Dyslexia and Stuttering
Stuttering and Dyslexia: Symptoms and Treatment The two pathologies, both in Italy and in the world, are much more common than you might think. Dyslexia is a pathology that involves difficulties in language and in the ability to read and write. In Italy it affects about one and a half million individuals and, in the world, between 5 and 15% of the population. In the onset of the disease there seems to be a genetic involvement. This is the conclusion presented in April 2003 by Juha Kere of the University of Helsinki. A gene mutation has been identified that occurs in 10% of dyslexics and only in 2-3% of healthy subjects. Dyslexia manifests itself in the first years of school: learning difficulties, difficulty in reading and writing continuously and fluently. The dyslexic child is often able to read, but cannot do so continuously, which makes learning more difficult. Dyslexia and Stuttering: Differences Stuttering and dyslexia are often confused or considered synonymous. In this article, we will talk about the differences in symptoms and therapies in different pathologies. Dyslexia The word dyslexia is the union of two words “dis” which means missing and “lexis” which means language. Therefore, this term of Greek origin can be translated as missing language. Only in the last century did a clinical and detailed description of this pathology appear for the first time, thanks to Hinshelwood who wrote an entire treatise on a case of a boy affected by this deficit. Before then, everyone considered this problem in relation to the field of language understood as an impossibility in linguistic production, more often linked to mental retardation. The person who suffers from dyslexia has a lower speed and accuracy in reading aloud and in writing, compared to other subjects of his age. Reading words and brands seem deficient. It is a specific learning disorder, therefore, we speak of DSA. In Italy it affects about one and a half million individuals. Perceptual and acoustic-motor process It is commonly said that the child confuses the letters; in reality, when it comes to confusion of letters similar in sound, the child confuses the sounds and consequently also the letters. In fact, each language has sounds that are very similar to each other. In Italian for example c-g, p-b, t-d, etc. To associate a letter with a sound or phoneme, you need to know how to distinguish the phonemes from each other. The normal subject does it easily, in some dyslexic subjects however, there may be a deficiency from this point of view. That is, he has difficulty in perceiving a sound through the proprioceptive movements of the phonatory apparatus. In these cases it is difficult to analyze in a clear and precise way the sounds that characterize the language, and to correctly grasp the system of their graphic reproduction. Symptoms of Dyslexia The symptoms of dyslexia concern the difficulty in recognizing letters, spelling symbols, rules for converting graphemes to sounds and in automatically constructing individual sounds into words. Dyslexic children therefore struggle to acquire fluent and fluent reading. The reading process remains slow and tiring even as schooling progresses. However, it is possible to develop one’s reading skills, even in the case of a serious starting situation. Educational treatment of dyslexia As regards treatment, it is advisable to take into account an education of verbal expression. Therefore, it is advisable to proceed with a visual-motor check and evaluation and progressively with rhythmic education for the acquisition of temporo-spatial structures. Furthermore, it is necessary to educate to acquire automatism in reading and in understanding the text. If it is a very structured dyslexia, it is necessary to focus on integrative teaching systems, to avoid that an inappropriate teaching method causes the worsening of dyslexia. However, it is necessary to act with care and professionalism, to avoid that the dyslexic child feels different from others. Stuttering At the beginning we said that many people tend to confuse dyslexia and stuttering. Previously we talked about dyslexia, reading this part dedicated to stuttering, you will notice the differences. It is a problem with profound psychological implications, in fact, before speaking, the stutterer is seized by anxiety that can only aggravate his defect. There is no right synergy between thought and word and this derives from the control that the stutterer exercises on his language, a mechanism learned in the early stages of the onset of the disorder. The stutterer is blocked in words, in the fluid emission of his language, but is equally blocked in general in the ability to live his energies in a genuine way. The stutterer also learns to control the word. In fact, unlike the normal speaking person who pays attention to the content, the stutterer does exactly the opposite. Being insecure about his verbal performance, he acts precisely in the direction of what he realistically should not do, that is, control his word. To stop stuttering, the stutterer must overcome his fears, feel strong towards others and above all, learn to feel good about himself. There is no remedy for not stuttering, understood as the use of a method. Any method, only temporarily eases the problem, which will reappear when the support technique is abandoned. The best time to treat stuttering children is between the ages of 3 and 5, preferably at least a year before starting school. These are just a few tips, for more information contact us. You might be interested in: stuttering; psychological meaning of stuttering; famous stutterers.
Presentation of Dr. Antonio Bitetti in Minneapolis (U.S.A.)
