Stuttering

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What is stuttering?

Stuttering is a neurological communication disorder in which a person has difficulty forming a normal flow of speech. This often takes the form of repeating or prolonging various syllables, sounds or words when speaking.

People who stutter do not necessarily have a cognitive disability and most often know what words they want to say, but find it challenging to express them. For some, the stutter may only come out in certain situations or for only specific sounds. Others may have difficulty speaking at all.

Stuttering affects about 1% of American adults. The condition generally starts in early childhood, before school age; around 5% of children have episodes of stuttering at some point. Stuttering can come on gradually or suddenly. More males stutter than females.

Researchers have not confirmed what causes stuttering but believe there may be familial or environmental factors, as stuttering can run in families. It may also be associated with other issues, such as difficulties with sensory and motor coordination.

Once diagnosed, treatment for stuttering involves working with a speech-language pathologist to help improve speech fluency and to find alternatives when fluency is too difficult. While many children who stutter grow out of it, some people continue to have difficulty throughout their lifetime, making effective oral communication challenging.

What are the different types of stuttering?

Stuttering can develop for different reasons. The primary types of stuttering are:

  • Developmental stuttering. This is the most common type of stuttering. Developmental stuttering occurs when a child is learning how to speak, around ages 2 to 5, but has a slowed development of language skills.

  • Neurogenic stuttering. Neurogenic stuttering occurs when there is a disconnect between the brain and the nerves and muscles. Damage in the brain could result from a stroke or a brain injury.

  • Psychogenic stuttering. A rare type of stuttering, psychogenic stuttering occurs after someone has experienced an emotional trauma or has difficulties in thinking or reasoning.

What are the symptoms of stuttering?

Stuttering is often perceived simply as the repetition of a sound at the beginning of a word or sentence, but this is just one symptom of stuttering. In young children, some stuttering symptoms may be a normal part of speech development, as they learn how to form words. However, if symptoms continue after 3 to 6 months, they may indicate development stuttering.

Talk to your doctor if your child or someone else is showing these symptoms of stuttering.

Common symptoms of stuttering

The most common symptoms of stuttering are:

  • Prolonging the sound of a word or syllable

  • Repeating a sound or syllable

  • Changing words while speaking, self-correcting

  • Lengthy pauses between words or sounds

  • Inserting extra sounds for time, such as “um”

  • Tightened facial and neck muscles from the strain of getting out the right sounds

  • Anxiety about having to speak

In addition to speech symptoms, someone who stutters may also experience physical symptoms, including:

  • Clenching fists

  • Facial tics

  • Head nodding

  • Rapid blinking

  • Tremors in the lips or jaw

Symptoms may worsen in specific scenarios, including when a person is in a rush, feeling fatigued, or experiencing stress, such as if asked to speak in front of a crowd. In other situations, such as when alone or when singing, a person’s stuttering may go away.

What are the levels of stuttering?

Experts categorize stuttering through several factors, including the severity of symptoms, secondary behaviors, and emotions associated with the stuttering.

For children, doctors identify three primary levels of stuttering:

  • Normal disfluency. Children who have occasional episodes of stuttering may have normal disfluency. The stuttering can come and go, especially when a child is tired or overexcited. 

  • Mild stuttering. When stuttering occurs more often, but not all the time, this could be mild stuttering. Words and sounds may be repeated or prolonged, along with fluttering eyelids or muscle tension in the face. The child may show some embarrassment or frustration.

  • Severe stuttering. This level of stuttering is much more frequent and noticeable. There may be a change in the pitch of the child’s voice, as well as the use of extra words or fillers, like “um.” Unlike mild stuttering, the child is usually acutely aware of the stuttering and embarrassed by it. The stuttering is not limited to specific situations but can occur at any time.

Other levels of stuttering defined by some experts include:

  • Borderline stuttering. There are some repetitions but no secondary behaviors, like eyelid fluttering or muscle tension.

  • Beginning stuttering. Along with repetitions and prolonging sounds, the child experiences some change in voice pitch, tension in the face and neck, and difficulty initiating speech.

  • Intermediate stuttering. Along with the typical stuttering, the child avoids using certain words and situations, and feels fear and shame about stuttering.

  • Advanced stuttering. In addition to the stuttering, the child has tremors and feels angry or helpless. This level of stuttering most often affects older children or teenagers.

What causes stuttering?

Researchers do not know the direct cause of developmental stuttering, but they believe it may be rooted in a disconnect between the brain and the muscles and nerves used for speech. It may be a selective disconnect as people who stutter don’t often stutter when singing. In some cases, the cause may be familial, as stuttering can run in families.

