by the end of the establishment program.

This is followed by transfer therapy (moving the new speech skills to the real-life environment and desensitizing "difficult" speech situations.) During the transfer, the sessions occur at a rate of one to two hours weekly for 10-12 weeks until the client and clinician feet that fluency is "solid."

Another important component of the program is group therapy. Once weekly throughout both the initial and transfer stages, clients spend an hour (one evening) in group. This provides the client with an opportunity to practice skills as they are being learned in a "safe" environment. It also provides the support the client needs in changing long-held negative attitudes toward himself and his speech.

How effective is CAFET?

CAFET has been in use in the Annadale Fluency Clinic since 1983. Thousands of adults and teens have completed the program. The clinic measures the success of therapy with pre-therapy videotapes, audiotapes, computer speech analysis, home baseline tapes and a series of taped phone calls to strangers.

This data collection process is performed pre-treatment, at six months, one year and two years post therapy and includes an interview and attitude assessment.

At six months post-therapy, 82 percent of the patients interviewed met the criteria for fluid, natural-sounding speech. At 12 months post therapy, that figure rose to 89 percent, and at two years post therapy, 92 percent of former patients had retained their speech control. In addition, many of them responded that they seldom, if ever, thought about stuttering anymore.

The goal of the CAFET program is to provide a treatment program that produces the best results and at the same time is the most cost-effective for the client. A comparison with other forms of therapy suggests that this therapy not only produces excellent results, but does so very efficiently.

Is CAFET covered by insurance?

Evaluation and treatment of communication disorders may be covered by your health insurance, with an appropriate medical referral and treatment plan. If included, speech and language services are generally covered when rendered by a speech-language pathologist who is certified by the American Speech-Language-Hearing Association and is licensed by the state. Covered services include: speech and/or language evaluation and provision of necessary habilitative or rehabilitative speech language pathology services for a speech or language disorder.

Since health insurance policies vary widely in the range of services covered, it is important to have a copy of your policy and to contact your insurance provider.

For More Information

To schedule an appointment for outpatient speech therapy, call (859) 260-6129.

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