Stuttering

Stuttering (known as stammering in parts of the UK and scientifically known as dysphemia) is a speech disorder in which the normal flow of speech is frequently disrupted by repetitions (sounds, syllables, words or phrases), pauses and prolongations that differ both in frequency and severity from those of normally fluent individuals. The term stuttering is most commonly associated with involuntary sound repetition, but it also encompasses the abnormal hesitation or pausing before speech, referred to by stutterers as blocks, and the prolongation of certain sounds, usually vowels. Much of what constitutes &quot;stuttering&quot; cannot be observed by the listener; this includes such things as sound and word fears, situational fears, anxiety, tension, shame, and a feeling of "loss of control" during speech. The emotional state of the individual who stutters in response to the stuttering often constitutes the most difficult aspect of the disorder.

About 1% of adults and 5% of children in the world are afflicted with some form of the disorder, with slightly higher percentages of affected African (8%–9%) and West Indies (3%–4%) adults 2. Men account for approximately 80% of all stutterers, while women are much more likely to either outgrow or recover from the disorder 1.

Stuttering is essentially neurogenic (neuropathological rather than mental) in origin, and is generally not a problem with the physical production of speech sounds (see Voice disorders) or putting thoughts into words (see Dyslexia, Cluttering). Stuttering does not affect intelligence, and apart from their speech problem, people who stutter are normal. Anxiety, low confidence, nervousness, and stress therefore do not cause stuttering, although they often worsen it. The disorder is also variable. This means that in certain situations, such as talking on the telephone, the stuttering might be increased, or it might be lessened, depending on the anxiety level connected with that activity. In other situations, such as singing (as with country music star Mel Tillis) or speaking alone (or reading from a script, as with actor James Earl Jones), fluency improves. Some mild stutterers, such as Bob Newhart, have used it to their advantage. Although the exact etiology of stuttering is unknown, both genetics and neurophysiology are thought to contribute. One theory is that an inherited genetic factor may cause the speech pathways in the brain to be less efficient, contributing to the development of a stutter. Although there are many treatments and speech therapy techniques available to help increase fluency, there is essentially no "cure" for stuttering at present.

Causes
There is no known cause for stuttering. Theories about the causes of stuttering can be divided into three categories.

Genetics
Stuttering could possibly be inherited, and 50% to 70% of all stutterers are related to another stutterer. 8 9  While having a stutterer in the family does not automatically create another stutterer, it has been shown to create &quot;stuttering potential&quot; or a &quot;stuttering predisposition.&quot;  This inherited genetic factor may cause the speech pathways in the brain to be less efficient, making it difficult for the stutterer to meet fluency demands and get his or her words out quickly. Genetics may also influence the temperament of some stutterers, which makes them react negatively to their own early stuttering behavior. In a 1999 study conducted jointly between U.S. and Australian researchers,  hundreds of twins who stuttered were examined, with significant differences in concordance rates for stuttering being found between identical and  fraternal twin pairs. Scientists are also working to identify the "stuttering genes", largely through the Stuttering Research Project at the University of Illinois.

Childhood development
In the past, the cause of stuttering was most often attributed to events during childhood development. Some argued that neurotic conflict or disturbed interpersonal relationships during crucial stages of a child's development could create a stutter. Others said that stuttering develops from the normal mistakes all children make when learning to speak (see Onset and development), when some children get caught in a vicious cycle of putting too much effort into speaking, tensing their speech-production muscles too much, and consequently worsening their speech. While such activity does worsen an already present stutter, it does not create one. Today, these theories are generally disregarded in favor of the genetic and neurophysiological models.



