is stuttering a speech impediment

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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.

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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.

Risk factors

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.

Complications

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. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/stuttering/. Accessed Feb. 2, 2024.
• Fluency disorders. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Accessed Feb. 2, 2024.
• Childhood-onset fluency disorder (stuttering). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Feb. 2, 2024.
• Stuttering. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/stuttering. Accessed Feb. 2, 2024.
• Sander RW, et al. Stuttering: Understanding and treating a common disability. American Family Physician. 2019;100:556.
• Laiho A, et al. Stuttering interventions for children, adolescents and adults: A systematic review as part of the clinical guidelines. Journal of Communication Disorders. 2022; doi:10.1016/j.jcomdis.2022.106242.
• 6 tips for speaking with someone who stutters. The Stuttering Foundation. https://www.stutteringhelp.org/6-tips-speaking-someone-who-stutters-0. Accessed Feb. 2, 2024.
• 7 tips for talking with your child. The Stuttering Foundation. https://www.stutteringhelp.org/7-tips-talking-your-child-0. Accessed Feb. 2, 2024.
• Clark HM (expert opinion). Mayo Clinic. Feb. 11, 2024.

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What is stuttering?

Who stutters, how is speech normally produced, what are the causes and types of stuttering, how is stuttering diagnosed, how is stuttering treated, what research is being conducted on stuttering, where can i find additional information about stuttering.

Stuttering is a speech disorder characterized by repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech known as blocks. An individual who stutters exactly knows what he or she would like to say but has trouble producing a normal flow of speech. These speech disruptions may be accompanied by struggle behaviors, such as rapid eye blinks or tremors of the lips. Stuttering can make it difficult to communicate with other people, which often affects a person’s quality of life and interpersonal relationships. Stuttering can also negatively influence job performance and opportunities, and treatment can come at a high financial cost.

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 3 million Americans stutter. Stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 6 as they are developing their language skills. Approximately 5 to 10 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are 2 to 3 times as likely to stutter as girls and as they get older this gender difference increases; the number of boys who continue to stutter is three to four times larger than the number of girls. Most children outgrow stuttering. Approximately 75 percent of children recover from stuttering. For the remaining 25 percent who continue to stutter, stuttering can persist as a lifelong communication disorder.

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). Muscle movements are controlled by the brain and monitored through our senses of hearing and touch.

The precise mechanisms that cause stuttering are not understood. Stuttering is commonly grouped into two types termed developmental and neurogenic.

Developmental stuttering

Developmental stuttering occurs in young children while they are still learning speech and language skills. It is the most common form of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands. Most scientists and clinicians believe that developmental stuttering stems from complex interactions of multiple factors. Recent brain imaging studies have shown consistent differences in those who stutter compared to nonstuttering peers. Developmental stuttering may also run in families and research has shown that genetic factors contribute to this type of stuttering. Starting in 2010, researchers at the National Institute on Deafness and Other Communication Disorders (NIDCD) have identified four different genes in which mutations are associated with stuttering. More information on the genetics of stuttering can be found in the research section of this fact sheet.

Neurogenic stuttering

Neurogenic stuttering may occur after a stroke, head trauma, or other type of brain injury. With neurogenic stuttering, the brain has difficulty coordinating the different brain regions involved in speaking, resulting in problems in production of clear, fluent speech.

At one time, all stuttering was believed to be psychogenic, caused by emotional trauma, but today we know that psychogenic stuttering is rare.

Stuttering is usually diagnosed by a speech-language pathologist, a health professional who is trained to test and treat individuals with voice, speech, and language disorders. The speech-language pathologist will consider a variety of factors, including the child’s case history (such as when the stuttering was first noticed and under what circumstances), an analysis of the child’s stuttering behaviors, and an evaluation of the child’s speech and language abilities and the impact of stuttering on his or her life.

When evaluating a young child for stuttering, a speech-language pathologist will try to determine if the child is likely to continue his or her stuttering behavior or outgrow it. To determine this difference, the speech-language pathologist will consider such factors as the family’s history of stuttering, whether the child’s stuttering has lasted 6 months or longer, and whether the child exhibits other speech or language problems.

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.

Therapy for children

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 3 to 6 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 3 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.
• Listen attentively when the child speaks and focus on the content of the message, rather than responding to how it is said or interruptng the child.
• Speak in a slightly slowed and relaxed manner. This can help reduce time pressures the child may be experiencing.
• Listen attentively 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.

Stuttering therapy

Many of the current therapies for teens and adults who stutter focus on helping them learn 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.

Drug therapy

The U.S. Food and Drug Administration 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.

Electronic devices

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 may help improve fluency in a relatively short period of time. Additional research is needed to determine how long such effects may last and whether people are able to easily use and benefit from these devices in real-world situations. For these reasons, researchers are continuing to study the long-term effectiveness of these devices.

Self-help groups

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.

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 stuttering that tend to run in families. NIDCD scientists have now identified variants in four such genes that account for some cases of stuttering in many populations around the world, including the United States and Europe. All of these genes encode proteins that direct traffic within cells, ensuring that various cell components get to their proper location within the cell. Such deficits in cellular trafficking are a newly recognized cause of many neurological disorders. Researchers are now studying how this defect in cellular trafficking leads to specific deficits in speech fluency.

Researchers are also 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 are also using brain imaging to examine brain structure and functional changes that occur during childhood that differentiate children who continue to stutter from those who recover from stuttering. Brain imaging may be used in the future 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.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on stuttering:

• Speech-language pathologists
• Physician/practitioner referrals

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Pub. No. 97-4232 February 2016

* Note: PDF files require a viewer such as the free Adobe Reader .

ROBERT W. SANDER, MD, AND CHARLES A. OSBORNE, MA, CCC-SLP

Am Fam Physician. 2019;100(9):556-560

Patient information: See related handout on stuttering , written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Childhood-onset fluency disorder, the most common form of stuttering, is a neurologic disability resulting from an underlying brain abnormality that causes disfluent speech. Stuttering can lead to significant secondary effects, including negative self-perception and negative perception by others, anxiety, and occasionally depression. Childhood-onset fluency disorder affects 5% to 10% of preschoolers. Early identification of stuttering is important so that therapy can begin while compensatory changes to the brain can still occur and to minimize the chances of the patient developing social anxiety, impaired social skills, maladaptive compensatory behaviors, and negative attitudes toward communication. However, stuttering may be persistent, even with early intervention, and affects about 1% of adults. In patients with persistent stuttering, speech therapy focuses on developing effective compensatory techniques and eliminating ineffective secondary behaviors. The role of family physicians includes facilitating early identification of children who stutter, arranging appropriate speech therapy, and providing support and therapy for patients experiencing psychosocial effects from stuttering. Finally, physicians can serve as advocates by making the clinic setting more comfortable for people who stutter and by educating teachers, coaches, employers, and others in the patient's life about the etiology of stuttering and the specific challenges patients face.

Fluent speech is a complex process that combines word selection with the motor activities that allow the articulation of those words. This involves coordination of the respiratory, laryngeal, and articulatory muscles. Speech is a defining feature of human cognition 1 , 2 and one of the principal developmental tasks for preschool children.