Buon pomeriggio a tutti, sono il dott. Antonio Bitetti, psicologo italiano e da molti anni mi occupo di balbuzie, con un modello nuovo di trattamento che ho definito: Approccio Integrato. E’ importante sottolineare che sono stato balbuziente fino all’età di 30 anni. Ho sofferto molto per il mio disturbo e dopo essermi laureato in psicologia all’Università di Roma, ho iniziato un percorso di gruppoanalisi, su suggerimento di un importante psicoanalista italiano. Di solito, questa terapia non si usa per curare chi soffre di balbuzie, ma il prof. Leonardo Ancona, allora direttore di psichiatria e psicologia all’Università Cattolica, mi suggerì di intraprendere questo percorso, e dopo 5 anni, superai completamente la mia balbuzie. A distanza di anni, in una lettura della biografia di questo importante professore, lessi che anche lui aveva fatto una esperienza di gruppoanalisi a Londra, nel lontano 1960, in tempi in cui era agli albori la teoria dei gruppi di Foulkes e la cosa mi sorprese molto. In quel contesto di gruppo ero l’unico partecipante ad avere questo problema e durante tutto il percorso, a volte, mi chiedevo perchè ero in quel contesto, gli altri partecipanti avevano altri tipi di problemi psicologici, molto diversi dal mio. Lo capii gradualmente e mi resi conto che ancor prima dei 5 anni di gruppoanalisi mi trovai a constatare con non ero più affetto da balbuzie. Iniziai a provare un grande senso di libertà, fisica e soprattutto psicologica e relazionale. E’ difficile spiegare cosa succede ad un paziente che vive quella esperienza. Posso dirvi che ti cambia la vita, perché ti costringe a vedere una prospettiva nuova riguardo al proprio problema. La gruppo analisi, per chi riesce a tollerare quella esperienza, poichè è una esperienza molto forte da un punto di vista psicologico, ti porta inevitabilmente ad un confronto graduale con i problemi degli altri partecipanti. Ti sembra che il tuo problema sia diverso dagli altri partecipanti al gruppo, ed invece non è così. Come diceva J. Lacan noto psicoanalista francese freudiano, nella sua celebre – Teoria dello specchio – “ Se vuoi capire te stesso, ti basta guardare gli altri ”. In tutti questi anni, come terapeuta della balbuzie, ed ex-balbuziente, non ho mai incontrato nessuno che abbia vissuto la mia stessa esperienza. Good afternoon everyone, My name is Doctor Antonio Bitetti. I’m an Italian psychologist and for many years I have been treating stuttering by using a new treatment model that I refer to as the Integrated Approach. It is important to point out that I myself was a stutterer up to the age of thirty. I suffered greatly from my disorder and after graduating in psychology from the University of Rome, I joined a programme of group analysis on the advice of an well known Italian psychoanalyst. This type of therapy is not usually used to treat people who suffer from stuttering, but Professor Leonardo Ancona, who was then director of psychiatry and psychology at Cattolica University, suggested that I follow this path. Five years later, my stuttering had been completely cured. Years later, while reading the biography of this important professor, I was surprised to discover that he too had had an experience of group analysis in London back in 1960, at a time when Foulkes’ group theory was still in its infancy. I was the only participant in the group with this problem and throughout the process, I often wondered why I was in that context, as the other participants had types of psychological problems which were very different from mine. Gradually I understood why and realized that even before the five years of group analysis were over, I was no longer stuttering. I began to feel a enormous sense of freedom, both physical and above all psychological and relational. It’s hard to explain what happens to a patient who lives through this experience but I can tell you that it changes your life, because it forces you to see your problem from a new perspective. For those who can tolerate what is a very intense experience psychologically, group analysis inevitably leads you to a gradual confrontation with the problems of the other participants. You may feel that your problem is different from those of the other participants in the group, but in fact it is not. As the well-known French Freudian psychoanalyst J. Lacan stated in his famous “Theory of the Mirror” – “If you want to understand yourself, you just need to look at others”. And in all these years as a stuttering therapist and ex-stutterer I have never met anyone who has undergone the same experience as I have.