The "Monster" study
In 1939, a controversial study on the possibility of "creating a stutterer" was conducted by University of Iowa speech pathologist Wendell Johnson and his graduate student Mary Tudor. The study tried to create stutterers over the course of 4 months, using 22 unwitting orphans from the Soldiers and Sailors Orphans&rsquo; Home in Davenport, Iowa. Ethically acceptable at the time, it was designed to induce stuttering in normally fluent children and to test out Johnson's "diagnosogenic theory"&mdash;a theory suggesting that negative reactions to normal speech disfluencies cause stuttering in children. The study divided the orphans into 3 groups: 6 normally fluent orphans would be given negative evaluations and criticisms regarding their speech, another group of 5 orphans who allegedly already stuttered would also receive that treatment, and the remaining 11 would be treated neutrally. The study concluded that the children given negative evaluative labeling went on to develop persistent, permanent stutters. The study was influential at the time, with many speech pathologists and child-health and educational professionals accepting Johnson's theory. In 1988, Silverman first reported the results of this study in the Journal of Fluency Disorders and labeled it "The Monster Study." While the information was well known to professionals in the area of stuttering, it was not until 2001 when the information was distributed to the public in a newspaper article. In June 2001, the San Jose Mercury News revealed this study to the public for the first time, leading to widespread controversy and debate about scientific ethics. Soon after, University of Illinois professors Nicoline Ambrose and Ehud Yairi wrote a paper discrediting the 1939 study, revealing flaws in data collection and method, as well as pointing out that none of the orphans actually did develop a permanent stutter. While criticism of a developing child's speech can certainly make a present stutter worse, it does not create a stutter. 1

Neurophysiology
Another prominent view is that stuttering is caused by neural synchronization problems in the brain. Recent research indicates that stuttering may be correlated with disrupted fibers between the speech area and language planning area, both in the left hemisphere of the brain. Such a disruption could potentially be due to early brain damage or to a genetic defect.

Structural neuroimaging, where the anatomy of the brain can be visualized and analyzed, has shown an anatomical difference between the brains of those who stutter and those who do not: see research by Sommer et al. and Jaehnke et al. Functional neuroimaging, where processes in the brain can be observed, has also shown some differences in the state of stuttering. Differences in brain activity have been observed in other areas that are associated with speech motor function, such as the area of the primary motor cortex that controls mouth movements, the areas associated with perceiving and decoding sounds, the areas involved with the formulation and expression of language, and the area that controls the human body's Valsalva mechanism (see Blocking).

Other causes
Stutters can be acquired late in life, usually through a stroke or other brain trauma, but sometimes from neurosurgical procedures. Rarer still are stutters induced by specific medications. Medications such as antidepressants, antihistamines, tranquilizers and selective serotonin reuptake inhibitors have been known to affect speech in this way. While these afflictions create stutter-like conditions they do not create a stutter in the traditional sense.

Onset and development
Like most other speech disorders, stuttering begins in early childhood, when a child is first developing his or her speech and language skills. The vast majority of stutters develop between the ages of two and five, with many stutterers outgrowing their stutter before adolescence. Most stutters manifest before the age of 7, although there have been rare cases of a stutter developing later. Almost all children go through a stage of disfluency in early speech, but when a child displays signs of a serious stutter, it is wise to seek professional help because stutters are much easier to prevent or lessen in their early stages. Stuttering can become a serious disability, and an untreated stutter usually becomes worse with time. For a developing child, a stutter can cause lower self-esteem and can increase anxiety and stress, all of which serve to worsen a stutter. Stutters can and often do hamper social development and limit educational and professional opportunities.

As speech and language are difficult and complex skills to learn, almost all children have some difficulty in developing these skills. This results in normal disfluencies that tend to be single-syllable, whole-word or phrase repetitions, interjections, brief pauses, or revisions. In the early years, a child will not usually exhibit visible tension, frustration or anxiety when speaking disfluently and most will be unaware of the interruptions in their speech. With young stutterers, their disfluency tends to be episodic, and periods of stuttering are followed by periods of relative fluency. This pattern remains through all stages of a stutter's development, but as the stutter develops, the disfluencies tend to develop more into repetitions and sound prolongations, often combined together (e.g., "Lllllets g-g-go there").

Usually by the age of 6, a stutter is exacerbated when the child is excited, upset or under some type of pressure. Also around this age, a child will start to become aware of problems in his or her speech. After this age, stuttering includes repetitions, prolongations, and blocks. It also becomes more and more chronic, with longer periods of disfluency. Secondary motor behaviors (eye blinking, lip movements, etc.) may be used during moments of stuttering or frustration. Also, fear and avoidance of sounds, words, people, or speaking situations usually begin at this time, along with feelings of embarrassment and shame. By age 14, the stutter is usually classified as an "Advanced stutter," characterized by frequent and noticeable interruptions, with poor eye contact and the use of various tricks to disguise the stuttering. Along with a mature stutter come advanced feelings of fear and increasingly frequent avoidance of unfavorable speaking situations. Around this time many become fully aware of their disorder and begin to identify themselves as "stutterers." With this may come deeper frustration, embarrassment and shame.

