Stuttering

	Topic Overview
	Symptoms
	Exams and Tests
	Treatment Overview
	Home Treatment
	Other Places To Get Help
	Related Information
	References
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What is stuttering?

Stuttering is a speech problem in which people may repeat, draw out, not complete, or skip words or sounds without meaning to. The problem can range from mild to serious.

Stuttering is normal in young children around ages 2 through 7 years. Stuttering that starts during a child's early language-learning years and goes away on its own sometime before puberty is called normal disfluency. It is a normal part of language development.

Stuttering that lasts or gets worse over time is called developmental stuttering. It can be embarrassing and hard to deal with. This type of stuttering probably won't get better without treatment.

What causes stuttering?

Stuttering happens when the brain is not able to send and receive messages in the normal way. Doctors don't know why this happens.

Stuttering may run in the family. It may be triggered by things like stress or a developmental delay, especially if stuttering runs in the family.

In rare cases, stuttering may be caused by brain damage, such as after a head injury or stroke.

What are the symptoms?

People who stutter may:

• Repeat sounds, parts of words, and sometimes entire words.
• Pause between words or within a word.
• Choose simple words instead of those that are harder to speak.
• Show tension or discomfort while talking.
• Use only parts of phrases.
• Add "uh" or "um" in the middle of a sentence.
• Add words or phrases that are not related.

Stuttering often gets worse at stressful times, such as during public speaking. It often does not occur during other activities, such as singing, whispering, talking while alone or to pets, or reading aloud with a group.

How is stuttering diagnosed?

A speech-language pathologist can usually diagnose stuttering by having the child read aloud. The pathologist may videotape or record the child talking or may check speech patterns in other ways.

Doctors may do a physical exam to rule out other health problems, such as hearing problems, which can affect speech development.

If you are an adult who has started to stutter, see your doctor. Stuttering that starts in an adult is most often linked to an injury, a health problem, or severe emotional trauma. To diagnose the problem, the doctor will do a physical exam, ask you some questions, and watch and listen to you speak.

How is it treated?

When it begins in early childhood, stuttering tends to go away on its own. Even if the speech problem is not expected to last long, treatment can help. Treatment often includes speech therapy for the child and counseling for the parents.

Parent counseling teaches parents and other caregivers about how speech develops. You learn how to relate to your child in a positive way. It also shows you how to help your child at home by using proper eye contact and body language when your child is trying to talk to you.

Speech therapy for your child is also important, especially if stuttering lasts, gets worse, or is severe. The exact methods vary. But most often a child will learn to use speech techniques in different settings or directly with the therapist. The goal is for your child to master certain speech and language skills and feel better about his or her ability to speak.

People who stutter may also get counseling. This is most common in adults. Counseling can help you manage other problems you may have, such as anxiety or low self-esteem, that can make stuttering worse.

When stuttering is caused by brain damage, such as after a head injury, the person may need a group of treatments. These often include speech therapy, physical rehabilitation, medicines, and treatments for the brain damage itself.

Frequently Asked Questions

Stuttering involves irregular and interrupted speech patterns. Characteristics of typical speech patterns include:^{1, 2}

• Repetitions of sounds, syllables, or short words. These may occur as:
  • False starts: "c-c-cold."
  • One-syllable words: "I-I hear you."
  • Entire words that have more than one syllable: "Giraffes-giraffes are tall!"
  • Phrases: "I want-I want to go too."
• Pauses:
  • With word interruptions (interjections): "How do I—um—get up there?"
  • Within a word (broken words): "I am hun ... [pause] ... gry."
  • With lips together or mouth open but no words are produced.
• Word substitutions (circumlocution) to avoid trying to say difficult words.
• Complete changes of words or thoughts: "I found my—Do you want to eat?"
• Drawn-out words (prolongations), usually at the beginning of sentences: "M-m-m-m-m-mommy, you have ice cream."

You may notice that your child stutters more when excited, anxious, overwhelmed, or tired. For example, talking to someone who does not appear interested or asking or answering questions may trigger or increase stuttering. In addition, stuttering often gets worse when a child tries to explain something complex.

Stuttering may also occur with repetitive gestures or unusual mannerisms, such as exaggerated blinking or tension around the mouth. This is more likely to occur when stuttering is severe or getting worse. These symptoms often indicate that the speaker is aware of and embarrassed by his or her stuttering.

