Stuttering, or stammering, is a disruption in speech where a person repeats or prolongs words, syllables, or phrases. They may also pause during speech and make no sound at some points despite knowing what they want to say. Many people with a stutter feel stigmatized, and it can adversely affect their daily lives.

This article explains the causes of stuttering, diagnosis, types, therapies, and management techniques.

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Stuttering is a speech disruption where a person may have difficulty pronouncing certain syllables or an inability to articulate words despite knowing what they want to say.

Stuttering is common when children learn to speak and is three to four times more common in boys than girls.

However, the problem persists for some people, and many seek professional help, such as speech therapy.

There are three main types of stutter:

  • Developmental. Children may experience this when they are still developing their speech and language skills.
  • Neurogenic. Neurogenic stuttering is the result of damage to the central nervous system.
  • Psychogenic. A person’s stutter may result from psychological disorders, such as depression or anxiety.

Stuttering often involves repeating words or parts of words, prolonging certain speech sounds, and having difficulty finding some words.

According to the American Speech-Language-Hearing Association, some individuals who stutter appear extremely tense or out of breath when they talk. They may experience the sensation that their speech is being blocked or stopped.

Blocked is when a person’s mouth is in the correct position to say the word, but virtually no sound comes out. This may last several seconds. Sometimes, they utter the desired word or use interjections to delay the initiation of a word they know is difficult.

Examples of interjections include such words as “um,” “like,” “I mean,” “well,” or “umm.”

Common signs and symptoms associated with stuttering include:

  • problems starting a word, phrase, or sentence
  • hesitation before uttering certain sounds
  • repeating a sound, word, or syllable
  • prolonging certain speech sounds
  • speech may come out in spurts
  • substituting words with certain sounds for others (circumlocution)

Sometimes, other behaviors accompany speech disruptions, such as:

  • rapid blinking
  • trembling lips
  • foot tapping
  • a trembling jaw
  • tightening of the face, upper body, or both

While stuttering is more common in children, around 25% of people with a developmental stutter continue to have it into their adult life.

Head trauma or injury to the CNS may also cause neurogenic stuttering in adulthood.

People may also develop a psychogenic stutter later in life due to psychological conditions, such as anxiety or depression. The perception of someone listening to them, either real or imagined, may play a role in stuttering in adult life.

A small 2021 study reported that most adults who stutter do not do so in private speech.

Some aspects of stuttering are apparent, while others are not. A speech-language pathologist (SLP) can make a comprehensive and reliable diagnosis.

The SLP will note the types of problems the individual experiences when speaking and how often problems occur. They will also assess how the person copes with the stutter.

The SLP may perform other assessments, such as speech rate and language skills, depending on the individual’s age and history.

The SLP will analyze all the data and determine whether there is a fluency disorder and how it affects the person’s daily life.

An SLP can also predict whether a young child’s stutter will become long term. They can do this with tests, observations, and interviews.

While experts do not understand the exact causes of stuttering, the following factors may play a role:

Speech development

As children learn to speak, they often stutter, especially early on when their speech and language skills are still developing. This typically lasts less than 6 months and is most common between 2–6 years.

The majority of children experience fewer and fewer symptoms as this developmental stage progresses until they can speak flowingly.

Neurological changes

A disruption in the signals between the brain and speech nerves and muscles may cause stuttering. This may affect children and adults after a stroke or brain injury. The following may cause neurogenic stuttering:

Psychological factors

Psychological factors may make stuttering worse for people who already stutter.

For instance, stress, embarrassment, and anxiety can make the stutter more pronounced, but, typically, these are not the underlying cause.

In other words, anxiety, low self-esteem, nervousness, and stress do not cause stuttering; instead, they result from living with a stigmatized speech problem, which can sometimes worsen symptoms.

  • Family history. Many children who have a stutter that persists beyond the developmental stage of language have a close family member who stutters. Around 2 in 3 people with a stutter have a family history of stuttering.
  • Age when stutter starts. A child who begins stuttering before 3.5 years of age is less likely to stutter later in life. The earlier the stuttering starts, the less likely it is to continue long term.
  • Time since stuttering started. About three-quarters of all young children who stutter will stop doing so within 1 or 2 years without speech therapy.
  • Sex. Long term stuttering is three-to-four times more common among boys than girls. Experts are not sure why this occurs but believe there may be neurological reasons.

Developmental stuttering will typically resolve without intervention. However, parents should consider visiting their doctor when:

  • the child’s stuttering has persisted for over 6 months
  • when the stuttering occurs more frequently
  • when tightness of the facial and upper body muscles accompany stuttering
  • when it interferes with the child’s schoolwork
  • when it causes emotional difficulties, such as fear of places or situations
  • when it persists after the child is 5 years old

A good evaluation of stuttering is vital, as this determines the best therapy.

Therapies involve teaching the person skills, strategies, and behaviors that help oral communication. This may include:

Fluency shaping therapy

Fluency shaping therapy involves teaching a person to stretch vowels and consonants. This can help a person speak at higher speeds without interruption and use longer sentences and phrases.

One technique involves practicing smooth, fluent speech at a very slow speed, using short sentences and phrases.

Stuttering modification therapy

This therapy does not aim to eliminate the stutter. Instead, it aims to modify the stuttering to require less effort, making it easier for someone to manage.

This therapy works on the principle that if anxiety makes stuttering worse, reducing the effort needed will alleviate the stuttering.

Electronic fluency devices

These devices use the so-called altered auditory feedback effect. The person wears an earpiece that echoes the speaker’s voice so that they feel they are talking in unison with someone else.

Some people respond well to this treatment, but others do not.

People who are not used to talking to somebody with a stutter might be unsure how to respond.

Sometimes, the listener will look away whenever the person stammers, try and help by completing their missing words or phrases, or simply avoid people who stutter.

It is essential to remember that a person who stutters wants to communicate just like everybody else. It is important to focus on the speaker and listen to the information they are imparting rather than how it sounds.

If you are really unsure how to behave when talking to a person who stutters and nobody else is around, it might be helpful to ask them what would be the best way to respond.

Stuttering, or stammering, causes a disruption in speech that may involve a person elongating or repeating words and syllables or preventing them from pronouncing words altogether.

Stuttering is common in children still developing their speech and language skills, but it can persist into adulthood.

A person may develop a stutter following an injury to their central nervous system, and some psychological conditions can worsen existing symptoms.