It is important to note that stuttering does not affect intelligence and that stutterers are sometimes wrongly perceived as being less intelligent than non-stutterers. This is mainly due to the fact that stutterers often resort to a practice called word substitution, where words that are difficult for a stutterer to speak are replaced with less-suitable words that are easier to pronounce. This often leads to awkward sentences which give an impression of feeble mindedness. Stuttering is a communicative disorder that affects speech; it is not a language disorder&mdash;although a person's use of language is often affected or limited by a stutter. 1  2

Fluency
Speech fluency consist of three variables: continuity, rate, and ease of speaking. Continuity refers to speech that flows without hesitation or stoppage. Rate refers the speed in which the words are spoken. For English-speaking adults, the mean overall speaking rate is 170 words per minute (w/m), substantially quicker than the approximately 120 w/m that stutterers produce.1  Ease of speaking refers to the amount of effort being expended to produce speech. Fluent speakers put very little muscular or physical effort into the act of speaking, while stutterers exert a relatively large amount of muscular effort to produce the same speech. In addition to the physical effort involved in producing speech, the mental effort is usually much greater in stutterers than non-stutterers. 1

Disfluency in speech, including repetitions and prolongations, is normal for all speakers, but stuttering is distinct from normal disfluency in that it occurs with greater frequency and severity—the disfluencies occur much more often and tend to last longer with more strain. The types of disfluencies are also markedly different: normal disfluencies tend to be a repetition of whole words or the interjection of syllables like "um" and "er," while stuttering tends to be repetition and prolongation of sounds and syllables. The various behaviors that can disrupt the smooth flow of speech include repetition, prolongations, and pauses: 4


 * Repetition is by far the most common behavior exhibited by stutterers. In speech, repetition occurs when a unit of speech, such as a phrase, word, or syllable, is superfluously repeated. (Examples of repetition for a phrase would be, "I want.. I want.. to go.. I want to go to the store," or, "I want to go to the - I want to go to the store." A word repetition would often resemble, "I want to-to-to go to the store," and a syllable or sound repetition being, "I wa-wa-want to go to the store," or, "I w-w-want to g-go to the store.") Repetition occurs in the speech of both stutterers and non-stutterers, but non-stutterers are less likely to repeat shorter units of speech, mainly repeating phrases and sometimes words but rarely syllables. Non-stutterers will also, in the majority of cases, repeat the unit once or twice as opposed to the 6 or so times common from stutterers.


 * Prolongations are one of the least typical behavior exhibited by stutterers. Prolongations normally happen with child stutterers and with the sounds, , , or any other fricative consonant or vowel. With stutterers, prolonging a sound sometimes leads to a pitch and volume increase.


 * Pauses are also a common source of disfluency in both stutterers and non-stutterers. Most pauses can be divided into two categories: filled pauses and unfilled pauses.
 * Unfilled pauses are extraneous portions of silence in the ongoing stream of speech. These pauses differ from the pauses that punctuate normal speech, where they reflect common sentence structure or are used to add a particular rhythm or cadence to speech. Unfilled pauses by stutterers are usually unintentional and may cause the larynx to close, restricting the flow of air necessary for speech. Stutterers refer to this as "blocking". (''See Blocking.)
 * Filled pauses are interjections typical in normal speech like "um", "uh", "er", and so on. In speech these serve as a kind of place-holder—a way a speaker lets listeners know that he or she still has the floor and is not finished speaking. In addition to being used as a way of preempting interruption, they are also used by stutterers as a way of easing into fluency or deflecting embarrassment when they cannot speak fluently. Each stutterer has different sounds that he or she personally finds difficult to speak, usually plosive consonants or close vowels, and by using filled pauses the stutterer can ease into continuous speech that otherwise would be more difficult to begin. This is a form of avoidance behavior. Another element of speech that is similar to filled pauses are parenthetical interjections—interjections like "so anyways", "like", or "you know". This pattern is quite common in teenagers and is also used heavily by some stutterers.

