What To Know About Stuttering
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Medically reviewed by Brigid Dwyer, MD
Stuttering is a speech disorder characterized by disruptions in speech flow. Symptoms include repetition of sounds, syllables, or words, stretching out words, taking long pauses, and word-switching or using filler words to increase fluency.
Symptoms of stuttering can vary greatly from person to person, as well as throughout the day. The exact causes of stuttering are not understood, but it often occurs during speech and language development.
Stuttering can be stigmatizing and can greatly affect the lives of people who stutter (PWS). It can contribute to low self-esteem, social anxiety and isolation, and job or career advancement limitations. Treatment involves working with a speech-language pathologist (SLP) or speech therapist (ST) and focuses on developing confidence and more effective communication.
How Common Is Stuttering?
About three million people in the United States stutter. It mostly affects children. Up to 10% of children will stutter at some point, but about 75% outgrow it by adolescence (about age 16). About 1% of adults stutter.
Signs and Symptoms
People who stutter (PWS) know what they want to say but have difficulty expressing it fluently. Common signs and symptoms of stuttering include:
Repetition: Repetition of sounds, syllables, or words, or phrases—for example, “d-d-d-dog” or “can-can-can-I”
Prolongations: Stretching out a sound, syllable, or word, such as “tttttake”
Blocks: Getting stuck on a word or sound, which creates the inabilty to start speaking, such as “h-------hello”
Interjections: Using filler words like "uh” to help initiate speech
Avoidance behaviors: Strategies to avoid words that may be difficult to say, such as word substitution or avoiding conversations (e.g., using text instead of a phone call, or not speaking up during meetings)
Secondary behaviors: Physical characteristics like tension, clenching fists, facial grimaces, lip or jaw tremors, head bobbing, looking away, or rapid eye blinking
Related: Types of Aphasia and the Symptoms of Each
Types of Stuttering
There are two primary types of stuttering:
Developmental: Developmental stuttering occurs in early childhood, between 2-6 years old, as a child learns to speak.
Neurogenic: Also known as acquired stuttering, this type of stuttering occurs in adulthood. It's less common than developmental stuttering and might occur due to brain injury, stroke (blood clot or bleeding in the brain), emotional trauma, or as a result of using certain medications.
Stuttering can also be classified as chronic or recovery, meaning that some people (children) stop stuttering, while others stutter throughout life. Severe stuttering is more likely to be chronic.
What Causes Stuttering?
The exact cause of stuttering is unknown, and research in this area continues. It seems to be a combination of multiple factors, including:
Neurological: Brain differences can affect speech and language. For example, a person who stutters may use the right side of their brain more than the left.
Genetic: Developmental stuttering often runs in families, so there is most likely a genetic component. Studies suggest that genetics account for 50-80% of stuttering. Researchers have also identified four gene mutations that might be related to stuttering.
Autoimmune: A recent case report shows that a childhood autoimmune disorder, streptococcus infections (PANDAS), may also cause stuttering. An autoimmune disorder occurs when your immune system mistakenly attacks healthy cells. PANDAS harms the basal ganglia, a group of structures in the brain that can affect speech.
Research on possible mechanisms of stuttering includes:
Which children are more likely to outgrow stuttering
Common causes shared by people with similar stuttering characteristics
Medical imaging studies to examine brain anatomy and activity in PWS
Whether PWS can learn to identify speech patterns associated with stuttering and avoid them
Risk Factors
Certain risk factors increase the likelihood that someone will stutter or that stuttering will persist into adulthood. Stuttering is more common in people who:
Were assigned male at birth
Began stuttering after three years old
Have environmental stressors like a demanding family environment or bullying
Triggers
Certain triggers can make stuttering worse. Triggers include:
Feeling stressed, rushed, excited, or tired
Speaking on the phone versus in person
Speaking in front of a group rather than one one-on-one with someone
Feeling embarrassed because someone brings attention to your stutter
Greater Fluency In Certain Situations
Stuttering is more common during spontaneous (conversational) speech. Interestingly, stuttering tends to be less frequent or even disappear in some situations. For example, PWS are often fluent when:
Singing
Acting
Reading aloud in groups
Speaking in unison
Alone (talking to themselves)
Jamie Wolff, Health Editor
"I had a relatively severe stutter as a child, but I was fluent when I performed—and I performed often. Singing and acting empowered me and helped me learn how to use my voice in lyrical ways in order to make my speech more effective."
