Stuttering -

Stuttering is a speech condition that disrupts the normal flow of speech. Fluency means having an easy and smooth flow and rhythm when speaking. With stuttering, the interruptions in flow happen often and cause problems for the speaker. Other names for stuttering are stammering and childhood-onset fluency disorder.

People who stutter know what they want to say, but they have a hard time saying it. For example, they may repeat or stretch out a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they’ve reached a word or sound that’s hard to get out.

Stuttering is common among young children as a usual part of learning to speak. Some young children may stutter when their speech and language abilities aren’t developed enough to keep up with what they want to say. Most children outgrow this type of stuttering, called developmental stuttering.

But sometimes stuttering is a long-term condition that remains into adulthood. This type of stuttering can affect self-esteem and communicating with other people.

Children and adults who stutter may be helped by treatments such as speech therapy, electronic devices to improve speech fluency or a form of mental health therapy called cognitive behavioral therapy.

Stuttering symptoms may include:

Having a hard time starting a word, phrase or sentence.
Stretching out a word or sounds within a word.
Repeating a sound, syllable or word.
Brief silence for certain syllables or words, or pausing before or within a word.
Adding extra words such as “um” if expecting to have problems moving to the next word.
A lot of tension, tightness or movement of the face or upper body when saying a word.
Anxiety about talking.
Not being able to communicate well with others.

These actions may happen when stuttering:

Rapid eye blinks.
Trembling of the lips or jaw.
Unusual face movements, sometimes called facial tics.
Head nodding.
Tightening of fists.

Stuttering may be worse when the person is excited, tired or under stress, or when feeling self-conscious, hurried or pressured. Situations such as speaking in front of a group or talking on the phone can be especially hard for people who stutter.

But most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak along with someone else.

When to see a doctor or speech-language pathologist

It’s common for children between the ages of 2 and 5 years to go through periods when they may stutter. For most children, this is part of learning to speak, and it gets better on its own. But stuttering that continues may need treatment to improve speech fluency.

Call your healthcare professional for a referral to a specialist in speech and language called a speech-language pathologist. Or you can contact the speech-language pathologist directly for an appointment. Ask for help if stuttering:

Lasts more than six months.
Happens along with other speech or language problems.
Happens more often or continues as the child grows older.
Includes muscle tightening or physically struggling when trying to speak.
Affects the ability to effectively communicate at school or work or in social situations.
Causes anxiety or emotional problems, such as fear of or not taking part in situations that require speaking.
Begins as an adult.

Researchers continue to study the underlying causes of developmental stuttering. A combination of factors may be involved.

Developmental stuttering

Stuttering that happens in children while they’re learning to speak is called developmental stuttering. Possible causes of developmental stuttering include:

Problems with speech motor control. Some evidence shows that problems in speech motor control, such as timing, sensory and motor coordination, may be involved.
Genetics. Stuttering tends to run in families. It appears that stuttering can happen from changes in genes passed down from parents to children.

Stuttering that happens from other causes

Speech fluency can be disrupted from causes other than developmental stuttering.

Neurogenic stuttering. A stroke, traumatic brain injury or other brain disorders can cause speech that is slow or has pauses or repeated sounds.
Emotional distress. Speech fluency can be disrupted during times of emotional distress. Speakers who usually do not stutter may experience problems with fluency when they are nervous or feel pressured. These situations also may cause speakers who stutter to have greater problems with fluency.
Psychogenic stuttering. Speech difficulties that appear after an emotional trauma are uncommon and not the same as developmental stuttering.

Males are much more likely to stutter than females are. Things that raise the risk of stuttering include:

Having a childhood developmental condition. Children who have developmental conditions, such as attention-deficit/hyperactivity disorder, autism or developmental delays, may be more likely to stutter. This is true for children with other speech problems too.
Having relatives who stutter. Stuttering tends to run in families.
Stress. Stress in the family and other types of stress or pressure can worsen existing stuttering.

Stuttering can lead to:

Problems communicating with others.
Not speaking or staying away from situations that require speaking.
Not taking part in social, school or work activities and opportunities for success.
Being bullied or teased.
Low self-esteem.