Blocking
Stuttering often develops into blocking, where the first letter or syllable becomes very difficult to pronounce and is in effect "blocked" from being spoken. When this happens the larynx closes, halting the flow of air. This closure is very similar to the closure of the larynx during the Valsalva maneuver&mdash;a maneuver commonly used as pressure equalization technique by scuba divers and airplane passengers to avoid barotrauma. The Valsalva maneuver intentionally exploits the Valsalva mechanism, which is a natural mechanism involving a group of neurologically coordinated muscles in the mouth, larynx, chest, and abdomen. The speech therapy techniques of "gentle onset" or "passive airflow", where the speaker controls his or her airflow to ease into words, aim to avoid abrupt increases in air pressure, and thereby reduce the likelihood of the Valsalva mechanism activating. Constant use of the Valsalva mechanism in speech can create nerve pathways linking speech to the Valsalva mechanism, making it more difficult to reduce blocking.

Avoidance behavior
When stuttering, stutterers will often use nonsense syllables or less-appropriate (but easier to say) words to ease into the flow of speech. Stutterers also may use various personal tricks to overcome stuttering or blocks at the beginning of a sentence, after which their fluency can resume. Finger-tapping or head-scratching are two common examples of tricks, which are usually idiosyncratic and may look unusual to the listener. In addition to word substitution or the use of filled pauses, stutterers may also use starter devices to help them ease into fluency. A common practice is the timing of words with a rhythmic movement or other event. For instance, stutterers might snap their fingers as a starter device at the beginning of speech. These devices usually do work, but only for a short amount of time. Often a person who stutters will do something at some point to avoid, postpone, or disguise a stutter and, by coincidence, will not stutter. The stutterer then makes a cause-effect connection between that new behavior and the release of the stuttering, and the behavior becomes a habit. 4

As stutterers often resort to word substitution in order to avoid stuttering, some develop an entire vocabulary of easy-to-pronounce words in order to maintain fluent speech&mdash;sometimes so well that no one, not even their spouses or friends, know that they have a stutter. Stutterers who successfully use this method are called "covert stutterers" or "closet stutterers". While they do not actually stutter in speech they nevertheless suffer greatly from their speech disorder. The extra effort it takes to scan ahead for feared words or sounds is stressful, and the replacement word is usually not as adequate a choice as the stutterer originally intended. Famously, some stutterers drastically limit their options when dealing with employees at given establishments; only eating cheeseburgers at fast-food restaurants, ordering toppings they do not like on pizzas, or getting a style of haircut they do not want as a by-product of their inability to pronounce certain words. Some stutterers have even changed their own given name because it contains a difficult-to-pronounce sound and frequently leads to embarrassing situations.

Severity
When the behaviors of a stutter are infrequent, brief, and are not accompanied by substantial avoidance behavior, the stutter is usually classified as a mild or a non-chronic stutter. Non-chronic stuttering is often called "situational stuttering" because the afflicted person generally has difficulty speaking only in isolated situations&mdash;usually during public speaking or other stressful activities&mdash;and outside of these situations the person generally does not stutter. When the behaviors are frequent, long in duration, or when there are visible signs of struggle and avoidance behavior, the stutter is classified as a severe or chronic stutter. Unlike mild or situational stuttering, chronic stuttering is present in most situations, but can be either exacerbated or eased depending on different conditions (see Positive conditions). Severe stutters often, but not always, are accompanied by strong feelings and emotions in reaction to the problem such as anxiety, shame, fear, self-hatred, etc. This is usually less present in mild stutterers and serves as another criteria by which to define stutters as mild or severe. Another way of discerning between the two severities is by percentage of disfluency per 100 words. When a speaker experiences disfluencies at a rate around 10%, they usually have a mild stutter, while 15% or more is usually indicative of a severe stutter.2 In addition to the disfluency, many people who stutter display secondary motor behaviors. Observers often notice muscles tensing up, facial and neck tics, excessive eye blinking, and lip and tongue tremors. In extreme cases entire body movements may accompany stuttering. Most common with stutterers is the inability to maintain eye contact with the listener, which in many cultures may hamper the growth of personal or professional relationships.

