Stuttering

Overview

Stuttering — also called stammering or childhood-onset fluency disorder — is a speech disorder that involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say, but have difficulty saying it. For example, they may repeat or prolong a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they've reached a problematic word or sound.

Stuttering is common among young children as a normal part of learning to speak. 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 developmental stuttering.

Sometimes, however, stuttering is a chronic condition that persists into adulthood. This type of stuttering can have an impact on self-esteem and interactions with other people.

Children and adults who stutter may benefit from treatments such as speech therapy, using electronic devices to improve speech fluency or cognitive behavioral therapy.

Symptoms

Stuttering signs and symptoms may include:

• Difficulty starting a word, phrase or sentence
• Prolonging a word or sounds within a word
• Repetition of a sound, syllable or word
• Brief silence for certain syllables or words, or pauses within a word (broken word)
• Addition of extra words such as "um" if difficulty moving to the next word is anticipated
• Excess tension, tightness, or movement of the face or upper body to produce a word
• Anxiety about talking
• Limited ability to effectively communicate

The speech difficulties of stuttering may be accompanied by:

• Rapid eye blinks
• Tremors of the lips or jaw
• Facial tics
• Head jerks
• Clenching 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 particularly difficult for people who stutter.

However, most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak in unison 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. However, stuttering that persists may require treatment to improve speech fluency.

Call your doctor for a referral or contact a speech-language pathologist directly for an appointment if stuttering:

• Lasts more than six months
• Occurs with other speech or language problems
• Becomes more frequent or continues as the child grows older
• Occurs with muscle tightening or visibly struggling to speak
• Affects the ability to effectively communicate at school, at work or in social interactions
• Causes anxiety or emotional problems, such as fear or avoidance of situations where speaking is required
• Begins as an adult

Causes

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

• Abnormalities in speech motor control. Some evidence indicates that abnormalities 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 result from inherited (genetic) abnormalities.

Stuttering resulting from other causes

Speech fluency can be disrupted from causes other than developmental stuttering. A stroke, traumatic brain injury, or other brain disorders can cause speech that is slow or has pauses or repeated sounds (neurogenic stuttering).

Speech fluency can also be disrupted in the context of emotional distress. Speakers who do not stutter may experience dysfluency when they are nervous or feeling pressured. These situations may also cause speakers who stutter to be less fluent.

Speech difficulties that appear after an emotional trauma (psychogenic stuttering) are uncommon and not the same as developmental stuttering.

Risk factors

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

• Delayed childhood development. Children who have developmental delays or other speech problems may be more likely to stutter.
• Having relatives who stutter. Stuttering tends to run in families.
• Stress. Stress in the family, high parental expectations or other types of pressure can worsen existing stuttering.

Complications

Stuttering can lead to:

• Problems communicating with others
• Being anxious about speaking
• Not speaking or avoiding situations that require speaking
• Loss of social, school, or work participation and success
• Being bullied or teased
• Low self-esteem

Diagnosis

Diagnosis is made by a health professional trained to evaluate and treat children and adults with speech and language disorders (speech-language pathologist). The speech-language pathologist observes the adult or child speak in different types of situations.

If you're the parent

If you're the parent of a child who stutters, the doctor or speech-language pathologist may:

• Ask questions about your child's health history, including when he or she began stuttering and when stuttering is most frequent
• Ask questions about how stuttering affects your child's life, such as relationships with others and school performance
• Talk to your child, and may ask him or her to read aloud to watch for subtle differences in speech
• Differentiate between the repetition of syllables and mispronunciation of words that are normal in young children, and stuttering that's likely to be a long-term condition
• Rule out an underlying condition that can cause irregular speech, such as Tourette's syndrome

If you're an adult who stutters

If you're an adult who stutters, the doctor or speech-language pathologist may:

• Ask questions about your health history, including when you began stuttering and when stuttering is most frequent
• Rule out an underlying health condition that could cause stuttering
• Want to know what treatments you've tried in the past, which can help determine what type of treatment approach may be best
• Ask questions to better understand how stuttering affects you
• Want to know how stuttering has impacted your relationships, school performance, career and other areas of your life, and how much stress it causes

Treatment

After a comprehensive evaluation by a speech-language pathologist, a decision about the best treatment approach can be made. Several different approaches are available to treat children and adults who stutter. Because of varying individual issues and needs, a method — or combination of methods — that's helpful for one person may not be as effective for another.