Types of Stuttering

Preschoolers often have difficulty mastering motor planning and execution as they struggle with the complex process of learning to speak. This is developmentally normal and formally labeled as “other disfluencies.” However, those with childhood-onset fluency disorder (the most common form of stuttering) exhibit additional stutter-like disfluencies that usually do not occur in peers who do not stutter ( Table 1 ) . 3

The incidence of childhood-onset fluency disorder varies somewhat among studies but is typically between 5% and 10% of preschoolers. 4 Most instances of childhood-onset fluency disorder resolve, but the condition persists in about 1% of adults, making it a relatively common disability. 1 , 5

Childhood-onset fluency disorder is distinct from neurogenic and psychogenic stuttering. Neurogenic stuttering is an acquired form of stuttering that follows brain injury, such as from stroke or trauma. Psychogenic stuttering is a manifestation of a psychiatric condition. These forms of stuttering are much less common than childhood-onset fluency disorder and are not addressed further in this article.

Etiology and Effects

Neuroimaging of those with childhood-onset fluency disorder, from preschoolers to adults, has revealed consistent abnormalities of the portions of the brain that control how speech is planned and executed. 1 , 2 , 5 – 7 However, the precise abnormalities vary somewhat among individuals. 7 The degree of disfluency and the rate of recovery represent an interplay between these abnormalities and genetic and environmental factors that is not completely understood. 1

Psychosocial responses to stuttering can cause secondary harm, such as negative self-perception and negative perception by others, anxiety, and occasionally depression. Even preschoolers tend to view disfluency negatively, which can cause those who stutter to feel inferior and can lead to teasing and bullying. 8 Thus, children who stutter often socially withdraw and have reduced verbal output. 8 Adults who stutter experience similar adverse social effects. Adult fluent speakers have been noted to show discomfort when listening to people who stutter. 1 , 9 People who stutter may be perceived as neurotic, unconfident, or shy. 10 , 11 One study showed that people who stutter are given lower ratings when being evaluated for occupations with high speaking demand, raising concerns about how disfluency can affect employment. 12 In the United States, people who stutter are significantly less likely to finish college, be fully employed, and advance in their careers. 13

Although preschool children who stutter do not have an increased predisposition to anxiety, the adverse social effects of stuttering can lead to anxiety, especially social anxiety, beginning as early as seven years of age. This can continue into adulthood in those who have persistent stuttering. 14 – 16 Increased anxiety can worsen the underlying disfluency, much as fluent people might have speech difficulties when faced with a stressful situation. 17

Electroencephalography studies indicate that people who have persistent stuttering typically learn to engage in enhanced speech motor preparation as a compensatory strategy. 6 Thus, for people who stutter, fluent speech requires the conscious monitoring of a process that is largely unconscious for fluent speakers. 1 Factors that interfere with monitoring, such as social anxiety, fatigue, or complexity of speech content, can lead to increased disfluency.

Speech Therapy Referral

Childhood stuttering.

The U.S. Preventive Services Task Force found insufficient evidence to recommend routine screening for speech and language delay and disorders, 18 and there are no well-validated screening recommendations from other organizations. A literature review developed for the U.S. Preventive Services Task Force found that early therapy for stuttering had a positive impact; however, the review was limited by the small size and heterogeneity of the studies and therefore did not meet criteria to support a recommendation for routine screening. 19

Although most children younger than seven years who stutter will eventually develop what is perceived to be fluent speech, there currently is no method to determine which children will have persistent disfluency with lifelong adverse consequences. Thus, referral to a speech-language pathologist should be considered for any child who exhibits stutter-like disfluencies ( Table 1 3 ) , either directly observed by the physician or based on parental report. Referral is particularly indicated if there are parental concerns or the disfluency has remained unchanged for 12 months or is worsening in severity or frequency. 1 , 19 , 20 The speech-language pathologist can confirm the diagnosis of stuttering, provide additional education and support to the parents, and initiate therapy if warranted.

It is generally considered best to institute therapy early, while the speech centers of the brain are more plastic, allowing compensatory changes in the brain to occur. 1 Early therapy can also minimize the chances of developing debilitating social anxiety, impaired social skills, and negative attitudes toward communication. 1 , 8 , 14 , 16 , 19 , 21 , 22

Therapy may be indirect (training parents to increase fluency-enhancing behavior while decreasing fluency-inhibiting behavior) or direct (training parents to encourage fluent speech with the child). 23 Therapy consists of joint sessions with the child and parent where the parent learns interventions to practice with the child. 20 The goal is to decrease disfluencies to a level where they are not noticed by the child or others. After extensive studies, no pharmacologic agent has been shown to have a significant benefit for persistent stuttering at any age. 24 , 25

PERSISTENT STUTTERING

Rates of stutter resolution by seven years of age range from 65% in a prospective study to 87.5% in cohort studies, regardless of whether the child received treatment. 4 By seven years of age, the growth and remodeling of the brain is largely complete, although childhood-onset fluency disorder occasionally starts after this age. 23 Stuttering that continues after seven years of age is classified as persistent stuttering. At this point, the rate of achieving normal fluency slows significantly. 1

For many people with persistent stuttering, the inability to predictably communicate is the most debilitating effect, and regaining a sense of control over communication is often their principal goal in therapy. 26 As stuttering persists, the patient may begin to develop ineffective secondary behaviors, including word avoidance and mannerisms such as grimacing. This makes speech and appearance even more dysfunctional; therefore, reducing or eliminating these secondary behaviors is also an important therapeutic goal. 1 Another important component of therapy is helping the patient accept that it is okay to be a person who stutters. 27 The goal of therapy for persistent stuttering transitions from a principal emphasis on achieving fluency to developing effective compensatory techniques and eliminating ineffective secondary behaviors. 28

Many different speech therapies have been developed, partly because of the variety of neurologic deficits that can cause stuttering and the many ways that people who stutter react to their disability. A systematic review of available therapies found that most interventions are beneficial for at least some people and thus the focus of speech therapy should be individualized. 28

The Family Physician's Role

Family physicians have several key roles in treating those who stutter and supporting them and their families. Family physicians can offer reassurance that stuttering is primarily the result of brain abnormalities and is not the fault of the patient or family. 1 , 2 , 5 – 7 Additionally, the physician can facilitate early identification of children who have significant disfluency characteristic of stuttering and offer appropriate referral. Stuttering resources for physicians, parents, and patients are included in Table 2 .

If speech therapy is indicated or requested, the family physician should assist with finding a competent speech-language pathologist who has the necessary training and experience to work with people who stutter. A list of certified speech-language pathologists is available from The Stuttering Foundation at https://www.stutteringhelp.org/referrals-information and the American Board of Fluency and Fluency Disorders at https://www.stutteringspecialists.org/search/newsearch.asp . Patients with persistent stuttering should be advised that many different therapy techniques can be effective and that the emphasis of their therapy should be on the development of a personalized treatment plan that addresses their specific needs. 28

Parents of young children should be counseled to engage in techniques that may reduce the frequency of disfluency and may help prevent progression to more severe disfluency. This includes the parents slowing the rate of their own speech and ensuring that the child is given an equal opportunity to speak during group conversations. Parents should also acknowledge any episodes of evident speech frustration, because this provides needed emotional support, but avoid attempting to correct the speech (i.e., filling in words, offering prompts such as to “slow down,” or interrupting) outside of designated speech therapy times. 20

The family physician should support parents and other caregivers and address parental guilt, anxiety, and frustration as needed. 8 Even if they are not interested in pursuing formal speech therapy, it is important to evaluate people with persistent stuttering for the presence of secondary emotional, social, and psychological effects, especially feelings of isolation, social anxiety, and depression, and offer appropriate treatment. 1 , 8 , 10 , 14 – 16 , 22 , 28 Treatment of secondary mental health effects can draw on any commonly used therapies, although cognitive behavior therapy has been shown to be particularly effective. 16 The physician should remain vigilant for physical symptoms that can be exacerbated or caused by the stress associated with stuttering.

