I just finished an intensive fluency placement at University. We work in pairs with adult clients who stutter for nine hours a day for five days, teaching them the Smooth Speech technique. It was intense, and at a conservative estimate I think I provided over two thousand verbal corrections to my assigned client (who I’ll anonymize as X and use the gender neutral pronoun ‘they’). Several of the clients spoke multiple languages, and I thought it would be interesting to take a quick look on the state of the literature on bilingual stuttering and then present a quick anecdote regarding a complication of Smooth Speech therapy in multilingual clients.
- Do bilinguals stutter more? I think it’s safe to say no. An ELVS paper on stuttering (perhaps the best designed/controlled study of its type) found bilingualism or speaking a language other than English not to be a predictor of stuttering (n>1500) .
- Are bilinguals less likely to recover? This is more controversial. One study of 38 children found bilingualism to be an risk factor for persistence of stuttering . This seems suspect to me, if only because it should be easy to see if stuttering is more prevalent in adulthood in linguistically rich countries where many are bilingual (say, Switzerland) as opposed to reasonably resolutely monolingual countries (like Australia).
- Can monolingual clinicians treat bilingual clients? Here I will defer to my anecdotal experience in the next section of this post.
It’s difficult to say too much about client X without revealing confidential information. Suffice to say that they had stuttered from early childhood, and spoke five languages: three widely spoken Indo-Aryan languages, Arabic and English.
We began by taking a detailed language history. We asked X which languages they spoke, where they had learned them, when they used them today, whether they understood/spoke/read/wrote better in any, and if their stuttering was better in any of the languages. X reported that they spoke most fluently in English, but thought this was because they spoke English at home and work, and only used their other languages on the phone home. X stuttered in each language, and the loci of the stuttering appeared to be common (word initial glides, stops and fricatives). We did not take an initial rating in X’s other languages, as X believed delivering monologues in these languages was not representative of their usual verbal requirements.
I did a little research into the phonology of X’s languages (Wikipedia normally has great summaries). X’s primary language distinguishes four voicing types for each stop:
- tenuis, as /p/, which is like ⟨p⟩ in English spin
- voiced, as /b/, which is like ⟨b⟩ in English bin
- aspirated, as /pʰ/, which is like ⟨p⟩ in English pin, and
- murmured, as /bʱ/. [according to Wikipedia]
English distinguishes two, which are generalised to voiced and unvoiced, although English stop allophones encompass many more possibilities.
X’s stops in English were tense and explosive, and led to the characteristic ‘choppy’ sound of the speech stream associated with Indo-Aryan speakers who speak English. This presented a problem for the smooth speech treatment, which relies on gentle onsets – For my client, using the gentle onsets in Hindi would cause the stops to sound murmured, and would possibly change the meaning of the word. Much of the week involved softening and elongating X’s utterance-initial syllables, something they found quite difficult due to the bilingual interference. Tasks were completed in all of X’s languages, and luckily their were other clients who could converse with them in multiple languages (us clinicians felt fairly linguistically inadequate by comparison).
By the end of the week, X found a happy medium in their native language and English between not saying the right word and being ‘explosive’, and the end result was rewarding for them to see.
- Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O. C., . . . Wake, M. (2013). Natural history of stuttering to 4 years of age: a prospective community-based study. Pediatrics, 132(3), 460-467. doi: 10.1542/peds.2012-3067