BODY WATCH : Voicing Confidence : Therapists Have Made Strides in Treating Stuttering With the Help of Technology and Changing How Patients Feel About Speaking

Only a few months ago, Derrick Lane would fill with anxiety every time his telephone rang. He is a stutterer. The 14-year-old was embarrassed when he would stumble over his “Hello.” Instead, he recalled, he often simply let the phone ring.

The phone “always rings unexpectedly, and so I would get nervous right before I answered it,” Derrick explained. “I would stutter when I did answer it, because I didn’t know who was calling. I felt uncomfortable and didn’t like it.”

For the 2.5 million Americans who stutter, everyday activities such as ordering a pizza, chatting at the office water cooler or asking directions can be formidable. For them, such simple communication requires overcoming both obvious symptoms and subtle pains.

“I would stutter when I had to read stuff in class and talk to adults,” said Derrick, who lives in Washington, D.C. “I started to get down on myself because I wished I didn’t stutter. That’s when my mother and I decided to find some help with my problem. . . . I don’t want to be stuttering all my life.”

Stuttering, once thought to be a physical problem with the mouth or tongue, is now believed to be rooted in neurological problems. The exact cause is still not understood, but therapists have made strides in treating stuttering with new techniques. And the therapies have been enhanced--especially for children--with computer technology.

Speech pathologists today place just as much emphasis on changing how stutterers feel about speaking as they do on changing the mechanics of their speech. Two methods of treatment--stuttering modification and fluency shaping--dominate the field.

Stuttering modification is counseling designed to lessen the fear and anxiety stutterers have. Stutterers learn to reduce the tension that causes them to become completely blocked in speech.

When people gain confidence in their communication skills and don’t fight to stop their stuttering, the frequency of stuttering often drops dramatically, say officials at the American Speech Language Hearing Assn.

“We take the kind of stuttering they are doing and make them do it better,” said Walt Manning, a speech pathologist and researcher at the University of Memphis and a former stutterer. “We adjust their feelings about speaking and help them to realize they can get through a stutter successfully.”

Because normal speakers do stutter occasionally, recipients of this “stutter-easy” therapy can learn to speak without noticeable hesitations.

“I consider myself a reformed stutterer although I still stutter,” said Peter Kupferman of Reston, Va., who underwent the therapy. The 49-year-old astronomer said that by age 25 he had tried “all sorts of therapy” that didn’t work before a therapist encouraged him to speak in public--intentionally displaying his stuttering--and stop hiding his problem.

Gradually he was able to get over what he calls “every stutterer’s greatest fear”: being exposed as a stutterer.

Fluency shaping, which is used more with children than adults, is essentially physical therapy for the speech-production system. Stutterers are taught devices they can use--speaking more slowly and softly, linking words, using light articulation and enunciating all syllables--that may eventually prevent the problem. Ideally, children are able to use these devices until they become second nature.

Computer systems have been used with fluency shaping. They provide therapists with on-screen biofeedback regarding patients’ respiratory curves and speech patterns.

Such programs are very popular with children because they are made into video games that they can win by reaching desirable speech targets. Mastery of the video game requires patients to monitor the biofeedback while they manipulate breathing and speech to the point of fluency. Eventually, they become accustomed to what they must do to speak fluently, and the computer crutch is no longer needed.

Researchers at the National Institutes of Health say these methods have not been subjected to the kind of well-controlled studies that would determine whether the treatments are truly effective. Clinical trials require a control group that does not receive such help, and there is an unwillingness on the part of researchers and parents to prevent any children from receiving therapy.