Advocacy is also an important role for the family physician, beginning with making the clinic setting more comfortable for people who stutter. Office staff should be educated about stuttering and the issues that may interfere with the care of people who stutter, including feeling uncomfortable speaking to office staff and physicians, avoiding obtaining health care because of this discomfort, and overcoming staff resistance to the patient's request to rely on a third party to help them navigate the medical system. 29

Finally, family physicians are well positioned to educate teachers, coaches, employers, and others in the patient's life about the etiology of stuttering and the specific challenges patients face. When discrimination occurs, the family physician should provide information emphasizing that stuttering is due to neurologic deficits and thus is classified as a disability covered under Title I of the Americans with Disabilities Act.

This article updates a previous article on this topic by Prasse and Kikano . 30

Data Sources: PubMed searches were completed using the terms stutter, stuttering, stutterer, anxiety and stuttering, depression and stuttering, stuttering guidelines, and speech disfluency. References at the end of good-quality articles were reviewed to identify additional pertinent articles. The Agency for Healthcare Research and Quality's Effective Healthcare Reports, Cochrane Database of Systematic Reviews, National Center for Complementary and Integrative Health, U.S. Preventive Services Task Force, UpToDate, and Essential Evidence Plus were also searched, but no additional useful information, including relevant guidelines, was found. Articles used in this paper were systematic reviews, including meta-analyses, other reviews, prospective cohort studies, case-control observational studies, randomized controlled trials, and some observational studies if no other information was available. Search dates: August to December 2018; February to April, 2019; and July 2019.

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Quesal RW. Empathy: perhaps the most important E in EBP. Semin Speech Lang. 2010;31(4):217-226.

Yaruss JS, Coleman CE, Quesal RW. Stuttering in school-age children: a comprehensive approach to treatment. Lang Speech Hear Serv Sch. 2012;43(4):536-548.

Baxter S, Johnson M, Blank L, et al. Non-pharmacological treatments for stuttering in children and adults: a systematic review and evaluation of clinical effectiveness, and exploration of barriers to successful outcomes. Health Technol Assess. 2016;20(2):1-302.

Perez HR, Doig-Acuña C, Starrels JL. “Not unless it's a life or death thing”: a qualitative study of the health care experiences of adults who stutter. J Gen Intern Med. 2015;30(11):1639-1644.

Prasse JE, Kikano GE. Stuttering: an overview. Am Fam Physician. 2008;77(9):1271-1276. Accessed August 30, 2019. https://www.aafp.org/afp/2008/0501/p1271.html

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What causes stuttering? A speech pathology researcher explains the science and the misconceptions around this speech disorder

PhD Candidate in Speech Pathology, University of Minnesota

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Xiaofan Lei receives funding from the University of Minnesota and the National Stuttering Association.

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What comes to mind when you think of someone who stutters? Is that person male or female? Are they weak and nervous, or powerful and heroic? If you have a choice, would you like to marry them, introduce them to your friends or recommend them for a job?

Your attitudes toward people who stutter may depend partly on what you think causes stuttering. If you think that stuttering is due to psychological causes, such as being nervous, research suggests that you are more likely to distance yourself from those who stutter and view them more negatively .

I am a person who stutters and a doctoral candidate in speech, language and hearing sciences . Growing up, I tried my best to hide my stuttering and to pass as fluent.

I avoided sounds and words that I might stutter on. I avoided ordering the dishes I wanted to eat at the school cafeteria to avoid stuttering. I asked my teacher to not call on me in class because I didn’t want to deal with the laughter from my classmates when they heard my stutter. Those experiences motivated me to investigate stuttering so that I can help people who stutter, including myself, to better cope with the condition.

In writing about what the scientific field has to say about stuttering and its biological causes, I hope I can reduce the stigma and misunderstanding surrounding the disorder.

The experience of stuttering

The most recognizable characteristics of developmental stuttering are the repetitions, prolongations and blocks in people’s speech. People who stutter may also experience muscle tension during speech and exhibit secondary behaviors, such as tics and grimaces.

People who stutter often react to their experience of stuttering with anxiety, frustration and embarrassment . In addition, people often anticipate that they may stutter and – as I did – actively avoid stuttering by avoiding sounds or situations. Some may also develop unhelpful thoughts and beliefs about themselves and their ability to communicate with others, such as that they won’t succeed in life or that they cannot talk properly.

A neurodevelopmental disorder

The exact cause of stuttering is still unknown. However, it’s widely agreed upon that stuttering is a complex neurodevelopmental disorder .

Neuroimaging studies from both children and adults who stutter point to a malfunction in areas of the brain responsible for timing of movements and skilled motor control – such as speech production – called the cortico-basal ganglia-thalamocortical loop. Yet researchers also know that brain development can be shaped by experience.

Therefore, the anomalies in brain connectivity among adults who stutter could result from their experience of stuttering rather than what contributes to its onset. Ongoing studies looking at differences between children and adults who stutter could help illuminate the core deficits that are associated with the onset of stuttering.

About 1 in 100 people across the world stutter. About 5% to 8% of preschool age children develop stuttering. The majority of children who stutter – about 80% – spontaneously recover from it with or without intervention before around 7 years of age, while the remaining 20% experience stuttering into adulthood.

Researchers have found similar neuroanatomical deficits in children ages 9 to 12 years old who continue to stutter and those who recover from it. But those who continue to stutter as adults are more likely to be male and have a family member who also stutters. When stuttering begins, the boy-to-girl ratio is about 1 to 1. Girls who stutter are more likely to recover than boys; as a result, the male-to-female ratio among adults who stutter is about 4 to 1.

People whose stuttering persists also tend to have poorer performance on at least one standardized assessment in pronouncing or manipulating sounds in words – such as saying a word without its initial sound.

Researchers are still exploring the factors that predict stuttering persistence versus recovery.

Multiple pathways

A common misconception about stuttering is that it’s caused by anxiety . After all, you may notice that someone who stutters may not always stutter in the same way. Adults who stutter do not stutter when they are talking to themselves in private . They also self-report that they stutter more when the pressure is high, when the listeners are impolite or when talking on the phone.

But the causal factors are often more complex than you might think. For one, observing that two things are associated, like stuttering and anxiety, does not mean that one causes the other .

Researchers usually do not know which variable comes first, the stuttering or the anxiety, nor whether alternative explanations for the association exist. Also, many factors are usually involved in the development of any complex neurodevelopmental disorder . Teasing these factors apart and learning how they relate to each other is extremely challenging and will take many years of research.

Because stuttering primarily involves disfluent speech, it’s likely that neural deficits in the brain regions responsible for speech production are at the root of the disorder. Yet research points to a set of conditions, such as linguistic and emotional factors , that could maintain stuttering over a lifetime or increase stuttering in certain situations.

Overcoming the stigma

Research shows that stuttering is usually considered an undesirable characteristic and that people who stutter are discriminated against and often socially devalued . Examples include being fired from a job, being patronized, being taken less seriously and being avoided.

In recent years, there have been more and more headlines about people who stutter. The election of President Joe Biden, who has stuttered since childhood , has been inspiring for millions of people who stutter.

At the same time, Biden’s speech has been put under greater scrutiny and has invited insensitive critiques, such as that his “brain just broke” . Politics aside, the rhetoric on stuttering could further stigmatize the disorder and give others permission to mock one’s speech differences.