Radio interview on stuttering on Rete Due RSI-CH of Lugano
On October 22, 2024, on the occasion of World Stuttering Awareness Day, Dr. Antonio Bitetti gave a radio interview on the topic of stuttering on the radio della Svizzera Italiana in Lugano, Canton Ticino. The presenter Marco Pagani gave a brief introduction to the problem, also pausing to list the statistics of the World Health Organization (WHO) and recalling the famous film dedicated to King George VI, “The King’s Speech” affected by stuttering and well interpreted by the actor Colin Firth. Immediately after, Dr. Bitetti illustrated his point of view on this topic which has always been identified as a language problem. In truth, it is not because there is clear evidence that the stutterer knows how to express his language very well, but only in a context isolated from people. Unfortunately, the dominant culture believes that stuttering is a language problem and everyone is trying to cure it with re-educational, phonetic and/or speech therapy methods, leaving aside the internal matrix of the problem. The presenter was quite surprised by Dr. Bitetti’s statements and understood the interpretative message regarding the emotional and relational implications of stuttering, greatly appreciating the description given by Dr. Bitetti in this interview. The time is now ripe to decide to affirm that stuttering is not a language problem at all and also in the international therapeutic scenario the therapeutic model proposed by Dr. Antonio Bitetti should take hold, with his: Integrated Approach. This therapeutic model, now known throughout Italy, addresses stuttering even at an early age, on disfluent children aged between 2 and 5 years, intervening on the parents to avoid the chronicization of the problem and obtaining truly interesting results.
Stuttering Therapy in Adults
The stutterer constantly experiences the problem of saying, not saying, there is not that spontaneity typical of the normoloquent, that is, of someone who speaks without any verbal hitches. The treatment of stuttering in adults requires an Integrated Approach to the problem. For a long time, the problem of stuttering has been ironized and in very distant times there was a tendency to associate the difficulty of speaking with an intellectual delay. The fluency of language is hindered, but not the intelligence and the ability to complete one’s own projects. On a cognitive level, however, the stutterer is constantly influenced by a type of thinking, where the fundamental element is the control of the word1. Stuttering in Adults: the result of wrong methods Usually, the adult stutterer has already done speech therapy cycles and courses on stuttering as a child, based mainly on phonation or similar techniques, accompanied by breathing exercises. However, few adult stutterers have addressed the deeper aspects of their stuttering and find themselves with an unchanged, or slightly improved, situation, at least in terms of language. In fact, it often happens that after several cycles of re-education sessions with treatment methods based on improvised intuitions, the adult stutterer often returns to his old habits. Fear of Stuttering: between states of anxiety and desire to relate The fear of stuttering leads to a constant focus on how to speak, rather than focusing on realistic and logical factors, that is, what you want to say. With such a sequence of thoughts it is easy to fall into a state of anxiety that compromises speech itself. The normal speaker, on the contrary, does not control his words, they are fluid, he is more attentive to what he says, than to how. Through the Integrated Approach, his method of treating stuttering, Dr. Antonio Bitetti addresses the difficulties of the adult stutterer from different points of view, focusing especially on relational dynamics. These dynamics explain one of the character traits of the adult stutterer: passivity. It is understood as a subtle fear on the part of the stutterer to bring out all the underlying energy that he has always held back. A passivity that leads him to give up various social and relational activities. Not only that, this holding back of energy often has repercussions on the emotional sphere, and it is easy to find stuttering adults who are emotionally isolated. The patient brings with him many painful experiences, made of sacrifices, humiliations and often imbued with feelings of social isolation, loneliness and even anger. This is why the stuttering adult is constantly looking for interpersonal relationships with other stutterers. He feels more reassured by his peers, he feels protected and not judged. This explains the continuous search for methods of treating stuttering that are based on support techniques, using the group as a basis for therapeutic work. However, this does not mean that stuttering is actually being treated, but rather that the symptomatic aspect is simply being treated. Indeed, it is important to emphasize that through interacting with other people affected by the same problem, the patient receives a pleasant sensation, as if they were actually making progress, but the truth is that the fear of speaking in front of others is inhibited by the fact that others share the same disorder as the speaker. Therefore, it is not an effective resolution of the problem. The emotional dynamics behind adult stuttering Stuttering therapy in adults opens up a fascinating world of emotional dynamics in the stutterer. The stutterer constantly experiences the problem of saying, not saying, there is no spontaneity typical of the normal speaker, that is, of someone who speaks without any verbal hitches. The stutterer finds it more difficult when he has to verbalize thoughts with high emotional content, or when he has to present a topic in front of several people, especially if they are considered authoritative, or that he considers such. This suggests the presence of complex psychological mechanisms, which have fueled the scientific literature on the etiopathogenesis of this disorder. In general case studies, it is found that almost all stutterers stutter in the presence of strangers, or those considered important. The example of the adult who has to take a job interview, or who has to present a report in front of a multitude of people, is emblematic. On a relational level, the stutterer feels like a prisoner of his disorder and experiences social relationships with difficulty and suffering. For example, he fears verbal exposure in any group relationship, feels uncomfortable and embarrassed if he is asked to