Stuttering — also called stammering or childhood-onset fluency disorder — is a speech disorder that involves frequent and significant problems with the 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, syllable or phrase, or stop during speech and make no sound for certain syllables.
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.
If you're an adult who stutters, seek help if stuttering causes you stress or anxiety or affects your self-esteem, career or relationships. See your doctor or a speech-language pathologist, or search for a program designed to treat adult stuttering.
Children and adults who stutter may benefit from treatments such as speech therapy, psychological counseling or using electronic devices to improve speech patterns. After a comprehensive evaluation by a speech-language pathologist, a decision about the best treatment approach can be made.
Stuttering signs and symptoms may include:
- Difficulty starting a word, sentence or phrase
- Prolonging a word or sounds within a word
- Repetition of a sound, syllable or word
- Brief silence for certain syllables 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 you're excited, tired or under stress, or when you feel 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 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 get better.
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 visible struggling to speak
- Affects the ability to effectively communicate at school, 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
Researchers are still studying the underlying causes of persistent stuttering. A combination of factors may be involved. Possible causes of persistent stuttering include:
- Abnormalities in speech motor control. Some evidence indicates that abnormalities in speech motor control, such as timing, sensory and motor coordination, are implicated.
- Genetics. Stuttering tends to run in families. It appears that stuttering can result from inherited (genetic) abnormalities in the language centers of the brain.
- Medical conditions. Stuttering can sometimes result from a stroke, trauma or other brain injury.
- Mental health problems. In rare, isolated cases, emotional trauma can lead to stuttering.
Factors that increase the risk of stuttering include:
- Having relatives who stutter. Stuttering tends to run in families.
- Delayed childhood development. Children who have developmental delays or other speech problems may be more likely to stutter.
- Being male. Males are much more likely to stutter than females are.
- Stress. Stress in the family, high parental expectations or other types of pressure can worsen existing stuttering.
Stuttering can lead to:
- Low self-esteem
- Problems communicating with others
- Not speaking or avoiding situations that require speaking
- Loss of social, school or work participation and success
- Being bullied or teased
- Being anxious in social situations or being diagnosed with social anxiety disorder
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).
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
Take these steps before your appointment:
- Prepare key personal information, 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 how stuttering has affected your life, current problems it's causing and what treatments you've had.
- Make a recording, if possible, to catch an episode of stuttering to play at the appointment.
- Make a list of all medications, vitamins and supplements that you or your child takes, including the dosages.
- Make a list of questions you'd like to ask your doctor or speech-language pathologist.
Some basic questions to ask include:
- What's causing my stuttering or my child's 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 questions at any time 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 discuss further. Your doctor or speech-language pathologist may ask:
- 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?
Diagnosis is made by observations of the adult or child while speaking in a number of 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's 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 more questions to better understand how stuttering affects you
- Want to know how it has impacted your relationships, school performance, career and other areas of your life, and how much stress it causes
- Want to know what treatments you've tried in the past, which can help determine what type of treatment approach may be best
- Rule out an underlying medical or mental health condition that could cause stuttering
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.
A few examples of treatment approaches — in no particular order of effectiveness — include:
- Controlled fluency. This type of speech therapy teaches you to slow down your speech and learn to notice when you stutter. You may speak very slowly and deliberately when beginning this type of speech therapy, but over time, you can work up to a more natural speech pattern.
- Electronic devices. Several electronic devices are available. 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.
- Cognitive behavioral therapy. This type of psychological counseling can help you learn to identify and change ways of thinking that might make stuttering worse. It can also help you resolve underlying stress, anxiety or self-esteem problems related to stuttering.
Parental support and involvement 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.
Treatment for stuttering may be done at home, with a speech-language pathologist or as part of an intensive program. The goal is to help you or your child communicate effectively and fully participate in daily activities.
Although some medications have been tried for stuttering, no drugs have been proved yet to help the problem.
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.
You can reach the Stuttering Foundation of America at 800-992-9392 and the National Stuttering Association at 800-WeStutter (800-937-8888), or visit their websites.
Aug. 20, 2014
- Stuttering. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/stuttering.htm. Accessed July 21, 2014.
- Childhood-onset fluency disorder (stuttering). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.com. Accessed July 21, 2014.
- Stuttering. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/stutter.aspx. Accessed July 21, 2014.
- The facts. Stuttering Foundation of America. http://www.stutteringhelp.org/Default.aspx?tabid=17. Accessed July 21, 2014.
- 7 tips for talking with your child. Stuttering Foundation of America. http://www.stutteringhelp.org/7-tips-talking-your-child-0. Accessed July 21, 2014.
- Craig A, et al. Trait and social anxiety in adults with chronic stuttering: Conclusions following meta-analysis. Journal of Fluency Disorders. 2014;40:35.
- Blomgren M. Behavioral treatments for children and adults who stutter: A review. Psychology Research and Behavior Management. 2013;6:9.
- Strand EA (expert opinion). Mayo Clinic, Rochester, Minn. July 28, 2014.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. July 27, 2014.