Redefining recovery

There currently isn’t an effective cure for stuttered speech when it persists into adulthood. In a large-scale survey study, fewer than 2% of adults who grew up with a stutter indicated that they no longer self-identify as someone who stutters . Stuttering in adulthood, therefore, is not a sign of moral failure that someone is not working hard enough or with enough self-discipline to be fluent.

Yet, about 30% of adults who stutter said that they experienced recovery , even though around 10% of them relapsed. Recovery was defined not only as reduced stuttering but also as having greater control of how they stutter, saying what they intended to say as well as greater acceptance of stuttering, decreased avoidance and less negative emotions toward stuttering.

Ironically, in an environment in which people were allowed to stutter without judgment – such as at self-help conferences – people who stutter reported that their speech became easier, they experienced less anxiety when talking , and they felt more outgoing and friendlier toward others.

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Stuttering is a speech disorder that disrupts the natural flow of speech, marked by repeating, pausing, or prolonging certain sounds and syllables. Individuals who stutter know what they want to say; the challenge lies in producing the physical sound.

In the DSM-5 , stuttering is called Child-Onset Fluency Disorder.

• What Is Stuttering?
• Living with a Stutter

Stuttering, also called stammering, emerges in childhood . The condition typically begins between 2 and 6 years old, but three-quarters of children who stutter eventually outgrow the condition. Stuttering may influence relationships, academic goals , and professional pursuits, but there are effective strategies to address the condition or embrace it.

Around 70 million people worldwide stutter, representing 1 percent of the global population. In the United States, about 3 million people stutter , and boys are two to three times more likely to stutter than are girls. Stuttering is most common in young children, but 75 percent eventually outgrow the condition, according to the National Institute on Deafness and Other Communication Disorders.

Stuttering takes two forms . Developmental stuttering begins in childhood and may materialize when a child wants to express language, but their speech skills haven’t fully developed yet. The second type of stuttering, neurogenic stuttering, occurs as a result of brain injury such as stroke or head trauma , after which the brain regions involved in speech production aren’t able to coordinate effectively.

The causes of stuttering are not fully understood, but genetics play an important role. Researchers have identified several genetic mutations that occur in those who stutter, and the risk of stuttering is three times higher when a first-degree relative has the condition, according to the DSM-5 . Differences in brain structure and function and family dynamics may play a role as well.

Stuttering is diagnosed by a speech-language pathologist. The clinician will listen to the patient’s speech to assess characteristics of stuttering, such as whether the person repeats syllables, prolongs sounds, pauses in the middle of words or between words, or avoids certain words. The speech language pathologist will also take into account a person’s age, length of time of stuttering, and family history of stuttering to make the determination.

Stuttering often emerges between 2 and 6 years old in children developing language, when their desire to speak exceeds their speech and language abilities. Around 5 to 10 percent of toddlers develop a stutter, yet three-quarters of those children will outgrow it, according to the National Institute on Deafness and Other Communication Disorders. If this occurs, experts advise to wait until the age of 3 to see if it passes, be patient and listen, avoid giving advice, smile encouragement, ask one question at a time, and acknowledge the stutter kindly and supportively.

The belief that anxiety causes stuttering is a myth. Although anxiety can at times exacerbate stuttering, it does not always indicate that a person is anxious. Folks who don’t stutter may have this misconception because they stumble over their words when they become nervous or anxious. But that’s not what’s at the root of stuttering for people with this speech disorder.

Stuttering and Tourette syndrome may be more closely connected than previously thought. Tourette syndrome—a neurological disorder characterized by involuntary verbal or nonverbal tics—is associated with elevated levels of dopamine . Dopamine is a chemical that helps the basal ganglia function, the network of brain structures that control movement. Medications that target high dopamine levels have reduced symptoms of Tourette syndrome. When patients with stutters were provided similar medications in a recent study, the effects were equally positive. This suggests that stuttering may function similarly to Tourette syndrome , as both involve dopamine levels in the brain.

People who stutter may struggle with embarrassment , frustration, or self-esteem at times. Yet speech therapy can help with speech fluency and talk therapy can address those difficult emotions. Many who stutter come to feel resilient and empowered, and some refrain from treating the condition altogether, choosing to embrace their stutter instead.

People often work with a speech therapist to alleviate stuttering. Adults who stutter can speak more slowly, use breathing exercises to relax, and address the accompanying anxiety. Techniques for parents of children who stutter include providing plenty of time to talk in a relaxed environment, not rushing or interrupting, and speaking more slowly themselves.

No medications are currently approved to treat stuttering, but drugs for epilepsy, anxiety, and depression may be helpful, although they are not without side effects. An electronic device, similar to a hearing aid, can also help people who stutter to speak more fluently.

Stuttering can vary widely by context. For example, stuttering is often exacerbated during public speaking but disappears while singing or reading. A difficult cycle underlying the condition is that stuttering can lead to anxiety while speaking, which in turn can lead to more stuttering—especially in pressured situations such as a school presentation or job interview.

Absolutely. Many people who stutter occupy corporate or political leadership positions, such as President-Elect Joe Biden, CEO Jack Welch, actress Emily Blunt, and news anchor Byron Pitts. People who stutter often report that the challenge of stuttering has instilled a sense of insight, grit, and resilience that allows them to achieve their personal and professional goals.

Some people in the stuttering community have created and now counsel a movement toward self-acceptance. They believe it’s better to learn to accept their stutter rather than strive to overcome it. For many who have explored various therapies and programs, it may be better to release the constant pressure of trying to achieve fluency and replace feelings of guilt and shame with acceptance and solidarity.

People who stutter may find support and acceptance through community, such as the National Stuttering Association or other organizations. They may strive to reframe harmful views of stuttering that they’ve encountered in society. They may focus on fostering resilience, as people who stutter have reported positive outcomes, such as the fact that stuttering “increased their empathy” or “instilled a fighting instinct.” In one unique example, a woman turned her experiences of stuttering into jokes, which helped her to release frustration and accomplish her goal of becoming a comedian.

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What are the links between communication, leadership, innovation, and stuttering?

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Her quest to find a "cure" led her on a year-long journey.

In a place where stuttered speech is the norm, a thousand stutterers find in themselves a quiet dignity and immeasurable resolve.

I have been remiss in two key dimensions: the first in not having attended to this column for months, and the second in not having viewed The King's Speech before this week.

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Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

Centers for Disease Control and Prevention. Language and speech disorders .

Cincinnati Children's Hospital. Stuttering .

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, and language .

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Health Library Stuttering (Disfluency)

What is stuttering (disfluency).

Stuttering is a disorder that appears as an interruption in the smooth flow or “fluency” of speech. Breaks or disruptions that occur in the flow of speech are labelled “disfluencies.”  All speakers may experience disfluent events, especially under certain conditions, such as nervousness, stress, fatigue or complexity of language. Stuttering, on the other hand, is a different type of disfluency. People who stutter generally tend to have more disfluencies than other speakers overall.  They may develop negative perceptions and thoughts about their speech and themselves as a result of their speaking difficulties.

Stuttering usually begins in early childhood when speech and language skills are expanding and other developmental learning is taking place. This typically occurs between the ages of 2 and 5, and in most cases, stuttering will vary widely across days and months. In most cases, the stuttering resolves on its own. Current data suggests that between 75-80% of children who stutter at some time in their development will recover. For those who continue to stutter with consistency, early, effective treatment may leave them with little or no stuttering.  Currently, over three million Americans or 1% of the population stutter. Males are three to four times more likely to continue to stutter into adulthood than females.