Types of stuttering

Stuttering can be categorized into three main types according to when it begins, its typical pattern, and whether it resolves on its own.

• Normal disfluency is stuttering that occurs during early childhood, when speech is rapidly developing, but resolves without treatment before puberty. This type of stuttering may appear sporadically and gradually decrease until it no longer occurs. The irregular speech may be infrequent, and the child usually does not notice or is not bothered by it.
• Developmental stuttering generally requires treatment to improve. Speech problems most often first appear around age 5 during the critical stages of language development but can occur any time between about 2 and 7 years of age. Symptoms can range from mild to severe.
  • Mild developmental stuttering and normal disfluency can be difficult to tell apart. In general, mild stuttering causes more frequent symptoms. It may also recur after a temporary improvement or get worse. Children with mild developmental stuttering may feel frustrated and bothered by their speech problem.
  • Severe developmental stuttering affects almost every sentence of speech in all situations. Children usually become frustrated, upset, and embarrassed by their stuttering and often cover their mouths with their hands while attempting to speak. They also may develop mannerisms such as nodding the head or closing, blinking, or frequently moving the eyes in an exaggerated way. Severe stuttering most often affects older children, but it can occur in very young children as well.² Speech therapy and other forms of treatment are needed to improve severe stuttering.
• Acquired stuttering may result from an injury or condition that damages the brain, such as a stroke or Alzheimer's disease. Less often, stuttering begins after experiencing an emotional trauma. Typically, a person with acquired stuttering repeats or draws out sounds, syllables, or word patterns. The speaker maintains normal eye contact, does not seem anxious or bothered by his or her speech problems, and doesn't have unusual mannerisms, such as grimacing or eye-blinking.

Your health professional or a speech-language pathologist diagnoses stuttering by asking questions about your child's speech irregularities and assessing his or her risk factors for stuttering.

Diagnosing stuttering usually also includes:

• A history of your child's development. This includes identifying when developmental milestones were reached and if overall physical and thinking (cognitive) skills are normal for your child's age.
• Hearing tests. Hearing problems can affect how well a child pronounces words and uses language to communicate.
• Speech and language tests. These are useful in helping a speech-language pathologist identify and assess the severity of irregular speech patterns. A child's speech is evaluated while he or she reads a prepared sample or engages in conversation. A child may also be videotaped talking in different settings.

Your child's doctor is likely to do a physical exam to find out whether another condition is causing or occurring along with stuttering.

This process helps your doctor determine whether irregular speech is a type of normal disfluency, which usually resolves on its own, or a form of developmental stuttering, which requires treatment. In many cases, the child will be referred to a speech-language pathologist to fully assess the child's speech.

Speech problems that are not normal for your child's age may be diagnosed as developmental stuttering. General indications of developmental stuttering include:

• Having three or more speech-related problems (such as trouble starting words; repeating parts of words, sounds, or syllables; prolonging parts of a word; or visibly attempting to speak but producing no sound).
• Avoiding or escaping certain words or sounds. This may include pauses or interjections such as "uh" and "um."
• Appearing tense and uncomfortable when speaking. This may include grimacing, eye-blinking, head-nodding, and other nervous mannerisms.

Stuttering in adulthood

If you begin to stutter for the first time as an adult, visit your health professional. Be ready to answer questions about your general health and whether you have recently been injured. Your health professional will try to determine whether brain injury is present, such as from an accident or a stroke. If there is a possible relationship, you will be referred to a neurologist.

You may also be referred to a psychiatrist if recent emotional trauma or other mental health problems may be affecting your speech.

Stuttering that develops between ages 2 and 7 years is not uncommon and usually resolves on its own. Regardless of whether stuttering is expected to be a temporary condition, treatment can be helpful. Success is more likely to occur if a child gets help during the preschool years.²

Treatment usually includes parent counseling and speech therapy. Specific treatment varies depending on when and whether a child's stuttering is specifically diagnosed as:

• Normal disfluency, which likely will resolve on its own.
• Developmental stuttering, which most often first appears around age 5 and generally requires treatment to improve.
• Acquired stuttering, which develops as the result of brain injury (usually from an accidental injury or a disease that affects the brain, such as Alzheimer's) or, less often, from severe emotional trauma.