repeat a topic already exposed, and experiences his difficult moment on the phone, which becomes a painful experience and even a real block. This does not mean that all stutterers have social limitations, it depends on the severity and importance that the stutterer gives to his disorder. In fact, a fundamental element is given by the negative perception of oneself, and by the feared negative judgment by others, which can increase the level of anxiety, and thus affect normal social relationships. This brief exposition of the difficulties that the adult stutterer experiences, leads to reflections on the psychic dynamism underlying the disorder. How to Stop Stuttering Forever: Integrated Approach A true cure for adult stuttering must include a significant restructuring of the stutterer’s personality. The Integrated Approach in adults with stuttering addresses the deepest elements of stuttering. It is not a psychoanalytic therapy and it is not a cognitive behavioral therapy in the most classic definition. It is a comprehensive approach to stuttering, the result of over twenty years of studies and research in the specific sector. For all adult stutterers who have entrusted themselves to the care of Dr. Bitetti, after having undergone therapies in other fields, the Integrated Approach turns out to be a complete therapy. Complete, because it does not leave out any aspect, it goes in the right direction to offer the adult stutterer all the tools to bring out his true
Childhood stuttering
The main classification of childhood stuttering is the one that divides this disorder into primary stuttering and secondary stuttering. This classification takes into account the time of onset of the disorder and the characteristics of the disorder itself. The classification of childhood stuttering The main classification of childhood stuttering is the one that divides this disorder into primary stuttering and secondary stuttering. This classification takes into account the time of onset of the disorder and the characteristics of the disorder itself. Primary stuttering (also known as running-in stuttering or pseudo-stuttering) is a fairly common disorder; it is estimated, in fact, that the problem affects 30% of infants, especially males; primary stuttering usually disappears spontaneously without the need for speech therapy or language rehabilitation. Secondary stuttering (also called true stuttering) is a much more serious problem than primary stuttering. It usually manifests itself in that period of life that goes from the age of 6 to 14. It is very unlikely (although not impossible) that true stuttering manifests itself in adulthood. THE MAIN SYMPTOMS OF CHILDHOOD STUTTERING Repetitions of syllables or consonants such as pa-pa-pa-pane or ppppp-pappa, often accompanied by a blockage in the flow of air, which some confuse with a possible breathing problem. Interiors as “um” “em”. Negativism: The child who stutters often presents a negative and repulsive attitude towards speaking. It is the result of repeated attempts to speak correctly and the frustration that comes from several failed attempts. Synkinesias and facial tics: childhood stuttering is often accompanied by facial expression mimics, or even convulsive body movements, called synkinesias. These, especially in tonic stuttering. Facial tension is the result of an extreme attempt by the child who stutters to find the energy and strength necessary to get the word out correctly. Circumlocutions: the stutterer tries to avoid his difficulty by replacing words that he perceives as difficult to pronounce with others that may be more facilitating. Physical Problems: Repeated attempts to speak fluently can cause several physical changes. The person may clench their jaw, hold their breath, and clench their fists. This, in turn, can cause muscle tension in the shoulders, limbs, and forehead. Childhood stuttering can represent a particular moment in the gradual acquisition of language which, as we know, usually occurs between 12 months and 3 years. In particular, the average age of onset of childhood stuttering is around 3 years of age. There is no need to worry if, at this stage, the child breaks up, repeats or prolongs the syllables that form words. For some authors, it may be a question of more or less typical disfluencies. In 4 out of 5 cases, childhood stuttering resolves spontaneously, at most within 5 years from the moment of its onset and, in 75% of cases, even within the first 3 years. This does not change the fact that the phenomenon must be followed carefully and kept under careful observation from its first manifestations. Statistically, childhood stuttering is observed more frequently in males, and hence the tendency for some researchers to glimpse a strong heredity of the disorder, which in some cases can regress but reappear in adolescence. Even if the child has been stuttering for a year, it does not mean that the problem will persist. The disorder can regress spontaneously even 3-4 years after its onset. However, a lot can be done to alleviate it, or overcome it. For this reason, it is necessary to avoid what Dr. Antonio Bitetti explains in his work on prevention, that is, to absolutely avoid the problem becoming chronic and becoming a persistent and structured form. THE CURE FOR CHILDHOOD STUTTERING THE INTEGRATED APPROACH TO CHILDHOOD STUTTERING Childhood stuttering, on the other hand, represents an unsuccessful phase of this evolution, from stuttering to healthy and effective language. Important relational aspects can affect this developmental block. To avoid this risk of chronicity and therefore of stuttering, it is necessary to intervene early. Usually childhood stuttering, that is, stuttering in a child of 3-4 years or stuttering in a child under 5 years old, is usually not treated, we tend to wait for it to become chronic, to be sure that the symptoms are certain, on a safe diagnosis. Usually we tend to think that it can regress spontaneously. Dr. Antonio Bitetti has a different opinion. He has introduced an interesting therapeutic path, suitable for parents of children with stuttering of 3-4 years. Not only that, but also in 5-year-old children who still stutter and who present aspects susceptible to becoming elements of chronicity of the symptoms and therefore, of true stuttering. Pediatricians are cautious and wait-and-see, speech therapists give up because they do not have the right tools to deal with the initial aspects of childhood stuttering. The Integrated Approach to the symptoms of stuttering children aged 3-4 and 5 