It is worth noting that the severity of a stutter is not constant and that stutterers often go through weeks or months of substantially increased or decreased fluency. Stutterers universally report having "good days" and "bad days" and report dramatically increased or decreased fluency in specific situations. Below is an overview of the circumstances that harm and help the fluency of most stutterers:

Positive conditions
Subtle changes in mood or attitude often greatly increase or decrease fluency, with many stutterers developing tricks or methods to achieve temporary fluency. Stutterers commonly report dramatically increased fluency when singing, whispering or starting speech from a whisper, speaking extremely slowly, speaking in chorus, speaking without hearing their own voice (e.g., speaking over loud music), speaking with a metronome or other rhythm, speaking with an artificial accent or voice, speaking in a foreign dialect, or when speaking while hearing their own voice with a minuscule delay or pitch change. (See Treatments.) Stutterers also display increased fluency when speaking to nonjudgmental listeners, such as pets, children, or speech pathologists. It is perhaps most interesting to note that most stutterers experience extraordinary levels of fluency when talking to themselves. A rare few even experience increased fluency when they exclusively "have the floor" (public speaking or teaching), when they are intoxicated, or when they are explicitly trying to stutter. There is no universally accepted explanation for these phenomena.

Negative conditions
All speech is more difficult when under pressure. Commonly, social pressures, like speaking to a group, speaking to strangers, speaking on the telephone, or speaking to authority figures, will irritate and make worse a stutter. Also, time pressure often exacerbates a stutter. Pressure to speak quickly when answering or conversing is usually very difficult for a stutterer, particularly on the telephone where stutterers do not have body language to aid themselves. This usually leaves dead silence in the place of nonverbal communication, which will indicate to the listener that the stutterer is not there or the line has been disconnected. Other time pressures will also worsen a stutter, such as saying one's own name, which must be done without hesitation to avoid the appearance that one does not know his or her own name, repeating something just said, or speaking when somebody is waiting for a response.

Treatments
There are many treatments for stuttering, none of which is 100% effective. Traditional speech therapy reduces the frequency and severity of a stutter and teaches stutterers to use effective communications skills, such as making eye contact. While not a cure, speech therapy can lead to more fluent speech patterns and is especially effective in early childhood. The duration or type of therapy needed varies among stutterers but usually involves both speech training (articulation, intonation, rate, intensity) and language training (phonology, morphology, syntax, semantics). Depending on the nature and severity of the disorder, common treatments may range from physical strengthening exercises and repetitive practice to the use of medication, electronic devices, and neurosurgery.

Behavioral and cognitive therapy
Behavioral and cognitive therapy is the most common approach to stutter treatment. Such therapy usually involves the development of new speaking habits and attitudes towards speech, often including exercises in manipulating rates of speech, establishing new breathing patterns, practicing relaxation, and targeting troublesome sounds. Breathing control is often emphasized, which focuses on proper control of the diaphragm. Proponents of this method see uncoordinated movements of the diaphragm as the core cause of stuttering. Another area sometimes emphasized during speech therapy is Valsalva training, which is training that specifically targets blocks by focusing on the gaining of greater control on the bodily mechanism that produces a block by halting airflow, the Valsalva mechanism (See External Links for more).

Also, during behavioral and cognitive therapy, efforts are made to increase confidence through repetition and positive feedback, to help alleviate the anxiety and fear associated with speaking. While individual or group therapy with a licensed speech pathologist is common,  self-therapy is also a very popular practice, mainly due to its lower cost, convenience, and lower pressure. The stutterer invests in the necessary books or tapes and spends varying amounts of time per day doing exercises similar to the exercises used in professional speech therapy. Therapy usually provides some improvement to most individuals within a few weeks or months. But, like most therapy for other disorders or afflictions, it often requires constant attention and practice to maintain success. Other, less-accepted methods include everything from hypnosis to laughter to art therapy.

Medication
The use of medication that affects brain functions has also had limited success in increasing fluency, although it is usually used in conjunction with behavioral and cognitive therapy and may have side effects that limit its long-term usefulness. To date only two medications, haloperidol and risperidone, have been shown to be effective in a rigorous double-blind, placebo-controlled trial. Unfortunately, both drugs have side effects that limit their usefulness, with haloperidol having more severe side effects than risperidone. The largest study of risperidone for stuttering was completed by the University of California Stuttering Research Group. In the study, rispiradone improved fluency and was well tolerated by the participants. However, side effects associated with changes in levels of the hormone prolactin developed and the medication was discontinued. Another drug, olanzapine, is similar to risperidone and haloperidol, but has a different side effect profile and has not yet been tested under a comparable double-blind, placebo-controlled trial. While the medicinal treatments for stuttering have vastly improved over recent years, there is still no medication that can "cure" stuttering. Like traditional speech therapy, medications can only decrease the frequency and severity of a stutter.

