What is stuttering?
Stuttering is a speech disorder in which sounds, syllables, or words are repeated or prolonged, disrupting the normal flow of speech. These speech disruptions may be accompanied by struggling behaviors (secondary behaviors), such as rapid eye blinks, tremors of the lips, or movement of the extremities. Stuttering can make it difficult to communicate with other people, which often affects a person's quality of life.
Symptoms of stuttering can vary significantly throughout a person's day. In general, speaking before a group or talking on the telephone may make a person's stuttering more severe, while singing, reading, or speaking in unison may temporarily reduce stuttering.
Stuttering is sometimes referred to as stammering and by a broader term, disfluent speech.
Roughly three million Americans stutter. Stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 5 as they are developing their language skills. Approximately 5 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are twice as likely to stutter as girls; as they get older, however, the number of boys who continue to stutter is three to four times larger than the number of girls. Most children outgrow stuttering. About 1 percent or less of adults stutter.
How is speech normally produced?
We make speech sounds through a series of precisely coordinated muscle movements involving breathing, phonation (voice production), and articulation (movement of the throat, palate, tongue, and lips) (see figure). Muscle movements are controlled by the brain and monitored through our senses of hearing and touch.
What are the symptoms for stuttering?
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
What are the causes for stuttering?
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.
What are the treatments for stuttering?
Although there is currently no cure for stuttering, there are a variety of treatments available. The nature of the treatment will differ, based upon a person's age, communication goals, and other factors. If you or your child stutters, it is important to work with a speech-language pathologist to determine the best treatment options.
For very young children, early treatment may prevent developmental stuttering from becoming a lifelong problem. Certain strategies can help children learn to improve their speech fluency while developing positive attitudes toward communication. Health professionals generally recommend that a child be evaluated if he or she has stuttered for three to six months, exhibits struggle behaviors associated with stuttering, or has a family history of stuttering or related communication disorders. Some researchers recommend that a child be evaluated every three months to determine if the stuttering is increasing or decreasing. Treatment often involves teaching parents about ways to support their child's production of fluent speech. Parents may be encouraged to:
- Provide a relaxed home environment that allows many opportunities for the child to speak. This includes setting aside time to talk to one another, especially when the child is excited and has a lot to say.
- Refrain from reacting negatively when the child stutters. Instead, parents should react to the stuttering as they would any other difficulty the child may experience in life. This may involve gentle corrections of the child's stuttering and praise for the child's fluent speech.
- Be less demanding on the child to speak in a certain way or to perform verbally for people, particularly if the child experiences difficulty during periods of high pressure.
- Speak in a slightly slowed and relaxed manner. This can help reduce time pressures the child may be experiencing.
- Listen attentively and maintain eye contact when the child speaks and wait for him or her to say the intended word. Don't try to complete the child's sentences. Also, help the child learn that a person can communicate successfully even when stuttering occurs.
- Talk openly and honestly to the child about stuttering if he or she brings up the subject. Let the child know that it is okay for some disruptions to occur.
Many of the current therapies for teens and adults who stutter focus on learning ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Most of these therapies also help address the anxiety a person who stutters may feel in certain speaking situations.
The U.S. Food and Drug Administration (FDA) has not approved any drug for the treatment of stuttering. However, some drugs that are approved to treat other health problems - such as epilepsy, anxiety, or depression -- have been used to treat stuttering. These drugs often have side effects that make them difficult to use over a long period of time. In a recent study funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), researchers concluded that drug therapy has been largely ineffective in controlling stuttering. Clinical trials of other possible drug treatments are currently under way.
Some people who stutter use electronic devices to help control fluency. For example, one type of device fits into the ear canal, much like a hearing aid, and digitally replays a slightly altered version of the wearer's voice into the ear so that it sounds as if he or she is speaking in unison with another person. In some people, electronic devices help improve fluency in a relatively short period of time. Nevertheless, questions remain about how long such effects may last and whether people are able to easily use these devices in real-world situations. For these reasons, researchers are continuing to study the long-term effectiveness of these devices.
Many people find that they achieve their greatest success through a combination of self-study and therapy. Self-help groups provide a way for people who stutter to find resources and support as they face the challenges of stuttering.
What research is being done about stuttering?
Researchers around the world are exploring ways to improve the early identification and treatment of stuttering and to identify its causes. For example, scientists have been working to identify the possible genes responsible for the types of stuttering that tend to run in families. NIDCD scientists have identified three such genes - one on chromosome 12 and two on chromosome 16 -- that are the source of stuttering in some study participants in Pakistan, England, and the United States. The three genes, called GNPTAB, GNPTG, and NAGPA, work together to help in the breakdown and recycling of cellular components. Interestingly, other mutations in GNPTAB and GNPTG are tied to two serious metabolic disorders, called mucolipidosis (ML) II and III, which are also caused by problems with cellular recycling. Researchers are now studying how this defect in the recycling of cell components leads to specific deficits in speech fluency.
Researchers are working to help speech-language pathologists determine which children are most likely to outgrow their stuttering and which children are at risk for continuing to stutter into adulthood. In addition, researchers are examining ways to identify groups of individuals who exhibit similar stuttering patterns and behaviors that may be associated with a common cause.
Scientists are using brain imaging tools such as PET (positron emission tomography) and functional MRI (magnetic resonance imaging) scans to investigate brain activity in people who stutter. NIDCD-funded researchers also are looking at brain imaging as a way to help treat people who stutter. Researchers are studying whether volunteer patients who stutter can learn to recognize, with the help of a computer program, specific speech patterns that are linked to stuttering and to avoid using those patterns when speaking.
What are the risk factors for stuttering?
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.
Is there a cure/medications for stuttering?
A full evaluation by a speech-language pathologist is required before deciding on the appropriate treatment option. There are several ways approved to treat children and adults who stammer. Because everyone's challenges and requirements are different, a strategy — or combination of ways — that works for one person might not always work as well for another.
Treatment may not completely cure stuttering, but it might teach techniques that can help to:
1. Improve your speaking fluency
2. Improve your communication skills.
3. Take part in all school, work, and social events.
Here are a few examples of therapy approaches, in no particular order of effectiveness:
1. Therapy for speech: Speech therapy can help you learn to slow down your speaking and recognise when you stammer. When you first start speech therapy, you may speak slowly and carefully, but you can gradually work up to a more normal speech pattern.
2. Electronic gadgets: There are several electronic devices available to help with fluency. Because of the delayed auditory feedback, you must slow your speech, or it will sound distorted via the equipment. Another way is to replicate your speech so that it appears to be in unison with someone else. During daily tasks, some small electronic gadgets are worn. Seek the advice of a speech-language pathologist before selecting a device.
3. Cognitive behavioral treatment (CBT): This sort of psychotherapy can assist you in identifying and changing ways of thinking that may exacerbate your stuttering. It can also help you deal with stuttering-related stress, worry, and low self-esteem.
4. Parent-child interaction: Parental engagement in practicing strategies at home is an important aspect of assisting a kid with stuttering, particularly with some treatments. To identify the best method for your child, follow the advice of the speech-language pathologist.
Stumbling to start a word, phrase, or sentence,Word extension or sounds within a word,Recurrence of a sound, syllable, or word,Short periods of quiet for specific syllables or words, or pauses within a word (broken word),Extra words, such as "hmm," may be included if trouble progressing to the next word is anticipated,Excessive facial strain, tightness, or movement to produce a word,Concerns about speaking,Limited capacity to communicate effectively
Rapid eye blinks,Tremors of the lips or jaw,Facial tics,Head jerks,Clenching fists