years, unlike the therapeutic model aimed at older patients, is focused on correcting mainly the parents’ attitudes, and is specifically addressed to them, without the child’s presence, to avoid unfounded fears. This work is based on intuitions and cutting-edge research into the causes of childhood stuttering. The intra-family communication dynamic is addressed and all those difficulties that Dr. Antonio Bitetti believes to be fundamental in clarifying the entire dynamic in question are corrected, to allow the child to recover that basic serenity, necessary to speak well and move away as soon as possible from the risk of it becoming a real stuttering. This important research by Dr. Bitetti on childhood stuttering, supported by testimonies of parents of children undergoing treatment, will be the subject of disclosure in some American scientific journals in the sector and will be part of a broader and more detailed research in his new book, which will be published in the coming months, in which the mechanism of control over speech and other similar disorders will be addressed (Bitetti A. La Balbuzie Approccio Integrato, Milan, 2010). It is serious research that promotes knowledge and frees us from fears. On this, Dr. Antonio Bitetti has always
Stuttering Therapy
Stuttering therapy is an open field, where different interpretations of the same problem are compared and sometimes clash. In fact, even in the linguistic definition, many talk about stuttering and some persist in calling it stuttering. Some authors talk about a problem to be re-educated in language and others approach the problem from a strictly psychological point of view. Everyone unanimously agrees on a characteristic point of this disorder and that is: The stutterer knows very well what he wants to say, but is unable to express it in a fluid and serene way, as the vast majority of the population does. At this point, it is natural to ask why the stutterer has difficulty speaking when he relates to others, and instead does not stutter when he is alone. The answer cannot be simple and banal, since it involves those cognitive, emotional and relational aspects that language has in itself. We know that through language, human beings create connections, express emotions, ideas, projects and therefore, we all recognize the intrinsic value of this powerful tool. Language has a structural or genetic basis and an acquired basis, of a cultural or environmental type (Chomsky N.). In childhood, the child experiences an important phase in his delicate evolutionary period and is called the babbling phase, in which the child engages in the best possible research to converge structural aspects and cultural aspects. The same happens in walking, the child gradually learns to coordinate his movements, according to a series of trials and errors, also on the basis of a process of strengthening his own musculoskeletal system. Once he acquires the entire sequence, the child will be able to walk alone and without the help of adults. Language follows the same logic, but unlike motor activity, language has an important relational value, since through it we are able to express emotions, sometimes, in some negative or traumatic experiences, even with a strong aggressive value. This has pushed Dr. Bitetti to delve into the real reasons behind this widespread disorder, which, let us remember, affects 2-3% of the national population. In a recent interview he gave to a Spanish television station, the journalist recalled that in Spain there are at least 800,000 people affected by stuttering. In Italy, with a larger population than the Spanish one, we are in the order of a million people. Although, and it is appropriate to clarify, many statistics should be further investigated, since many forms of stuttering can be simple manifestations of lisping, mistaken for stuttering. Dr. Bitetti’s research Bitetti in the field of stuttering treatment, who is also the author of three books on stuttering (Bitetti A., 2001, 2006, 2010) the last one also translated into English and German, have focused on the mechanism of emotional control and in the case of those who suffer from stuttering, it becomes a control of the peripheral part of language, that is, the word. The vast majority of the population does not control the word while speaking, they know that it will be an automatic process, just as it happens in walking. No one would dream of controlling and verifying the movements of the legs during a walk or during a run, if we did, we would risk blocking ourselves or strongly conditioning the spontaneous activity. Therefore, control is the real negative element of those who stutter (A. Bitetti, Emotions, Behavior and Control, 2016) and it is an aspect learned as a child, in conjunction with events with a strong negative valence, such as the birth of a sibling, conflict between parents or different experiences in which frustration and consequent aggression predominate. If left free to consolidate, in the long run, the control mechanism can create a chronic disorder, commonly called stuttering. Treatment of stuttering in very young children. Dr. Bitetti has explained in various institutional contexts, such as the important congress of Phoniatrics and Speech Therapy, held in Bari in 1999, that stuttering represents an adaptive symptom at an age in which the child could not adequately manage an emotional turmoil that would have had greater repercussions in his psychic sphere. Only that not having received suitable therapy, the child (we are talking about children aged 2-5 years), remained imprisoned and made the whole dynamic in question become chronic. If kept active, this disorder risks compromising the normal relational and emotional growth of the child, to the point of making him acquire as an adult, what Dr. Bitetti defines: “the stutterer’s habit”. Stuttering, or rather stammering, in the initial stages is an adaptive mechanism that should be abandoned in a short time. evi, this is why it is necessary to intervene early, especially before the adolescent period, even better before it becomes definitively chronic. This is why Dr. Antonio Bitetti has extended his model of care intervention also in a preventive manner, in those children under 4-5 years of age, who have maintained active stuttering, but cannot be defined as stuttering children. This extension of his Integrated Approach is an achievement and an absolute novelty in the national panorama and is aimed at parents who would like to intervene quickly, but do not receive adequate responses from any area in Italy.
