Monday, January 23, 2012

Neurogenic or Acquired Stutter?

Even CNN knows!

I happened to find this clip after I wrote the text for this entry.

Just when you thought there couldn't possibly be any more stutter word police, I'm back with more! This one only came up because I met a man with a neurogenic case of stutter last week. Neurogenic stutter describes a condition that comes on due to either physical damage to the brain, through injury or stroke, or secondary to a disease like Parkinson's. Neurogenic stutter can also be caused by prescription drugs, and may disappear when the drug or dosage are changed.

Until now, it hadn't occurred to me, but using neurogenic in opposition to developmental stuttering is not proper usage. And in fact, there is another, correct term used: acquired stuttering. These two terms correctly differentiate between a condition that comes on during development and one that is not development-related, but is 'acquired' regardless of the developmental process.

The Stuttering Foundation has an informational web page for neurogenic stuttering here. Interestingly enough, in the reference section, they cite multiple papers that use the term 'acquired stuttering,' and two using 'acquired neurologic(al).' So obviously, the profession hasn't made up its mind on this subject.

My preference goes beyond wanting to align the rationale for the two terms along logical, developmental/non-developmental lines. The reason is that I believe that the evidence is clear (to me, at least), that developmental stutter is neurogenic. The only difference between the two conditions is that one results from existing neurological abnormalities and is expressed during development, and the other is expressed when damage is done to an otherwise healthy neural speech system.

As a practical matter, the shift away from using the term neurogenic stuttering would require pointing out to people in the field that no, developmental stutter is not 'learned.' It has an organic, neurological basis, just like acquired stuttering. This is another effort on my part to stick a fork in the effort to save learning theory and sneak it past the door. Stuttering is not learned. Whether it is always an inherited condition or not is not proven, but I am confident that it is organic, and distinction not made often enough. There are those in this field who give lip service to acknowledging the evidence for the organic basis of stuttering, and then sneak behaviorist learning theory in the back door. The less places they have to hide, the better.

Take-home message: Acquired stutter, good, neurogenic stutter, bad.


  1. You wrote: "There are those in this field who give lip service to acknowledging the evidence for the organic basis of stuttering, and then sneak behaviorist learning theory in the back door."

    But let's not forget that much of stuttering *is* behavioral, in the sense that behavioral therapies often do have the potential to reduce stuttering symptoms.

    I believe that your point is that the root causes of normal developmental stuttering are fundamentally not behavioral, and I think there's a broad consensus on this point. But it's not correct to conclude from this that behavioral interventions have no analytical or therapeutic value. And in that context - behavioral therapies for stuttering - it is entirely appropriate to discuss stuttering therapy in terms of learning (unlearning) theory and behavioral techniques.

    In fact, I would even go further. Although developmental stuttering may be fundamentally neurogenic, to a certain extent stuttering behaviors *are* learned. It doesn't make sense to me to pretend otherwise and avoid all talk of learning and behavior in the development of an individual's stuttering.

    In the nature/nurture divide, stuttering is not wholly nature and no nurture. Consider two people with identical neurology; their stuttering develops differently, doesn't it? That's the nurture component. In discussing that component, it's reasonable and appropriate to talk in terms of learning and behavior.

    People may go too far in this direction and slip down the slope toward the old-fashioned idea that stuttering is fundamentally learned. But since it is partly learned, we shouldn't slip too far down the slope in the other direction [I think my metaphor has stopped working] and reject all talk of behaviorist learning theory.

  2. Ora - thanks for taking the time to comment. Rather than answer here, I think this deserves its own post. It will take a little time, but I'll refer to each your points. I have no problem with a strong learned element to the condition, and necessary behavioral elements to therapy. My point is to focus on defining the condition, not on ignoring factors that are well-discussed elsewhere.

  3. I would like to share my own experience of an acquired stutter. Neurogenic/behavioral distinctions aside (really, as long as people understand that there are never necessarily easy ways to fix something, what's the fuss?), I had a whole host of behavioral, physical and memory-related side effects that were the result of extended and profound depression. Going back and forth from minimally functional to borderline-psychotic or even to full blown agitated catatonia for multiple years. My higher functions were amazingly intact (but distant without the power to drive motivation, i.e. prefrontal cortex was not talking to the mid-brain much). When I found my "miracle" med cocktail my mind was scrambled egg and I have had the uniquely eye-opening experience of putting it back together. When I was relearning basic social skills about 5 years ago I found I had a stutter when speaking. Nowadays it only comes up when I am nervous but I have found reading prose or work related stuff (I am a student researcher) aloud to be helpful as practice.

    For whatever it is worth I have studied linguistics and cognitive neuroscience formally to some extent. I have found more than one professor of psychiatry who shares the view from practical experience that a tremendous amount of issues can crop up in the wake of a serious mood or psychotic disorder. Most especially ones that are normally developmental.

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