When To Contact a Healthcare Provider
You might want to contact your healthcare provider or an SLP if the person who stutters:
Stutters for more than 6-12 months
Begins starting after three years old
Stutters more often than the used to
Exhibits secondary behaviors, like body tension, when stuttering
Is frustrated when trying to talk
Avoids talking
Testing and Diagnosis
Speech dysfluency isn't uncommon between 18 months and seven years old. Repetition of words or phrases often appears around the age of three years old, and children usually aren't frustrated by it.
In the past, pediatric and family healthcare providers took a “wait and see” approach to see if a child outgrew stuttering. Now, it's generally understood that early intervention improves outcomes. Screening and diagnosis might begin with these providers, but they will likely recommend a speech therapy consult.
Speech-language pathologists (SLPs) or speech therapists (STs) identify and treat speech and language disorders. Evaluation and diagnosis usually include the following:
Listening to speech patterns—e.g., types of disfluencies
Assessing receptive (ability to understand) and expressive (ability to verbalize) language
Observing how the person who stuttering reacts to it—e.g., if they try to "fix" it
An ST or SLP will ask questions like:
When did the stuttering begin?
How often does it occur?
When does it occur? What makes it worse or better?
Does anyone else in your family stutter?
How does the PWS react to the stuttering?
How do other people react to the stuttering?
How does it affect PWS's life?
Are there any additional speech difficulties?
Mild Stuttering | Severe Stuttering |
Often begins in younger childhood | Often begins in later childhood |
Occasional, more mild stuttering | More frequent and severe stuttering |
Possibly some mild secondary behaviors (e.g., closing eyes) | Often more secondary behaviors |
Minimal frustration | Feelings like frustration and embarrassment |
Stuttering tends to cause more anxiety in older children and adults. It can also:
Affect educational achievement
Interfere with job performance or growth
Inhibit people from talking to healthcare providers
How Is Stuttering Treated?
There is no cure for stuttering. Treatment often resembles coaching or therapy. It's very personalized and depends on things like age, severity of stuttering, and how it affects the person's life. It's also centered around a person's unique goals.
Fluency Strategies
For many people, the goal of speech therapy is to increase verbal fluency and gain a greater sense of control over stuttering.
Treatment for preschool children falls into two general categories:
Direct: A speech therapist, parent, or guardian gives positive feedback (praise) when a child speaks fluently and offers gentle corrections when stuttering occurs.
Indirect: Parents or guardians change their actions to help increase fluency in the child’s speech. This involves creating a calm environment, reducing time pressures, and minimizing stressors that worsen stuttering.
Treatment for school-age children, adolescents, and adults may include fluency shaping and stuttering modification. Fluency shaping creates new speech patterns using techniques such as:
Slowed speech: Prolonging the duration of syllables to slow speech
Gentle initiation: Beginning speech at a lower volume to create less tension on vocal cords
Breath control: Taking deep breaths to relax the rib cage and speech muscles
Some stuttering modification techniques acknowledge and address stuttering directly. School-age children may be able to implement these, but therapists may reserve some for adolescents and adults. Techniques include:
Voluntary stuttering: Briefly stuttering on purpose to gain greater verbal control
Cancellations or time-outs: Adding an intentional pause after stuttering and repeating the word with the goal of easier onset
Pull-outs: Gradually easing out of a stuttered word to interrupt a tense speech pattern and transition to a more relaxed way of speaking
Choral reading: Reading aloud with others in unison to help gain a rhythm of speech
Other therapeutic strategies include:
Cognitive-behavioral therapy (CBT): Challenging negative thoughts and unhelpful behaviors related to social anxiety
Self-disclosure: Openly sharing information about stuttering to promote understanding and reduce social anxiety
Self-modeling: Recording and reviewing yourself speaking fluently to reduce anxiety and build confidence
Ending avoidance behaviors: Breaking the cycle of avoidance behaviors to achieve greater acceptance of stuttering
Support groups: To increase confidence, change beliefs about self-identity, and gain a sense of connection to others who struggle with similar challenges
Technology may also be part of a treatment plan:
SpeechEasy: A delayed auditory feedback device that delays the time between speaking and hearing yourself
Metronome: A device that produces a sound at a specific tempo to create a sense of speech rhythm and reduce the urge to speak quickly, which can make stuttering worse
EMG biofeedback: Provides feedback about the level of muscle tension in the face, jaw, and neck area
Virtual reality (VR): VR might be used for things like recreating social situations to practice speaking in public
Telepractice: Speech therapy sessions using video conferencing platforms
Mobile applications: Self-directed tools to practice speech therapy techniques
Medications
There are no FDA-approved medications for stuttering. Some people take medications that treat conditions like anxiety, but these are not approved for stuttering itself. Austedo (deutetrabenazine) and Ecopiam hydrochloride are currently undergoing clinical trials for the treatment of stuttering.