Psychological meaning of stuttering
In my research on the deep meaning of stuttering, I am going to give a further contribution to the understanding of this disorder, especially in terms of analysis of the phenomenon of stuttering in a linguistic and relational sense. After an interesting journey of analysis of the problem and after having treated thousands of stuttering children and adults, I am about to take a further step forward in explaining what, in my opinion, could be the psychological meaning of the problem. My experience of group analysis to treat my stuttering and to train as a psychotherapist has been enlightening in giving me those ideas for reflection to better understand stuttering. Above all, its psychological and evolutionary meaning, within the mechanisms of language acquisition in children first and then in adults. Furthermore, the relational use that is made of the word in the processes of social integration within the social group. Joseph Sheehan compared stuttering to an iceberg, with the obvious aspects of stuttering positioned above the water level and the larger mass of negative emotions not visible, placed below the water level. This definition is similar to what I describe in the concept of the two areas within the personality of each of us, in which the negative component of the stutterer has a clear predominance over the positive one. Only the topical aspect of the dynamism in question changes. While Sheehan thinks of a concept more oriented to a level study, I go in the direction of the comparison between areas of the personality, with the substantial prevalence of one area over the other. THE MEANING OF THE SYMPTOM STUTTERING Now, beyond Sheehan’s concept of a great importance of the submerged part that forcefully affects the emerged one, I want to better explore the meaning of the symptom of stuttering. It is almost certain that the ancients, hearing a stutterer speak, thought of a person who spoke a language different from theirs. This is why the term stutterer derives etymologically from Balbus. This term refers to the concept of “barbarian” that in ancient times was used to define someone who spoke a language different from the reference group. In fact, the stutterer through his disarticulated language pushes us to believe that this is true. But, it is always necessary to point out, the stutterer when he is alone returns to being a person with shared language. At this point, the crucial question obviously arises as to why the stutterer uses this disarticulation during the comparison with others and returns to normality, in the calm condition of when he is alone. In my long research on stuttering, I see a defensive reasoning that the stutterer uses in his relational dynamics. A disjointed language learned in childhood to confuse and be confused by a situation that the child has experienced as unsustainable, where negative emotions, especially anger, have certainly prevailed. A strange language to divert attention from an experience that is not easily manageable and with uncertain outcomes. By choosing to stutter, he has chosen a more practical solution. Then, the symptom has generated reassurance in the short term and habit in the long term, until it has become what I call “the stutterer’s habit”. (Bitetti A., Stuttering Integrated Approach, IEB Editore, Milan, 2010) The need for a psychological therapeutic intervention model is of primary importance in this type of problem, precisely because of the relational value inherent in this type of disorder, both in childhood stuttering and in adult stuttering. This is to allow the positive part of the stutterer’s personality to recover and assert itself as a necessary factor to adequately stand up to comparison with others.