Many famous, successful people have dealt with stuttering in their lives. These include: James Earl Jones, Ed Sheeran, Joe Biden, Emily Blunt, Kenyon Martin, Shaquille O’Neal, John Stossel, Darren Sproles, Bill Walton, Nicholas Brendon, Alan Rabinowitz, Carly Simon, Bob Love, and Marilyn Monroe.

Causes of Stuttering

The exact cause of stuttering is unknown. However, most experts agree that stuttering has a neurological basis, affecting areas of the brain that control how speech and language are processed. Stuttering can run in families due to a genetic cause. The likelihood of recovery within a family that has a history of recovered stuttering is as significant as the likelihood of persistence in those families where recovery has not occurred.

Certain environmental stressors may increase the frequency and extent of stuttering, such as anxiety or stress, urge to speak quickly, changes in routine (such as the birth of a baby), and demands to speak in front of others.

Children who stutter are just as intelligent and well-adjusted as other children of the same age who do not experience stuttering.

Characteristics of Stuttering

Stuttering takes many forms and can be differentiated from the typical kinds of speech breaks that all speakers exhibit. In general most children tend to have more disfluencies as they are developing longer and more complex language structure. Below are some examples of typical disfluencies and those considered more stutter-like in nature.

Typical Disfluencies

• Whole phrase repetitions (“Where is … where is the ball?”)
• Single whole word repetitions (“Where … where is the ball?”)
• Interjections (“Where…um is the ball?”)
• Revisions (“What ... where is the ball?”)
• Hesitations (A long pause when thinking)

Less Typical (Stutter-Like) Disfluencies

• Repetition of sounds (“sh-sh-shoe”)
• Repetitions of syllables (“ba-ba-ball”)
• Prolongation: stretching of sounds (“Wh-------re is the ball?”)
• Blocks: a tense stop in the flow of speech; child may open his or her mouth to speak but no sound comes out and/or there is a noticeable stoppage of airflow at some point in the upper airway (mouth area).

Stuttering can become more difficult to deal with as children grow older. They may become more self-conscious and lack confidence in speaking situations. If left untreated, stuttering has the potential to affect future decisions, including job choices and social relationships.

Treatment for Stuttering

The child should see a speech-language pathologist if:

• The stuttering persists longer than six months and occurs frequently during the day
• The child shows tension, a facial grimace, or struggle behavior during speech
• The child avoids talking situations or expresses concerns about speech
• The child avoids saying certain words or sounds
• The family has a concern about their child’s speech
• The child has shown signs of frustration or embarrassment during or after a stutter event

Stuttering is treated through speech therapy. There are different kinds of therapy depending on the individual child and their family. Therapy also focuses on building confidence and enhancing communication skills. Families and patients are counseled and given support throughout the therapy process.

Helping Your Child

The treatment of stuttering depends on the unique needs of the child. However, the following are some general suggestions for helping a child who stutters:

Reduce Things That Tend To Exacerbate Stuttering

• Temporarily avoid creating situations that are likely to increase the child’s disfluencies. These situations may include talking on demand to an adult (e.g., “Tell grandma about your day at school”) or talking in front of the class.
• Refrain from telling your child to slow down, relax, take a deep breath, or think before trying to say something. Such suggestions may only bring more of a negative awareness about talking.

Listen Attentively

• Actively listen to your child when they are talking. Direct your attention to what your child is saying.
• Maintain eye contact when the child is talking. Don’t look away or show a negative reaction when the child is stuttering.
• Reinforce the child’s attempts at talking by responding positively.
• Make sure family members take turns when talking and don’t talk all at once.

Model Slower Talking with More Pauses

• Use a relaxed rate of speech when talking to the child. An unhurried, Mr. Rogers-like approach to talking is suggested.
• Talk about your own activities through the day. This will encourage the child to talk about their activities in a relaxed environment.

If the Child Is in Therapy

• Work closely with the speech-language pathologist and follow specific instructions given to do at home.

Website Resources for Stuttering

• American Speech-Language-Hearing Association
• Stuttering Foundation of America
• National Stuttering Association

Last Updated 12/2023

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

Overview - Stammering

Stammering, also sometimes referred to as stuttering, affects speech and is relatively common in childhood. It can also can persist into adulthood.

What is stammering?

Stammering is when:

• you repeat sounds or syllables – for example, saying "mu-mu-mu-mummy"
• you make sounds longer – for example, "mmmmmmummy"
• a word gets stuck or does not come out at all

Stammering varies in severity from person to person, and from situation to situation. Someone might have periods of stammering followed by times when they speak relatively fluently.

Find out more about how stammering can affect you .

Types of stammering

There are 2 main types of stammering:

• developmental stammering – the most common type of stammering that happens in early childhood when speech and language skills are developing quickly
• acquired or late-onset stammering – is relatively rare and happens in older children and adults as a result of a head injury, stroke or progressive neurological condition. It can also be caused by certain drugs, medicines, or psychological or emotional trauma

The information here focuses on developmental stammering.

What causes stammering?

It is not possible to say for sure why a child starts stammering, but it is not caused by anything the parents have done.

Developmental and inherited factors may play a part, along with small differences in how efficiently the speech areas of the brain are working.

Speech development

Speech development is a complex process that involves communication between different areas of the brain, and between the brain and the muscles responsible for breathing and speaking.

When every part of this system works well, the right words are spoken in the right order, with correct rhythm, pauses and emphasis.

A child learning to construct simple sentences needs practice to develop the different speech areas in the brain and create the "wiring" (neural pathways) needed for the different parts to work well together.

Stammering can happen if some parts of this developing system are not co-ordinated. This can cause repetitions and stoppages, particularly when the child has lots to say, is excited, or feels under pressure.

As the brain continues to develop, stammering may resolve or the brain can compensate, which is why many children stop stammering as they get older.

Sex differences and genes

Stammering is more common in boys than girls. It is unclear why this is.

Genes are also thought to have a role. Around 2 in 3 people who stammer have a family history of stammering, which suggests the genes a child inherits from their parents might make them more likely to develop a stammer.

When to get help

You should get advice if you have any concerns about your child's speech or language development.

Treatment for stammering is often successful in pre-school age children, so it's important to get advice as soon as possible.

Talk to a GP or health visitor about your concerns. If necessary, they may refer your child to a speech and language therapist (SLT) for an assessment.

In many areas, you can phone children's speech and language services directly and refer your child yourself.

Stamma (the British Stammering Association)  has more information and support for people who stammer and parents of stammering children. For support or to find out about the services available in your area, call the helpline on 0808 802 0002 or start a webchat (Monday to Thursday 10am to 2pm and 4pm to 8pm).

If you're an adult who stammers and it's having a significant impact on your social and work life, you may want to ask a GP to refer you to an SLT.

Treatments for stammering

There are different speech and language therapy approaches that can help people who stammer to speak more easily.

You'll work with a therapist to choose a suitable plan tailored to your child or you.

This may involve:

• creating an environment where your child feels more relaxed and confident about talking
• strategies to increase fluency and develop communication skills
• working on feelings associated with stammering, such as fear and anxiety

Electronic devices to reduce stammering are also available and can help some older children and adults, but they're not usually available on the NHS.

Find out more about treating stammering .

Who's affected

Studies suggest around 1 in 12 young children go through a phase of stammering.

Around 2 in 3 children who stammer will go on to speak fluently, although it's difficult to predict when this will happen in a particular child.