Electronic fluency aids
One recent trend in speech therapy is the use of electronic fluency aids. These devices are mostly based on altering the pitch with which the speaker hears his or her own speech (frequency altered feedback or altered auditory feedback), playing back speech slightly delayed (delayed auditory feedback), playing white noise to disallow the individual from hearing his own voice, and playing slow and steady clicks, much like a metronome. These approaches have variously been said to either offer great success, or to have no effect whatsoever. It is still unclear why these devices may work to alleviate stutters. Recent advances in digital technology have made the commercial application of these devices possible, and such products are already available, although they have yet to be widely adopted due to their high cost. The most popular form of electronic fluency aids are devices that are placed inside the ear, resembling hearing aids.

Stuttering and society
For centuries stuttering has often featured prominently in both popular culture and in society at large. Because of the unusual-sounding speech that is produced, as well as the behaviors and attitudes that accompany a stutter, stuttering has frequently been a subject of scientific interest, curiosity, discrimination, and ridicule. Stuttering was, and essentially still is, a riddle with a long history of interest and speculation into its causes and cures. Stutterers can be traced back centuries to the likes of Demosthenes, Aesop, and Aristotle&mdash;some interpret a passage of the Bible to indicate Moses also to have been a stutterer.5 Misinformation and superstition have influenced society's perceptions of the causes and remedies of a stutter, as well as the intelligence and perceived disposition of people afflicted with the disorder.



Partly due to a perceived lack of intelligence because of his stutter, the man who became the Roman Emperor Claudius was initially shunned from the public eye and excluded from public office. This exclusion from public life suited his inclination towards the academic and gave him time for study. His infirmity is also thought to have saved him from the fate of many other Roman nobles during the purges of Tiberius and Caligula. By studying history, Claudius became very knowledgeable about governmental institutions, which later aided him as an emperor. Balbus Blaesiuse is another Roman who stuttered severely, so much that he became an "exhibit" in a freak show, where he was displayed locked in a cage. His last name, Blaesius, is now the Italian word for stuttering. Issac Newton, the famous English scientist who developed the law of gravity, also had a stutter. Other famous Englishmen who stammered were King George VI and Prime Minister Winston Churchill, who led the UK through World War II. Although George VI went through years of speech therapy for his stammer, Churchill thought that his own mild stutter added an interesting element to his voice: "Sometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience&#133;"10



For centuries "cures" such as speaking with a pebble in the mouth (as per the legendary orator Demosthenes), consistently drinking water from a snail shell for the rest of one's life, "hitting a stutterer in the face when the weather is cloudy", strengthening the tongue as a muscle, and various herbal remedies were often used6 ; clearly to little effect.

Similarly, in the past people have subscribed to various theories about the causes of stuttering which today one might consider odd. Proposed causes of stuttering have included tickling an infant too much, eating improperly during breastfeeding, allowing an infant to look in the mirror, cutting a child's hair before the child spoke his or her first words, having too small a tongue, or the "work of the devil."3

Roman physicians attributed stuttering to an imbalance of the four bodily humors: yellow bile, blood, black bile, and phlegm. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century. Italian pathologist Giovanni Morgagni attributed stuttering to deviations in the hyoid bone, a conclusion he came to via autopsy. Later in the century, surgical intervention, via resection of a triangular wedge from the posterior tongue to prevent spasms of the tongue, was also tried.

In more recent times, movies such as A Fish Called Wanda (1988) and A Family Thing (1996) have dealt with contemporary reactions to and portrayals of stuttering. In A Fish Called Wanda, a lead character, played by Michael Palin, has a severe stutter and low self-esteem. His character&mdash;who is socially awkward, nervous, an animal lover, and reclusive&mdash;portrays a prevalent stereotypical image of stutterers. The three other characters in the movie generally make up the spectrum of reactions to stuttering: Jamie Lee Curtis's character is sympathetic and sees past it, John Cleese's character is polite but indifferent, and Kevin Kline's is malicious and sadistic. Upon release the film caused controversy among some stutterers who disliked the film for its portrayal of Palin's character as a pushover amid the bullying his character receives, and received favor from others who valued the film for showing the difficulties stutterers commonly face. Palin, whose father was a stutterer, stated that in playing the role he intended to show how difficult and painful stuttering can be. He also donated to various stuttering-related causes and later founded the Michael Palin Centre for Stammering Children in London.