Research on stuttering in teenagers
Many parents of children who stutter sometimes do not know that their child, when he elaborates arguments on his own, in his own room and therefore not subjected to the judgment of other people, speaks very well. If the stutterer is able to speak without any difficulty when he is alone, it means that all his phonatory and neurological structures are intact, from all points of view. It is difficult to imagine a person who speaks without a hitch when he is alone and instead stutters when he meets other people. At this point, it seems more logical to say that the real problem of those who stutter is the relationship, that is, the fear of calmly accepting dialogue with others, especially if they are strangers, or considered authoritative people, or superior to him. At school, the stuttering child feels a lot of discomfort, feels a lot of anxiety during questioning, or when reading aloud, precisely because he feels conditioned by the performance and stutters. He does not feel he has the right characteristics to calmly face these experiences that for other children, are usually accepted without any difficulty. So it is interesting to ask: “what drives the stutterer to have difficulties when relating to others?”. Doctor Antonio Bitetti has answered this question on many occasions, not only in the various symposiums and scientific conferences in which he has participated as a speaker and international expert, but also through his popular and therapeutic work, with his interpretative model, called: “Integrated Approach”. In his long research work on stuttering, thanks to his personal experience of complete and profound healing from the problem, strong in a solid psychotherapeutic preparation based on a group-analytic path, Dr. Antonio Bitetti has laid the foundations for a cutting-edge interpretative and methodological model, which he has spread throughout the entire national territory and which for many years has also crossed the borders of our country. ( A. Bitetti, 2001,2006,2010,2016). The normal speaking person, the person who does not stutter, does not control the word, takes it for granted that his phonatory apparatus will carry out the articulatory indications to the letter, trusting in a capacity learned over time and kept active in an appropriate manner. It is like when we walk, we do not control our legs in the motor act of the synergic movement, right leg, left leg. The stutterer, on the other hand, unlike the normal speaking person, precisely because he constantly lives in doubt about his verbal abilities, constantly questions his naturalness and controls, stuttering. Control is the true technical element of those who stutter, in fact the research of Dr. Bitetti goes in this direction ( A. Bitetti, 2016). The control of phonation is a learned model and must be overcome at an early age, if one does not want to remain imprisoned in an erroneous concept of control of performance. This, over time, can create a wrong idea of oneself, flowing into a blocked mental state, with constant negative feedback, which creates a vicious circle. The mother of the whole issue is: “thinking badly of oneself” Not because the stutterer does not possess qualities, but because he is used to excessively controlling his resources. It goes against the real needs of daily life. This censorship, for subjects predisposed to stuttering, hinders the possibility of expansion, thus inhibiting freedom of relationship. The stutterer has a strong fear of the judgment of others, but which is ultimately the negative judgment that he expresses towards himself and this, only in the moment of interpersonal relationships. This is why the stutterer when he is alone feels good, is serene, precisely because he does not put himself at risk and therefore, speaks well. Vice versa, speaking with others generates a strong fear of a possible negative judgment from others, but which ultimately is nothing more than his own negative judgment directed at himself. This becomes the most characteristic and deep-rooted anxiety-provoking element, which deeply marks the irrational thought pattern of those who stutter. (A. Bitetti, La Balbuzie Approccio Integrato, IEB Editore, 2010).
Personality of the stutterer
Author: Dr. Antonio Bitetti, psychologist-psychotherapist. Founder of the European Institute for Stuttering. Taken from: Report on: “Stuttering Integrated Approach”, published in 1997, in “PSYCHE nuova”, review of humanistic-existential psychotherapy, autogenic psychotherapy and brief psychotherapies. Official organ of the C.I.S.S.P.A.T of Padua- Italy. Tags: stuttering, personality, research, insights, Bitetti, integrated approach, stutterer. The stutterer constantly experiences the problem of saying, not saying, there is not that spontaneity typical of the normally speaking person. Analyzing the problem from a phonetic point of view, we realize that he finds it difficult especially in the emission of consonants, and is greatly facilitated by vowels. He finds it difficult when he has to verbalize thoughts with a high emotional content, or that he has considered as such, this suggests the presence of complex psychological mechanisms, which have fueled the scientific literature on the etiopathogenesis of this disorder. In general case studies, it is found that almost all stutterers stutter in the presence of strangers, or those considered authoritative, emblematic, the example of the child who fears questioning by the teacher. On a relational level, the stutterer feels a prisoner of his disorder and experiences social relationships with difficulty and suffering. For example, he fears verbal exposure in any group relationship, feels discomfort and embarrassment if he is asked to repeat a topic already exposed and his difficult moment is experienced on the phone, which becomes a painful experience and even a real block. This does not mean that all stutterers have social limitations, it depends on the severity and importance that the stutterer gives to his disorder. In fact, a fundamental element is given by the negative perception