It's estimated that stammering affects around 1 in 50 adults, with men being around 3 to 4 times more likely to stammer than women.

Page last reviewed: 17 March 2023 Next review due: 17 March 2026

Neurogenic Stuttering

• Parents of Preschoolers
• Parents of School-Age Children
• Just for Kids
• Speech-Language Pathologists

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What is neurogenic stuttering?

Neurogenic stuttering is a type of fluency disorder in which a person has difficulty in producing speech in a normal, smooth fashion. Individuals with fluency disorders may have speech that sounds fragmented or halting, with frequent interruptions and difficulty producing words without effort or struggle. Neurogenic stuttering typically appears following some sort of injury or disease to the central nervous system i.e. the brain and spinal cord, including cortex, subcortex, cerebellar, and even the neural pathway regions. These injuries or diseases include:

• Cerebrovascular accident (stroke), with or without aphasia
• Head trauma
• Ischemic attacks (temporary obstruction of blood flow in the Brain)
• Tumors, cysts, and other neoplasms
• Degenerative diseases, such as Parkinson’s disease or multiple sclerosis
• Other diseases, such as meningitis, Guillain-Barré Syndrome, and AIDS
• Drug-related causes such as side-effects of some medications

In the majority of cases, the injury or disease that caused the stuttering can be identified. In a small number of cases, however, the individual may only show evidence of some form of speech disruption without any clear evidence of neurological damage.

Who is at risk for neurogenic stuttering?

Generally individuals experiencing neurogenic stuttering have had a history of normal speech production prior to the injury or disease. In a few cases, neurogenic stuttering may occur in individuals who experienced developmental stuttering in childhood but had apparently recovered. Neurogenic stuttering can occur at any age; however, it appears more often in adulthood, and the highest incidence is in the geriatric population. This profile is quite different from developmental stuttering which is not typically seen as a result of brain damage and which most commonly appears in early childhood in children between 2 and 5 years of age.

What are the primary symptoms of neurogenic stuttering?

Because it results from a very diverse set of diseases and disorders, the symptoms of neurogenic stuttering may vary widely between different individuals. Neurogenic stuttering might be considered as a possible diagnosis if one or more of the following symptoms are observed:

• Excessive levels of normal disfluencies or interruptions in the forward flow of speech, such as interjections and revisions;
• Other types of disfluencies, such as repetitions of phrases, words, and parts of words (sounds or syllables, prolongations of sounds), etc;
• Hesitations and pauses in unexpected or inappropriate locations in an utterance;
• Cessation of speech during the production of a word without finishing the word;
• Intrusive or extraneous additional sounds during speech production;
• Rapid bursts of speech which may be unintelligible;
• Extraneous movements of lips, jaw, or tongue while attempting to speak, including posturing.

Many individuals may appear to be unaware of or at least unconcerned about the disruptions in their speech. Others may show awareness, and possibly express anxiety and even depression about the difficulty they encounter in speaking. This may be accompanied by other behaviors, which may include:

• Secondary or associated behaviors, such as obvious tension and struggle in speech production; movements of head or limbs while speaking; reduced eye contact;
• Postponement or delay in attempting to say a word or avoidance of words or speaking situations.

These behaviors may arise out of the speaker’s attempts to overcome or force his way through the disfluency, or from attempts to hide or disguise the fact that he is having difficulty producing normal sounding speech.

How does neurogenic stuttering differ from other types of fluency disorders?

The symptoms of neurogenic stuttering can be similar to those seen in other fluency disorders. Some communication disorders such as dysarthria, apraxia of speech, palilalia, and aphasia may impair the speaker’s ability to produce smooth and flowing speech production. These problems result from the same types of neurological injury or disease as neurogenic stuttering, and the disorders often co-exist. A diagnosis of neurogenic stuttering might be considered when the disfluency pattern includes the symptoms described above.

Occasionally, some individuals may experience psychogenic disfluency. This disorder results in a disfluent speaking pattern but no medical factors or history of developmental stuttering are present. Its appearance may be linked to emotional stress or trauma that the individual has recently experienced.

The disorder whose symptoms most resemble those of neurogenic stuttering is developmental stuttering. Developmental stuttering may persist into adulthood. In some cases, its symptoms may be noticeably worsened following injury, disease, or trauma, possibly making diagnosis between the two disorders more difficult. Similarly, an individual who had recovered from developmental stuttering in childhood may experience a re-emergence of stuttering following neurological injury or disease. In the vast majority of cases, however, the sudden appearance of disfluent speech in an adult should be considered abnormal. Developmental stuttering should only be considered as a possible cause when there is a prior history of childhood stuttering. Apart from the obvious difference in age of onset, differentiating between the two disorders is often difficult.

Some of the patterns that set the two apart include:

• Neurogenic stuttering may occur at any point in the production of a word, rather than primarily at the beginning, as is common with developmental stuttering.
• Neurogenic stuttering often occurs on any type or class of word anywhere in a sentence rather than being linked to content words such as nouns, verbs, adjectives and adverbs.
• Neurogenic stuttering may occur in any type of vocal behavior, including singing and repeating well-learned passages, such as the pledge of allegiance. The disfluencies may occur with equal frequency in any type of a speaking situation.
• Neurogenic stuttering is often not alleviated by the same conditions that significantly lessen developmental stuttering. These include choral reading, singing, adaptation (repeated oral reading of the same passage) or speaking while under auditory masking or delayed auditory feedback.

The aforementioned patterns, however, are not universal for all individuals experiencing neurogenic stuttering, and patterns may vary widely across individuals depending on the nature of the neurologic injury or disease.

Can other types of communication problems accompany neurogenic stuttering?

It is not uncommon for individuals with neurogenic stuttering to experience several other types of communication impairments. These might include:

• Aphasia—complete or partial impairment in language comprehension, formulation, and use
• Dysarthria—errors in the production of the speech sounds, such as slurring of sounds and words that affect the intelligibility of the individuals speech
• Apraxia of speech—irregularities in the timing and inaccuracies in the movement of the muscles used in speech production
• Palilalia—speech disorder in which a word, phrase, or sentence may be repeated several times, generally with increasing rapidity and decreasing distinctness
• Anomia—difficulty in finding the appropriate word to use
• Confusion—uncertainty as to their own identity and that of others, their location, current time period, etc.

How is neurogenic stuttering diagnosed?

Before getting treatment, it is important that someone suspected of neurogenic stuttering be diagnosed accurately. It is advisable to consult with a speech-language pathologist who specializes in stuttering to make the diagnosis. The SLP will want to seek input from the physicians involved in the clients’ care. The evaluation will include consideration of the fluency problem and the individuals’ case history, current medical status, and the presence of other communication impairments. The diagnosis should determine whether the disfluency is neurogenic in origin and whether any other communication impairments are affecting fluency.

How is neurogenic stuttering treated?

Because many conditions can cause neurogenic stuttering and affect the frequency with which it co-exists with other communication impairments, there is no single treatment approach that is effective in alleviating its symptoms. Treatment is often carried out by a speech-language pathologist working in conjunction with the clients’ physicians. Some therapy techniques that help reduce the symptoms of developmental stuttering may also be effective with neurogenic stuttering.

These include:

• Slowing speech rate (saying fewer words on each breath by increasing the duration of the sounds and words).
• Emphasizing a gentle onset of the start of each phrase (starting from a relaxed posture of the speech muscles, beginning with adequate respiratory support, a slow and easy initiation of the exhalation and gentle onset of the first sound).
• Emphasizing a smooth flow of speech production and use of relaxed posture, both in terms of general body posture and for specific speech production muscles.
• Identifying the disruptions in the speech patterns and instructing the client in the use of more appropriate patterns.