People with neurogenic stuttering may develop it after a brain trauma or a stroke. Psychogenic stuttering could be triggered by mental illness or emotional trauma.

What are the risk factors for stuttering?

Although researchers are still researching the specific causes of stuttering, there are some risk factors that seem to increase the chances of stuttering. Not all people with risk factors will stutter. Risk factors for stuttering include:

  • Age. Children who begin stuttering before about 3 and a half years old tend to outgrow it.

  • Being male. More boys stutter than girls; girls tend to outgrow it more than boys, as well.

  • Developmental delays in childhood

  • Family members who stutter

  • Stress and anxiety

Reducing your risk of stuttering

You may be able to lower the risk of stuttering by identifying if your child is struggling with speech or falling behind in language development. If you have concerns, speak with your doctor, particularly if there is a family history of stuttering.

What are some conditions related to stuttering?

Stuttering can be a stand-alone condition or it can be related to or associated with other disorders, such as:

How do doctors diagnose stuttering?

Diagnosing stuttering requires a doctor or speech-language pathologist who will evaluate factors including symptoms and medical history.

To diagnose stuttering in a child, your doctor or a speech-language pathologist will ask several questions related to the language difficulties, including:

  • When did you first notice speech symptoms?

  • How frequent are these symptoms?

  • Is there a family history of stuttering?

  • Was there any delay in language development up to now?

  • Are there any other behaviors, like facial tics?

To diagnose stuttering in an adult, the questions may include the above, plus:

  • Has there been any head injury or other physical or mental condition that could have triggered stuttering?

  • What treatments or therapies have you tried?

  • How is stuttering affecting your life?

  • Is there anything that seems to ease or worsen the stuttering?

If your doctor believes stuttering was caused by a brain injury, you may be sent for tests, such as magnetic resonance imaging (MRI), to look for any blockages or injuries to brain tissue.

What are the treatments and therapies for stuttering?

Stuttering therapy may not eliminate stuttering altogether. Instead, treatment for stuttering focuses on improving speech ability, making it easier for the person to be understood by others, and reducing frustration and embarrassment for the person who stutters.

Treatments and therapies for stuttering include:

  • Speech therapy, in which a trained speech-language pathologist (SLP) teaches how to form sounds and words in a slow, deliberate manner. As someone becomes more comfortable with making the sounds, speech can be sped up accordingly. SLPs also work with parents of children who stutter, so the therapy can continue at home, between sessions.

  • Cognitive behavior therapy (CBT), or talk therapy, may help some people who stutter, particularly if it is triggered or worsened by stress or emotions. A psychologist or qualified therapist provides guidance through ways of thinking that may worsen stuttering, and teaches coping mechanisms.

  • Electronic devices similar to hearing aids may help ease stuttering.

  • Medications are not currently approved for treating stuttering but some antidepressants and anti-anxiety medications may help a small group of people who stutter.

How to support someone who stutters

While there is no specific home treatment or therapy for stuttering, a supportive home, school and work environment can help ease anxiety or stress related to stuttering. Those who live with or work with people who stutter can support them by:

  • Allowing time for speech

  • Avoiding supplying the words you think the person is trying to say

  • Not interrupting or suggesting the person start over

  • Not telling the person to slow down or take their time

  • Listening closely

  • Maintaining eye contact

If the person stuttering is a child, it is helpful if the adults speak clearly and slowly so the child may try to mimic the speech pattern.

How does stuttering affect quality of life?

Stuttering can have a significant impact on quality of life. For people with moderate to severe stutters, calling to order a pizza may result in the restaurant hanging up, or even calling 911 in an emergency can be difficult. Finding work that requires oral communication may be close to impossible. Social relationships are often a challenge.

If you stutter and are having difficulty with work, relationships or everyday tasks, working with a speech-language pathologist may help you find alternative ways to communicate effectively.

If stuttering is causing anxiety or depression, working with a psychologist or therapist may help you learn some ways to cope. Support groups, either in-person or online, can provide opportunities to share experiences and advice with others like you who stutter.

What are the potential complications of stuttering?

Unless it is caused by a brain injury or other trauma, stuttering itself does not present a direct health threat. However, the emotions and symptoms associated with stuttering can lead to other conditions that can worsen mental and physical health.

Stuttering that affects your ability to communicate can result in:

  • Anxiety or depression

  • Low self-esteem

  • Social isolation due to withdrawal from situations in which speaking is required

  • Worsening of mental or physical illnesses due to the inability to seek help or to express the severity of symptoms
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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