By Hannah Blackwell, M.A., CF-SLP
Duncan Lake Speech Therapy, LLC
Have you ever seen a picture of an iceberg? It floats on the water as this giant chunk of ice. There’s no denying that what you see of an iceberg above the water is huge, but below the waterline looms an even larger mountain of ice that is the bottom of the iceberg. Once we look at both what’s above and below the water, we realize how small the part of the iceberg we can see above the water is and can appreciate the enormity of this mass of ice.
The image of an iceberg is often used to describe stuttering. The top of the iceberg is the small part of the disorder that others can observe about a person who stutters, or the “overt” characteristics of stuttering. The bottom of the iceberg is the largest part of the disorder, which encompasses what are called “covert” characteristics, the symptoms that an outside person cannot observe but the person who stutters experiences.
Stuttering is a neuro-developmental disorder, meaning it results from the atypical development of multiple parts of the brain including those involved in communication and motor movements. With stuttering, this difference in the brain’s development causes the person to be more susceptible to breakdowns in their speech. This is what others can perceive when a person’s stutters. The overt characteristics of stuttering include these audible stutters as well possible secondary behaviors which may accompany a person’s stutters such as certain facial or bodily motor movements.
The internal characteristics of stuttering, which only the person who stutters themself can experience and observe, are the “covert” characteristics of stuttering. In fact, one of the primary symptoms of stuttering is a covert characteristic: the sensation of being stuck while speaking and a loss of control over one’s speech. This is what a person who stutters may feel during a moment of stuttering and can result in a multitude of internal reactions to their own stuttering including avoidance behaviors, feelings of anxiety or embarrassment, and low self- esteem and self-confidence. These internal reactions can then impact other facets of their lives, adding on to the difficulties they experience.
As we can see, stuttering is much more than an individual can observe. In speech therapy not only do we address small, observable part of stuttering by teaching fluency enhancing strategies, but we also spend a large amount of our time helping the individual with the covert characteristics of stuttering they experience which others cannot observe. Speech language pathologists work to help people who stutter learn about their speech mechanism, muscle tension, and ultimately how to regain control during a moment of stuttering, in addition to assisting in whatever way we can to build confidence and self-acceptance. In doing this, speech- language pathologists can play a small role in allowing people who stutter to communicate more confidently and effectively despite the demands they encounter in everyday life.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
Smith, A., & Weber, C. (2016). Childhood Stuttering: Where Are We and Where Are We Going? Seminars in Speech and Language, 37(4), 291–297. https://doi.org/10.1055/s-0036-1587703
Tichenor, S. E., & Yaruss, J. S. (2019). Stuttering as Defined by Adults Who Stutter. Journal of Speech, Language, and Hearing Research: JSLHR, 62(12), 4356–4369. https://doi.org/10.1044/2019_JSLHR-19-00137