"THE King's Speech" about how George VI struggles to overcome his stutter draws attention to the problem afflicting 70 million people worldwide and more than 13 million in China. Zhang Qian reports.

Jack Zou is a stutterer. For years he stammered and suffered in school, in job interviews and in social situations. He gave up on finding a girlfriend, but he finally faced the problem and went to a special school. The condition gradually improved.

Zou, 26, remembers that after graduation he couldn't help stuttering in each job interview. He couldn't find work. People thought he had a bad case of nerves or that he was stupid and incapable. (Stuttering has no link to intelligence.)

The Zhejiang native remembers stuttering since age 8 when he imitated stutterers for fun. His parents repeatedly reprimanded him, but it had become a habit and nagging made him nervous. The stammer got worse.

Ridiculed and afraid to speak, he wrote a note before purchasing a train ticket in case he could not speak clearly.

The failure to find a job made him afraid of his future. He went to a language school for stutterers and practiced all the time. He spoke slowly, he spoke in public, he talked to strangers - it was all terrifying - but gradually he controlled his stutter.

"You cannot escape. Only by diligent and correct practice can stutterers overcome their problem both physically and psychologically," says Xiao Lou Ting Yu (his Internet name, which he prefers), president of China Stuttering Association (CSA) established 11 years ago (www.stutter.cn) and based in Yunnan Province.

Zou is one of more than 13 million stutters in China; there's no current data and that figure was an estimate 10 years ago. Experts say it must be considerably higher today. More males than females stutter. The Oscar-winning film "The King's Speech" has raised awareness of the problem and encouraged many stutterers.

It's not uncommon for young children between age 2 and 5 to stutter as they grapple with language and an estimated 80 percent outgrow it. Parents need to be patient and supportive, not critical. If it persists, speech therapy often helps. If it begins after a child is age 8-12, it's likely to persist into adulthood, though, as with Zou, it may be mitigated.

The precise causes in all cases are not known; some are genetic - it tends to run in families; some result from breathing and physical problems; some result from abnormal left-brain, right-brain activity. Contrary to popular opinion, experts say, it's seldom caused by great emotional trauma, though agitation can make it worse.

Quite a few stutters are fluent when they sing, read aloud or speak to themselves - that's because they don't have trouble assembling their thoughts, according to experts. Isolation, shame and low self-esteem are common problems.

Criticism, fear of failure, anxiety and low self-esteem all make people afraid of speaking and aggravate the problem, according to Xiao.

To help the stutters, CSA (there's a Shanghai association as well) holds regular activities involving practice, breathing and vocal exercises. Breathing in slowly and then speaking slowly while carefully breathing out can help.

Speaking with others is vital and members of the association tell stories and jokes at meetings to improve their speaking skills and build confidence.

Bob Yuan is an energetic 3-year-old, curious about everything, but when he tries to express himself he stammers and repeats syllables and first letters ("wa wa wa want" and "llllike" for example) in jerky speech.

"Listening to him makes me anxious and frustrated," says his mother. "I see how anxious he is to tell his story, but he just cannot deliver the message; he often gets stuck on the very first word."

Yuan's case is not unusual among children between 2-5 years old, according to Dr Zhang Yiwen, director of Developmental and Behavioral Pediatrics at Shanghai Children's Medical Center.

Stuttering affects about 5 percent of children in that age group, she says, but in most cases kids grow out of it in six months; it indicates a phase of inexperience with language.

At that age children want and are expected to compose their own sentences and not merely repeat, but language skills and development of everything it takes to speak (lungs, windpipe, tongue, mouth, lips) have not caught up with developing intelligence.

"Speaking is not as easy as we think," says Dr Zhang. "We have to get a thought in our mind first, compose sentences based on the thought and have the mouth and tongue coordinate to make speech. Adults do it fast because we are used to it, but you can't apply the same principle to kids, who have just started to learn."

Major cause

In these cases, the gap between demands and capacities is the major cause of stuttering. There's pressure to speak fast like adults, pressure from adults, nervousness and excitement.

Sometimes irregular breathing is a problem. Dr Zhang once treated one 7-year-old boy who tried to get everything out in one breath, and so he tripped up.

If stuttering is accompanied by flushing, difficulty in breathing, blinking eyes, stamping a foot, making a fist or other involuntary gestures, it may indicate a physical and chronic problem,

If stuttering persists after a child is 5 years old, parents should be concerned because it may become chronic, without proper intervention and speech therapy, says Dr Zhang. Later onset stuttering is likely to persist.

There are cases of life-long stuttering problems, as in the case of King George VI.

Genetic factors and brain activity disorder are likely factors in stuttering in adults. US researchers have found the occurrence of stuttering is higher among people with direct relatives who are stutterers, 20-74 percent, which is far higher than the rate in the general population, 1.3-1.4. This research was reported in 1996 by Ehud Yairi, Nicoline Ambrose and Nancy Cox.

Some adult stutterers also have insufficient activity in the language area in the left brain, while over-activity in the right brain.

Imitating stuttering at a young age is widely suspected as a cause, but there is no solid evidence to support the idea, according to Dr Zhang. Stuttering is made worse by stress and improper parental reactions, such as displeasure and constant correction, she says.

"Listening, even though the child is stuttering, usually plays a much more positive role than correcting at this stage," she says.

Parents should be patient and encourage them to speak slowly and to speak more. Slowing down often can eliminate the problem.

They should also focus on what the child says, not how they say it, and should respond with interest, encouraging them to say more.

Traditional Chinese medicine is seldom used but texts indicate that acupuncture may help relieve neural problems affecting the face, jaw and tongue.