of oneself and the negative judgment by others, which can increase the level of anxiety, and thus affect normal social relationships. This brief exposition of the difficulties that the adult stutterer experiences, leads us to reflect on the psychic dynamism underlying the disorder. In my vast clinical case history, with more than four thousand cases treated in 25 years of professional activity in Italy, I would like to highlight important contributions of analysis and comparison on this problem. Usually, as a child, the adult stutterer has already undergone cycles of speech therapy and courses on stuttering based mainly on phonation or similar techniques, accompanied by breathing exercises and so on. However, few have addressed the underlying aspects of stuttering and find themselves in adulthood with an unchanged or slightly improved situation, at least in terms of language. Starting from psychoanalytic concepts, stuttering is seen as a symptom of a neurosis with fixation to the sadistic-anal phase. According to Fenichel O., there are traits of strong aggressive valence. The word is life, while mutism is symbolically death and therefore, the alternating speaking, typical of stuttering, can represent the fear of saying things with an aggressive meaning. Behind the zeal of wanting to speak well and to show one’s value is hidden a hostile and sadistic tendency. Stuttering can be seen as a block, and a punishment of this. It is also possible to hypothesize a transfer to the oral level of complex sadistic-anal dynamics. There is a basic ambivalence: on the one hand a wanting to say that can mean action, dynamism and therefore growth. On the other; block, hesitation, which can make one think of the fear of exposing oneself and therefore, passivity. In this, we can glimpse the restorative and creative aspects of the stutterer’s psyche. For a long time, this problem was even joked about, and in very distant times, there was a tendency to associate speech difficulty with intellectual disability. The fluency of language is hindered, but not intelligence and the ability to complete one’s own plans. On a cognitive level, however, the stutterer is constantly influenced by a type of thought, where the fundamental element is the control of the word. The fear of stuttering leads to constant attention on how to say it, on the control in terms of predicting the judgment of others, and finally, on the most realistic and logical one, which is what one wants to say. With such a sequence of thoughts, excessive to say the least, it is easy to fall into a state of anxiety, compromising the speech itself. The normal speaking person does not control the word, it is fluid, he is more attentive to what he says, than to how. This psychic dynamism is certainly affected by counterproductive educational aspects. It is essential to underline in this regard that the obstinacy to correct the disorder, with reprimands from parents or teachers in children or stuttering boys is highly detrimental, and exacerbates the already high level of anxiety.
Modes of onset of stuttering
The symptoms, as well as the moment in which stuttering appears, vary from one subject to another. The survey carried out on some families does not always provide very precise information in this regard. Some parents do not realize the moment of onset of stuttering in children, unless it appeared suddenly, or in conjunction with a triggering event. When it is a tonic stuttering with more or less marked blocks, associated with uncoordinated movements of the organs used for speech, they believe they are faced with difficulties in breathing and articulation. STUTTERING BETWEEN 3 AND 4 YEARS In most cases, stuttering is a disorder that appears in early childhood, between the ages of 3 and 4, not at the same time as the first words appear, but rather at the time of the development of the first sentences, that is, at the time when language is organized and when the first contacts with the outside world take place, with other children both inside and outside the family environment: during games, or at nursery school, for example. At this age, some authors speak of primary stuttering, others of physiological stuttering (Weiss), or of development (Métreaux). Borel-Maisonny thinks that it is a phase of predictable physiological stuttering, since the child must learn to organize his language in a very short time. But most children of that age (about 50%), according to Johnson, can frequently be found with repetitions of syllables, verbal hesitations that regress from the moment in which the means of expression become efficient. STUTTERING BETWEEN 5 AND 6 YEARS For other children, the onset of stuttering occurs around the age of 5 or 6, coinciding with the start of elementary school. This can be explained by the emergence of new expressive needs related to the transition from the family environment, where “toddler” language is tolerated, to the school environment. The rules and obligations dictated by teachers force the child to pay attention to the choice of words and the construction of sentences that require a more rigorous and more constructive discipline that the child suffers more if he or she has a language delay. Depending on his or her mental formation, the subject may find his or her own way of adapting to this state or not. But if the parents are perfectionists, constantly scold him or her, unfairly scold him or her when difficulties arise, then the child may react either with aggressive attitudes or with mutism. STUTTERING BETWEEN AGE 10 AND 12 Finally, stuttering can appear much later, between the ages of 10 and 12. This is the time when the subject becomes more aware of his difficulties, which, due to the problems that arise in this difficult period, can intensify and inhibit the child. Sometimes, there are traumatic events that can trigger stuttering, particularly traumatic and painful circumstances: bombing in war events, illnesses, parental divorce, difficulties in the workplace, disturbances in emotional relationships, memories full of great emotion (Dinville C.).