Stuttering is diagnosed by a healthcare professional trained to evaluate and treat children and adults who have a problem with speech and language. This professional is called a speech-language pathologist. The speech-language pathologist listens and talks with the adult or child in different types of situations.

If you’re the parent

If you’re the parent of a child who stutters, the primary healthcare professional or speech-language pathologist may:

Ask questions about your child’s health history, including when your child began stuttering and when stuttering happens most often.
Ask questions about how stuttering affects your child’s life, such as relationships with others and school performance.
Talk to your child. This may include asking your child to read aloud to watch for subtle differences in speech.
Look for clues that can tell if the stuttering is part of usual child development or something that’s likely to be a long-term condition.
Learn about your child’s communication skills more broadly. This may include testing how well your child understands what is said and how accurately your child produces speech sounds.

If you’re an adult who stutters

If you’re an adult who stutters, your primary healthcare professional or speech-language pathologist may:

Ask questions about your health history, including when you began stuttering and when stuttering happens most often.
Rule out an underlying health condition that could cause stuttering.
Want to know what treatments you’ve tried in the past. This can help decide what type of treatment may be best now.
Ask questions to better understand how stuttering affects you.
Want to know how stuttering affects your relationships, school performance, career and other areas of your life, and how much stress it causes you.

After an evaluation by a speech-language pathologist, you can work together to decide on the best treatment. Many different methods are available to treat children and adults who stutter. Because problems and needs vary, a method — or combination of methods — that’s helpful for one person may not work as well for another person.

Treatment may not get rid of all stuttering, but it can teach skills that help you or your child:

Improve speech fluency.
Develop effective communication.
Participate fully in school, work and social activities.

A few examples of treatment methods include:

Speech therapy. Speech therapy can teach you to slow down your speech and learn to notice when you stutter. You may speak very slowly and carefully when beginning speech therapy. Over time, you can work up to a more natural speech pattern.
Electronic devices. Many electronic devices are available to improve fluency. With one device, you’ll hear delayed feedback that requires you to slow your speech or the speech will sound distorted through the machine. Another device copies your speech so that it sounds as if you’re talking along with someone else. Some electronic devices are small enough to wear during daily activities. Ask a speech-language pathologist for guidance on choosing a device.
Cognitive behavioral therapy. This type of mental health therapy, also called psychotherapy, can help you learn to identify and change ways of thinking that might make stuttering worse. It also can help you get rid of or improve problems with stress, anxiety or self-esteem related to stuttering.
Parent-child interaction. Practicing techniques at home with your child is a key part of helping your child cope with stuttering, especially with some treatment methods. Follow the guidance of the speech-language pathologist to decide on the best method for your child.

Medicine

Although some medicines have been tried for stuttering, and studies continue, no medicines have been proved yet to help the condition.

References

Stuttering. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/stuttering/. Accessed Feb. 2, 2024.
Fluency disorders. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Accessed Feb. 2, 2024.
Childhood-onset fluency disorder (stuttering). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Feb. 2, 2024.
Stuttering. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/stuttering. Accessed Feb. 2, 2024.
Sander RW, et al. Stuttering: Understanding and treating a common disability. American Family Physician. 2019;100:556.
Laiho A, et al. Stuttering interventions for children, adolescents and adults: A systematic review as part of the clinical guidelines. Journal of Communication Disorders. 2022; doi:10.1016/j.jcomdis.2022.106242.
6 tips for speaking with someone who stutters. The Stuttering Foundation. https://www.stutteringhelp.org/6-tips-speaking-someone-who-stutters-0. Accessed Feb. 2, 2024.
7 tips for talking with your child. The Stuttering Foundation. https://www.stutteringhelp.org/7-tips-talking-your-child-0. Accessed Feb. 2, 2024.
Medical review (expert opinion). Mayo Clinic. Feb. 11, 2024.

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Stuttering

When to see a doctor or speech-language pathologist

Developmental stuttering

Stuttering that happens from other causes

If you’re the parent

If you’re an adult who stutters

Medicine

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