Jane Fraser, president of the Stuttering Foundation of America, remembers the agony of watching her father present awards at his company's annual Christmas party. "He would stand up and give awards to the people who had been with his company the longest. I can remember not being able to eat because I was so scared that he wouldn't be able to talk," she says. "It was agonizing watching my dad have to go through that. He would stand up and say, 'B-B-B-B-Bill Jones has been with the company for f-f-f-f-fifty years.' Maybe he was alright, but I was a wreck."

The shame and embarrassment felt by stutterers is not uncommon. In fact, it is often so overwhelming that stutterers purposely try to avoid difficult phrases or humiliating situations, in which their speech difficulties would be magnified. Fraser remembers how her father would often circumvent social interactions. "On family vacations to upstate New York, we'd stop overnight," she says. "Whenever we stopped, he would always ask me, 'Why don't you run in and see if they have a room available?' because he knew he couldn't talk."

Debunking the Myth

According to Fraser, part of the shame felt by stutterers like her father stems from the common misconception that stuttering is caused by a mental disorder. Traditionally, the cause of stuttering was thought to be solely psychogenic, a sign of one's unresolved psychological conflicts. The long held belief has devastated stutterers who internalized their suffering because they couldn't 'solve' their problem. "My dad thought he just wasn't working hard enough," Fraser says. "He thought that if he could just work a little harder, he could overcome his stuttering. I think this was always the misconception, that stuttering is just some mental disorder."

In contrast to previous beliefs, recent studies focusing on the speech-language areas of the brain are providing physiological proof that stuttering is more than a psychological issue. New research from Purdue University, Lafayette, Ind., shows that even when stutterers are not speaking, their brains process language differently. Ongoing research from a New Orleans neurologist suggests that neural wiring in the brains of stutterers may be faulty, and the director of a Canadian-based stuttering research center is busy studying the role of blood flow and other functional irregularities. Together, this growing body of research is helping stutterers around the world break free from the shame and embarrassment that has been associated with the speech disorder.

Anatomic Anomaly

"Traditionally, stuttering is thought of as a problem with how someone speaks, and little attention has been given to the complex interactions between neurological systems that underlie speaking," says Christine Weber-Fox, PhD, CCC-SLP, an assistant professor of speech science at Purdue. "We have found differences in adults who stutter, compared to those who don't, in how the brain processes information when people are thinking about language but not speaking. For example, there was a significant delay in response time when subjects were given a complex language task. We also found that in people who stutter, certain areas of the brain are more active when processing some language tasks."

Weber-Fox, a cognitive neuroscientist, teamed with Anne Smith, PhD, professor of speech science at Purdue who studies the neurophysiologic bases of speech production, to study language and speech production systems. A series of studies were conducted to measure semantic, grammatical and phonological aspects of language.

In each study, the brain activity of adults who stutter and don't stutter were measured when they responded silently, by pressing a button, to questions regarding sentence meaning, grammar or sentence structure, and rhyming. The study analyzed brain electrical activity in a series of language tasks in stutterers to determine whether their brains function differently even when there are no overt speaking demands.

The results revealed many complex interactions between the language and motor systems, which leads the researchers to believe that there is no single cause for stuttering."Stuttering is the result of a complex interaction among many factors, including genetic, language, motor and emotional. These findings will help reduce the stigma -- such as the myth that the disorder is the result of poor parenting or a psychological problem -- often associated with stuttering," says Smith.

A study conducted by Anne Foundas, MD, associate professor of neurology at Tulane University School of Medicine in New Orleans, suggests that the brains of stutterers might be anatomically irregular. Using volumetric MRI scans, Foundas measured the brains of 16 patients with persistent developmental stuttering (PDS), a type of stuttering that develops in critical speech-language acquisition stages of childhood and persists into adulthood.

The study compared PDS scans to 16 controls matched for age, sex, hand preference and education. Handedness and sex were taken into account because prior research has shown that non-right-handed men are more at risk to stutter. Focusing on the cortical speech-language regions of the brain, MRI scans were taken of the frontal areas (pars triangularis, pars opercularis) and temporo-parietal areas (planum temporale, posterior ascending ramus) in the left and right hemispheres.

In addition to measuring the size of their brains, the study also assessed the amount of gyral variants (small bumps) within these perisylvian cortical speech-language areas. The study found that the planum temporale was irregular in patients with PDS, compared to the control group. In the people who stuttered, the region was significantly larger in the left and the right hemispheres.

The study also found that the magnitude of the planar asymmetry in stutterers was reduced, meaning that not only were the focal regions larger in size, but they were also more equal in size when comparing left and right hemispheres.

"That is different than what we usually see," says Foundas. "Usually, we see that this region is much larger in the left hemisphere."

To Foundas, the irregularity makes sense because it appears in the same part of the lobe known as the auditory association cortex. "The anatomical irregularity suggests that something in auditory perceptional processing may be atypical," she says. This finding validates evidence of auditory deficiencies previously found in stutterers. Earlier studies suggest that stuttering partially results from an inability to listen to your own speech.

Speech therapists are applying this theory in a treatment that uses delayed auditory feedback, allowing stutterers to listen to their speech through headphones. Stutterers listen to a playback of their recorded voice, which is delayed 120 msecs. The treatment has temporarily improved speech fluency in people with PDS.

Solving the Mystery

Despite the increasing evidence of a brain-based cause, Foundas admits that the reason people stutter remains a mystery. "To be honest, there are still many different hypotheses," she says. "We only speculate about what could be the cause, and there are many different camps. But hopefully this approach will help us figure out specific types of treatment. By identifying different biological subgroups, we could be more effective in treatment because we could predict which individuals would respond to different types of treatment."

Putting the new information to use requires more research, says Foundas. Research needs to expand to include more subjects as well as multiple imaging methods. "This is just the beginning," she says. "There are two directions we are going in. We need to expand this to look at more people; we want to look at adults and children. And the other direction is to start looking at functional imaging in individuals who stutter and then try to relate that to their anatomies."

Despite the questions left unanswered, stutterers can find relief in the recent findings suggesting a brain-based cause. Finding out your brain is irregular may be distressing to some, but to stutterers the research is liberating. "The fact that there is physiological proof should be a big relief," says Fraser. "These new studies are really exciting because they alleviate the shame and embarrassment that stutterers feel."

Jeremy Kuhar is editor of TherapyTimes.com.