Other Treatment Goals
Fear of stuttering and trying to avoid it can significantly affect communication and, in turn, all areas of life. Many people who stutter want to achieve greater fluency. Fluency might be considered "good" and dysfluency might be considered "bad." However, focusing on this alone can cause greater tension and difficulty. It can also make communication less effective.
Speech therapy also addresses cognitive, emotional, and psychosocial elements—all of which a person might continue to struggle with even if they speak fluently.
Other important treatment goals include:
Understanding stuttering: This might include recognizing triggers and other underlying components
Confident communication: For example, using more eye contact or speaking up in a classroom or work setting
Using your voice more effectively: For example, varying intonation (changing vocal pitch based on what you're trying to convey) and the pace at which you speak
Decentralizing stuttering: Recognizing that stuttering is part of who you are and that it doesn't define you
Increasing self-sufficiency: For example, making your own appointments over the phone or successfully ordering what you'd like at a restaurant
Success does not always mean greater fluency. It might mean learning how to embrace your stutter and learning how to communicate more effectively with it. The ultimate goals of stuttering treatment are communicating more effectively and confidently, developing more helpful emotional responses to stuttering, and learning how to cope in ways that feel good to you.
Jamie Wolff, Health Editor
"Over time, I’ve learned to appreciate the gifts of stuttering. For example, word substitution has made me into a walking thesaurus of sorts. I enjoy being creative with word choices and phrasing, which fuels my therapeutic outlet of choice: writing."
Coping Strategies
Stuttering can be a primary aspect of personal identity, and it can affect all areas of life. It can lead to embarrassment, frustration, anxiety, and low self-esteem. It can also potentially lead to missed opportunities.
Here are a few tips to help you or a loved one cope with a stutter:
Replace self-critical thoughts with positive affirmations
Practice deep breathing or progressive muscle relaxation techniques, which can release muscle tension and make fluent speaking easier
Visualize successful, fluent conversations or public speaking
Encourage open communication with friends, families, and peers to help change misconceptions
Consider joining a support group to gain new perspectives and connect with others
Consider CBT to reduce social anxiety or practice desensitization (discussing fears of stuttering in a safe environment)
National Stuttering Organizations
In addition to advocacy, the following national stuttering organizations provide education and a network of support groups:
Support Strategies
Support from family, friends, and professionals can make a significant difference in the lives of PWS. Here are some support strategies to help your child or someone you know:
Educate yourself and others about stuttering
Create a safe environment for the PWS to express themselves
Give the PWS time to talk at their own pace and finish their thoughts independently
Focus on their strengths and talents
Avoid teasing or negative reactions
Maintain eye contact to show that you are listening and value their words
Create an inclusive environment at home, schools, and workplaces
Seek professional advice from a speech therapist who specializes in stuttering
Jamie Wolff, Health Editor
"As a PWS, feeling relaxed and unhurried works wonders for my stutter. I appreciate listeners who allow me time and space without interrupting or trying to finish my sentences for me."
A Quick Review
Stuttering is a speech disorder characterized by speech disruptions like repetition of sounds, word prolongation, blocks, and avoidance. It typically develops during childhood but can be acquired as an adult due to a brain injury, stroke, or trauma.
The exact cause of stuttering is unknown, but it seems to be a combination of neurological, genetic, and environmental components. Speech therapy often focuses on improving fluency, but other goals include communicating confidently, increasing self-sufficiency, and learning how to use your voice more effectively.
Jamie Wolff is an editor at Health and has an M.A. in clinical mental health counseling and expressive therapies. She had a relatively severe stutter as a child. Though it's much milder now, it is still present most days.
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