In addition, if the person is expressing anxiety or concern about his fluency, therapy may include education about the disorder and counseling to change attitudes and perceptions. The use of different or additional techniques and approaches may be indicated based on the presence of other communication and cognitive disorders and the nature of the individual’s underlying neurological condition. If other communication disorders are also present, additional therapy directed at alleviating their effects may enhance fluency as well. Physicians, nurses, occupational, physical, and respiratory therapists may also be able to provide assistance in dealing with medical conditions and symptoms which have an impact on speech fluency.

Having an understanding of the disorder can help families and caregivers structure communication situations to best help the client. This can have a significant impact on reducing their concerns and improving communication. Strategies may include simplifying one’s speech, allowing more time for response, modeling slow, easy speaking patterns, and, in general, reducing communication demands and expectations. It is important to recognize that the recovery process from the underlying neurological injury or disease will often have a significant impact on fluency. Also keep in mind that because recovery from neurological injury or disease may be slow, patience will be needed.

How can I get help for neurogenic stuttering?

The Stuttering Foundation of America can supply you with the names of speech-language pathologists who specialize in stuttering. Call toll-free 800-992-9392 or visit www.stutteringhelp.org .

You may also want to contact the American Speech-Language-Hearing Association at 800-638-TALK.

Where Can I Learn More About Neurogenic Stuttering?

• Brady, J. P. (1998). Drug-induced stuttering: A review of the literature. Journal of Clinical Psychopharmacology , 18, 50-54. (A clinically-oriented article dealing with drug-induced stuttering.)
• Brookshire. R. H. (1997). Introduction to Neurogenic Communication Disorders - 5th Edition . St. Louis, MO: Mosby. (A book providing information on aphasia and other communication disorders associated with neurogenic stuttering.)
• Deal, J. & Cannito, M. P. (1991). Acquired neurogenic dysfluency. In D. Vogel and M. Cannito (Eds.), Treating Disordered Speech Motor Control . (pp. 217-239). Austin, TX: Pro-Ed. (An edited book with a chapter on neurogenic stuttering.)
• Duffy, J. R. (1995). Motor Speech Disorders . St. Louis, MO: Mosby. (A book that provides information about apraxia of speech and dysarthria, as well as some coverage of neurogenic stuttering.)
• Grant, A. C., Biousse, V., Cook, A. A., & Newman, N. J. (1999). Stroke-associated stuttering. Archives of Neurology , 56(5), 624-627. (A clinically oriented article dealing with stuttering symptoms associated with strokes.)
• Helm-Estabrooks, N. (1999). Stuttering associated with acquired neurological disorders. In R. Curlee (Ed.), Stuttering and Related Disorders of Fluency (2nd Edition) . NY: Thieme Medical Publishers. (An edited book with a chapter on neurogenic stuttering.)
• Market, K. E., Montague, J. C., Buffalo, J. C., & Drummond, S. S. (1990). Acquired stuttering: Descriptive data and treatment outcome. Journal of Fluency Disorders , 15, 21-33. (A clinically-oriented article dealing with treatment of neurogenic stuttering.)
• Stewart, T., Rowley, D. (1996). Acquired stammering in Great Britain. European Journal of Disorders of Communication , 31(1), 1-9. (A clinically oriented article dealing with treatment of neurogenic stuttering.)

Lawrence Molt, Ph.D., in collaboration with J. Scott Yaruss, Ph.D.

What Is Speech Therapy?

Speech therapy is a form of healthcare that helps improve communication and speech. It can also help improve swallowing function and other behaviors related to feeding.

About one in 12 children in the United States has a speech or swallowing disorder. Disorders are most common in young children, but many adults have a related condition. For example, about one million adults in the United States have aphasia (difficulty expressing or comprehending written and verbal language).

Speech therapists (STs) or speech-language pathologists (SLPs) assess and treat people of all ages. They use various techniques to help people with challenges related to speech production, language comprehension, hearing, voice quality, fluency, and swallowing. 

What Does Speech Therapy Treat?

Speech therapy treats various disorders involving hearing, speech, language, literacy, social communication, voice quality, executive functioning (for example, memory and problem-solving), feeding, and swallowing.

Specific speech disorders include:

• Articulation disorders: Difficulty pronouncing words or sounds such as the “s” sound (for example, saying “thun” rather than “sun”). This can occur during childhood language development or with structural problems like tongue-tie. A tongue tie is when a small band of skin connects the tip of the tongue to the bottom of the mouth. It is congenital, meaning it's present at birth.
• Dysarthria: Slow, slurred, or unclear speech. This occurs with oral (mouth) muscle control decline due to neurological conditions (related to the brain or nervous system), such as multiple sclerosis (MS) —a condition that occurs when the immune system attacks myelin, the covering wrapped around nerve cells.
• Apraxia: Knowing what you want to say but having difficulty producing the correct sounds or words. Apraxia can cause slow, error-prone speech or the need to intentionally move your tongue and lips in order to produce sounds and words. Apraxia can be present at birth, but it can also occur as a result of brain injuries, brain tumors , or a stroke .
• Fluency disorders: Speech flow disruptions like stuttering. Stuttering is experiencing interruptions in speech and repeating sounds, syllables, or words. Researchers are still exploring possible causes of dysfluency, but they seem to include genetics, developmental components, neurological factors (how the brain processes), and brain injury. Many children outgrow fluency disorders, but they can persist into adulthood.
• Voice disorders: Vocal cord spasming (choppy voice), hoarseness, pitch problems, or voice fatigue are examples of voice disorders. This can result from infection, overusing the vocal cords, or neurological disorders. 

Language or communication disorders include:

• Aphasia : Aphasia is a language disorder in which you have difficulty expressing or comprehending written and verbal language. Receptive aphasia is difficulty understanding written or verbal words. Expressive aphasia is difficulty communicating thoughts and ideas with language components like vocabulary, grammar, and sentence formation. Aphasia can occur with childhood development, language impairment, autism spectrum disorder (ASD), brain injury, or neurological disorders.
• Pragmatic language disorder: This relates to social communication. Signs include misunderstanding social cues like eye contact, body language, and personal space. It can occur during childhood development or with underlying neurodivergence (brain variation), such as autism spectrum disorder (ASD) , a brain development condition that affects how a person perceives and socializes with other people.
• Accent or tone: While this is not a disorder, speech therapists can also work with people who wish to modify their accent or an unusual speech rhythm, pitch, or tone. For example, a high-pitched, sing-song, or robotic tone can occur with ASD.
• Executive functioning: Executive functioning challenges include difficulty with memory, planning, organization, problem-solving, and attention. This can occur due to brain injuries or conditions like ASD and attention-deficit hyperactivity disorder (ADHD) , a neurodevelopmental disorder characterized by inattention (being distracted), hyperactivity (feeling restless), and impulsivity (making hasty decisions).
• Auditory processing disorder: This is a neurological condition that makes it difficult to make sense of sounds. 

Feeding and swallowing disorders affect how you suck, chew, and swallow food and drinks. Difficulty swallowing is also known as dysphagia , which can result in choking during meals—and lung infections if food or liquid enters the airways. It can occur with structural abnormalities, muscular weakness, or neurological conditions like a stroke. 

Related: Rediscover Sound: The Best Hearing Aids for Improved Quality of Life

How Does Speech Therapy Work?