Counseling

Parents of children with suspected normal disfluency may benefit from counseling. This therapy strives to educate parents about speech development and how to respond to their child's stuttering in positive ways. Appropriate responses to your child's stuttering can help the child avoid social and emotional problems that can develop. Being supportive of your child also helps prevent stuttering from becoming a more permanent condition.

Speech therapy

Speech therapy for stuttering has a number of different approaches depending on factors such as the person's age, whether stuttering is likely to resolve on its own, and the severity of the problem. Usually, a speech-language pathologist also combines and expands on elements of parent counseling techniques.

The two basic speech therapy methods used for treating stuttering are called indirect treatment and direct treatment.

• Indirect treatment focuses on creating a comfortable and relaxing environment in which the child's speech can improve naturally. A speech-language pathologist evaluates and monitors progress while observing the child and parents.
• Direct treatment is one-on-one personal interaction between a speech-language pathologist and a child who stutters. The speech-language pathologist teaches the child how to form words, speak slowly, and relax even while stuttering. The child can also practice these exercises outside of instruction time. The child also learns ways to eliminate the physical symptoms of stuttering, such as eye-blinking, and how to deal with the emotional difficulties that may result from speech problems.

Other treatments for stuttering are also sometimes used.

• Counseling is often recommended when stuttering is complicated by additional problems, such as anxiety. It is also sometimes used when speech therapy has failed. Counseling and speech therapy are often used together for teens and adults who have developmental stuttering. The longer stuttering is left untreated, the more difficult it is to manage because additional problems frequently develop, such as low self-esteem. Speech therapy alone is unlikely to resolve these problems. Treatment of teens and adults takes longer and is generally less successful than for children.
• Medicines are sometimes used as part of treatment for other conditions, such as depression or anxiety, that can make stuttering worse. Talk to your doctor if you have questions about when medicines may be appropriate.
• Specialized therapies are needed for acquired stuttering, which can happen as the result of brain injury (usually from an accidental injury or a disease that affects the brain, such as Alzheimer's) or, less often, from severe emotional trauma. After a thorough evaluation, a treatment program is specifically designed that often includes some combination of speech therapy, physical rehabilitation, and medicine.

To help a child who stutters:²

• Speak calmly and pause often. Use short, simple sentences.
• Establish a regular, uninterrupted quiet time to spend with your child each day. Let your child direct the activities, including conversation. Use slow, calm, and relaxed speech, and pause often. Showing that you enjoy this time together can help build your child's confidence.
• Be polite and courteous when your child speaks. Avoid criticizing, interrupting, or asking too many questions. Give your child the time and attention he or she needs to express thoughts and ideas.
• Use positive facial expressions and body language while listening to your child. When your child stutters, show that you are attentive and focused on the message rather than how he or she talks.
• Help all family members learn good communication skills. Make sure everyone makes an effort to listen attentively when talking with your child who stutters.
• Let your child know that you accept him or her no matter what. Support and unconditional love are the most important factors in helping a child overcome stuttering.

It is also helpful to keep a record of how your child's speech patterns improve or change. A speech-language pathologist can guide you on what to look for and how to keep track of your child's progress.

Make an appointment with your child's doctor or a speech-language pathologist if:

• You have any concerns about your child's speech.
• Stuttering lasts for more than 6 to 12 months.
• Stuttering runs in your family.

If you are an adult who starts stuttering for the first time, home treatment is not appropriate. See your health professional.

If you are an adult with ongoing or recurring stuttering, consult your health professional about resources to help improve your speech. Speech therapy will usually be advised; sometimes behavioral counseling may also be helpful.

Organizations

Related Information

• Growth and Development, Ages 2 to 5 Years
• Speech and Language Development

Citations

1. American Psychiatric Association (2000). Stuttering. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 67–69. Washington, DC: American Psychiatric Association.

2. Guitar B, Conture EG (2007). The Child Who Stutters: To the Pediatrician, revised 4th ed. (Publication No. 23). Memphis: Stuttering Foundation of America. Also available online: http://www.stutteringhelp.org/Portals/english/0023tped.pdf.

Other Works Consulted

• Paul R (2007). Disorders of communication. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 418–430. Philadelphia: Lippincott Williams and Wilkins.

• Prasse JE, Kikano GE (2008). Stuttering: An overview. American Family Physician, 77(9): 1271–1276.

• Sadock BJ, Sadock VA (2007). Stuttering section of Communication disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1186–1190. Philadelphia: Lippincott Williams and Wilkins.