Treatment may not eliminate all stuttering, but it can teach skills that help to:

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

A few examples of treatment approaches — in no particular order of effectiveness — 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 deliberately when beginning speech therapy, but over time, you can work up to a more natural speech pattern.
• Electronic devices. Several electronic devices are available to enhance fluency. Delayed auditory feedback requires you to slow your speech or the speech will sound distorted through the machine. Another method mimics your speech so that it sounds as if you're talking in unison with someone else. Some small electronic devices are worn during daily activities. Ask a speech-language pathologist for guidance on choosing a device.
• Cognitive behavioral therapy. This type of psychotherapy can help you learn to identify and change ways of thinking that might make stuttering worse. It can also help you resolve stress, anxiety or self-esteem problems related to stuttering.
• Parent-child interaction. Parental involvement in practicing techniques at home is a key part of helping a child cope with stuttering, especially with some methods. Follow the guidance of the speech-language pathologist to determine the best approach for your child.

Medication

Although some medications have been tried for stuttering, no drugs have been proved yet to help the problem.

Coping and support

If you're the parent of a child who stutters, these tips may help:

• Listen attentively to your child. Maintain natural eye contact when he or she speaks.
• Wait for your child to say the word he or she is trying to say. Don't jump in to complete the sentence or thought.
• Set aside time when you can talk to your child without distractions. Mealtimes can provide a good opportunity for conversation.
• Speak slowly, in an unhurried way. If you speak in this way, your child will often do the same, which may help decrease stuttering.
• Take turns talking. Encourage everyone in your family to be a good listener and to take turns talking.
• Strive for calm. Do your best to create a relaxed, calm atmosphere at home in which your child feels comfortable speaking freely.
• Don't focus on your child's stuttering. Try not to draw attention to the stuttering during daily interactions. Don't expose your child to situations that create a sense of urgency, pressure, or a need to rush or that require your child to speak in front of others.
• Offer praise rather than criticism. It's better to praise your child for speaking clearly than to draw attention to stuttering. If you do correct your child's speech, do so in a gentle, positive way.
• Accept your child just as he or she is. Don't react negatively or criticize or punish your child for stuttering. This can add to feelings of insecurity and self-consciousness. Support and encouragement can make a big difference.

Connecting with other people

It can be helpful for children, parents and adults who stutter to connect with other people who stutter or who have children who stutter. Several organizations offer support groups. Along with providing encouragement, support group members may offer advice and coping tips that you might not have considered.

For more information, visit the websites of organizations such as the National Stuttering Association or The Stuttering Foundation.

Preparing for your appointment

You'll probably first discuss stuttering with your child's pediatrician or your family doctor. The doctor may then refer you to a speech and language disorders specialist (speech-language pathologist).

If you're an adult who stutters, you may want to search for a program designed to treat adult stuttering.

Here's some information to help you get ready for your appointment and know what to expect from your doctor or speech-language pathologist.

What you can do

Before your appointment, make a list that includes:

• Examples of problematic words or sounds, such as words that start with certain consonants or vowels. It may help to make a recording of an episode of stuttering, if possible, to play at the appointment.
• When the stuttering started, such as when your child said his or her first word and started speaking in sentences. Also, try to recall when you first noticed your child stuttering and if anything makes it better or worse. If you're an adult who stutters, be prepared to discuss what treatments you've had, current problems and how stuttering has affected your life.
• Medical information, including other physical or mental health conditions.
• Any medications, vitamins, herbs or other supplements regularly taken, including the dosages.
• Questions you'd like to ask the doctor or speech-language pathologist.

Some basic questions to ask the doctor or speech-language pathologist may include:

• What's causing the stuttering?
• What kinds of tests are needed?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• Are there any alternatives to the primary approach that you're suggesting?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor or speech-language pathologist

Your doctor or speech-language pathologist is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. You may be asked questions such as:

• When did you first notice stuttering?
• Is stuttering always present, or does it come and go?
• Does anything seem to improve stuttering?
• Does anything appear to make it worse?
• Does anyone in your family have a history of stuttering?
• What effect has stuttering had on your life or your child's life, such as school or work performance or social interaction?