The 1983 movie The Right Stuff referenced the real-life stuttering problem of John Glenn's wife Annie, and how it rendered her fearful and unwilling to do a news conference during his initial space flight. As he reported in his autobiography, John Glenn: A Memoir, and as shown on-screen in The Right Stuff, her stuttering was never a problem between the two of them, he "just thought of it as something Annie did". But she grew frustrated with it, and some years later put herself through intense speech therapy to largely overcome it. A proud moment for the both of them was the first public speech she gave on her experiences as a stutterer.

Though a stutterer might seem to be an unlikely radio star, Howard Stern hired a stutterer sight unseen ("He stutters? Hire him.") to conduct celebrity interviews. Known on the Stern show as Stuttering John, John Melendez worked for Stern for 15 years before taking a position as the announcer on The Tonight Show. Howard Stern also has a collection of frequent guests, many of whom have speech impediments of some type; while their afflictions are exploited for comedic purposes, members of "The Wack Pack" are well-loved by Howard Stern and his fans.

In addition to personal feelings of shame or anxiety, outside discrimination is still a significant problem for stutterers. The vast majority of stutterers experience or have experienced bullying, harassment, or ridicule to some degree during their school years <sup id="fn_11_back">11, with this trend often carrying over into the workplace. Stuttering is legally classified as a disability in many parts of the world, affording stutterers the same protection from wrongful discrimination as for people with other disabilities. The UK Disability Discrimination Act 1995 and the Americans with Disabilities Act of 1990 both specifically protect stutterers from wrongful dismissal or discrimination. 

Along with disability legislation, many stutterer rights groups have formed to address these issues. One interesting example is the Turkish Association of Disabled Persons, which successfully appealed to the major Turkish telephone company Telsim, resulting in reduced rates for people with stutters or other speech disabilities because of the additional time it takes them to converse on the telephone. Also, the U.S. Congress passed a resolution in May 1988 designating the second week of May as Stuttering Awareness Week, while International Stuttering Awareness Day is held internationally on October 22.

Even though public awareness of stuttering has improved markedly over the years, misconceptions are still very common, usually reinforced by inaccurate media portrayals of stuttering and by various folk myths. A 2002 study focusing on college-age students and conducted by University of Minnesota Duluth found that a large majority viewed the cause of stuttering as either nervousness or low self-confidence, and many recommended simply "slowing down" as the best course of action for recovery.<sup id="fn_7_back">7 Many parents of children who have or are suspected to have a stutter still erroneously subscribe to the belief that ignoring the speech problem is the surest way toward rehabilitation. While these misconceptions are damaging, groups and organizations are making significant progress towards a greater public awareness.

Stuttering in Music
"K-K-K-Katy" was published in 1918 by Geoffrey O'Hara and became a huge hit in wartime America, referred to as "The Sensational Stammering Song Success Sung by the Soldiers and Sailors". Anyone who had either a stutter or a lisp was covered. The song uses stuttered lyrics in every line of the chorus, and refers to the stuttering of a stereotypically bashful suitor.

A stylized form of stuttering has frequently appeared in popular music over the past few decades. In some songs from the 1960s and 1970s the vocalist would rapidly repeat the first syllable of a word. An early example is The Who's 1965 song "My Generation", in which Roger Daltrey sings the line "Just talkin' 'bout my G-g-g-generation". In that particular case, the song's stuttering style provides a framework leading up to the sly lyric, "Why don't you just fu.. fu.. fade away!" Another example was the effected stuttering by the Bachman Turner Overdrive in their 1974 hit song "You Ain't Seen Nothin' Yet". By the early 1980s producers were creating the same effect synthetically using tape editing and digital sampling of lyrics. Paul Hardcastle's 1985 song "19" features it throughout in both the spoken word and vocal segments. Remixes of songs very frequently employed the effect. Starting in the 1990s stuttering effects fell out of popular use in music.

In 1995, stutterer Scatman John turned his problem into his asset and wrote the hit song "Scatman". Stuttering assisted him to scat sing and create incredible sounds. The lyrics are inspirational and directed at stutterers:
 * Everybody stutters one way or the other so check out my message to you
 * As a matter of fact, don't let nothin' hold you back
 * If the Scatman can do it, so can you.