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.

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

• Pay close attention when listening to your child. Keep natural eye contact when your child speaks.
• Wait for your child to say the word your child is trying to say. Don't jump in to complete the sentence or thought.
• Set aside time when you can talk with 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 lessen 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 so your child feels comfortable speaking freely.
• Don't focus on your child's stuttering. Try not to draw attention to the stuttering when talking with your child. Limit situations that create a sense of urgency, pressure or a need to rush.
• Offer praise rather than criticism. It's better to praise your child for speaking clearly than to draw attention to stuttering.
• Accept your child. 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. Many organizations offer support groups. Along with giving encouragement, support group members may offer advice and coping tips that you might not have thought about.

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

Other services

In the U.S., if your child stutters, your child may be able to receive speech and language services at no cost through the school. A speech-language pathologist can help you and the school decide what services are needed.

If stuttering causes major problems communicating, you may be able to have reasonable accommodations at work. These may vary depending on your job but can include aids needed for communication. A few examples are having extra time to give speeches, speaking in smaller groups, or using audio or video recordings rather than in-person speeches.

You'll probably first discuss stuttering with your child's pediatrician or your family healthcare professional. Then you may be referred to a specialist in speech and language disorders called a 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 an appointment for you or your child.

What you can do

Before your appointment, make a list that includes:

• Examples of words or sounds that are a problem. Such words may start with certain consonants or vowels. It may help to make a recording when stuttering, if possible, to play at the appointment.
• When the stuttering started. This may have started with your child's first word or early sentences. 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. Include other physical or mental health conditions.
• Any medicines, vitamins, herbs or other supplements. Include those taken regularly and include all the doses.
• Questions to ask the healthcare professional or speech-language pathologist.

Questions to ask may include:

• What's causing the stuttering?
• What kinds of tests are needed?
• Is this a short-term condition or long lasting?
• What treatments are available, and which do you recommend?
• Are there any treatment methods other than the main one that you're suggesting?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional or speech-language pathologist is likely to ask you questions such as:

• When did you first notice stuttering?
• Is stuttering always present, or does it come and go?
• Does anything seem to make stuttering better?
• Does anything seem to make stuttering 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 at school or work or talking in social situations?

Be ready to answer questions so you'll have time to discuss about what's most important to you.