Speech therapy involves techniques like language practice, pronunciation exercises, voice therapy, and swallowing exercises. It begins with a thorough assessment, including observation of communication strategies, challenges, and frustrations.

Speech therapy for infants, toddlers, and children involves fun and engaging activities like play, language exercises, reading, picture cards, and modeling correct sounds. This helps make learning more enjoyable. 

Parents or caregivers often attend sessions and learn ways to support children at home. The ST or SLP will tailor the treatment plan to the child’s developmental stage. Early recognition and intervention (treatment) can help improve outcomes.

With adults, the ST or SLP will begin with an assessment to identify specific challenges. They will then create a specific care plan that addresses underlying concerns such as:

• Medical conditions
• Accent modification
• Voice challenges
• Pronunciation
• Conversational language
• Problem-solving
• Memory exercises

What To Expect During Speech Therapy

Speech therapy can occur in a class, small group, online, or one-on-one. Speech therapists typically assign exercises to practice at home in order to reinforce what you learn. Activities might include:

• Vocal warm-ups like humming 
• Tongue twisters to improve articulation
• Breaking words into syllables to improve clarity
• Contrasting word exercises—for example, "ship" versus "sheep"
• “Pausing” practice (for stuttering)
• Repetition after listening to a native speaker 
• Repetition exercises for sounds like “s” 
• Speech rate control—for example, by tapping hands to a beat
• Pitch exercises
• Breathing and posture exercises

Receptive language exercises include:

• Memory or problem-solving exercises
• Reading comprehension (similar to a book report)
• Speech supplementation (written, gestural, voice amplifier, speech-generating devices)
• Word association
• Communication partner exercises, such as practicing eye contact and active listening

Exercises for swallowing and feeding include:

• Diet modification (pureed to solid foods)
• Oral muscle strengthening (like tongue “push-ups”)
• Swallowing exercises

Benefits of Speech Therapy

One of the main goals of speech therapy is to enhance a person’s ability to express thoughts, ideas, and emotions effectively. This can lead to a greater sense of self-expression, meaningful interactions with others, and less frustration. Other benefits include:

• Greater self-confidence: Gaining more control over language and communication can increase confidence and boost self-esteem. As a result, you might be more willing and excited to engage in social activities. 
• Improved academic or professional performance: Clear speech and language can lead to enhanced skills in comprehension, reading, and writing. This can support academic success. Better articulation, language, and presentation abilities can help with career development.
• Greater independence: Speech therapy can lead to greater self-reliance, especially if you have severe communication challenges. For example, augmented and alternative communication (AAC) methods , such as speech-generating devices (SGDs), can allow you to express yourself more independently.

How Successful Is Speech Therapy?

Speech therapy's “success” depends on your goals. The meaning of success can vary based on your underlying communication or medical condition and its severity, as well as your motivation and commitment to therapy, the therapist's expertise, and your support systems. The time it takes to reach your goals also varies based on underlying factors like these.

For example, you may define success as improved pronunciation, or you may work towards more effective communication, more skilled accent modification, or swallowing without choking. If you stutter, your goal might be improved fluency or feeling more comfortable communicating openly with a stutter. For most people, what’s most important is to set realistic expectations and recognize that any improvement in communication is a success.

How To Find a Speech Therapist

A qualified speech therapist or speech-language pathologist holds a master's degree in speech-language pathology and state licensure to practice in your area. You can find speech therapists in settings like:

• Home health agencies
• Rehabilitation centers
• Private practice
• Telehealth (online)

You can also ask for recommendations from healthcare providers or school personnel who may know local speech therapists. The American Speech-Language-Hearing Association (ASHA) also offers an online directory of certified speech therapies to help you locate someone in your area.

Check with your health insurance provider to see if they cover speech therapy. They can provide you with information about your co-payments and deductibles. If your insurance doesn't cover the cost, the clinic or speech therapist may offer payment plans. Some children may also qualify for:

• Individualized education programs (IEPs) that cover speech therapy costs as a service from the school district
• Early intervention (EI) or Preschool on Preschool Special Education (CPSE) programs for infants and toddlers for little or no cost to families
• State and federal programs, like Medicaid
• Financial assistance programs from non-profit and advocate organizations

A Quick Review

Speech therapy is a specialized healthcare field in which trained professionals help improve speech, language, hearing, swallowing, and feeding for people of all ages. Speech therapists (STs) and speech-language pathologists (SLPs) thoroughly assess and develop specific treatment plans for a wide range of conditions including difficulty communicating or processing language, stuttering, and voice disorders.

Speech therapy takes place in locations like schools, hospitals, and private practice. It can be one-on-one or in a group setting. Success depends on underlying factors such as the severity of the condition. It also depends on personal goals and your definition of success—which can vary widely from person to person.

Many people who have speech therapy experience powerful benefits that affect them in nearly every aspect of life, including greater self-confidence and self-reliance.

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Sports | Curtis Blaydes embraced his stutter and…

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Sports | Curtis Blaydes embraced his stutter and transformed his fighting. Now, he’s on the doorstep of shot at UFC heavyweight belt

The golden resident is coming off a ko of jailton almeida.

Blaydes, the UFC’s fourth-ranked heavyweight contender, has been a rising mixed martial arts star for some time. But with the post-victory interviews came apprehension.

That’s because the Golden resident has dealt with a lifelong battle to overcome his own fears, and others’ negative perceptions, associated with his stutter.

“Initially, I dreaded the interviews more than I was nervous for the actual fight,” Blaydes said. “It would be like, ‘Oh (damn), I won, now I’ve got to do an interview.’ And I had to get over that, because if you expect to win, that means you expect to do interviews.

“Growing up in Chicago, kids were mean. They can be mean everywhere, but there’s a special type of meanness in the cities. … Obviously having a speech impediment, that’s easy ammo, and I had to get over that, too.”

Combatting misunderstanding

Blaydes’ stutter drew him to wrestling, where on the mat his imposing frame and uncanny athleticism helped him bridge the gap between who he really is and what people falsely assumed about him because of his speech impediment.

According to SAY, the Stuttering Association for the Young , about 5% of young children and approximately 1% of all people stutter.

SAY executive director Noah Cornman says that Blaydes is the type of high-profile person who can combat the misunderstanding of stuttering as well as give hope to kids with the neurologic disability.

Blaydes, who appeared at SAY’s 2022 benefit gala and has been in talks with the organization to bring a SAY event to the Denver area, explains that many “don’t understand that stuttering has nothing to do with a person’s intelligence.” That’s why for much of his youth, Blaydes avoided speaking in school.

“Curtis is (bringing awareness) simply by talking about it at all, and by embracing it,” Cornman said. “Stuttering remains fairly stigmatized. There’s definitely not as much understanding of stuttering amongst kids, and amongst adults, too. But to see him confident in being who he is, and getting in front of the camera, that’s a really inspiring thing for a young person who stutters.

“Sadly, bullying of people who stutter is accepted by too many, and it doesn’t have the same understanding as a lot of other differences. That’s part of what someone like Curtis and (SAY spokesman and Blue Jays outfielder) George Springer are able to do, is to help us with the education part of it.”

Becoming a heavyweight force

As Blaydes grew more comfortable with the limelight, he also morphed into one of the UFC’s best heavyweights. Blaydes is 18-4 since turning pro in 2014, and 13-4 since joining the UFC in 2016.

When he started in the UFC, he was a pure wrestler with no sense for striking or any other MMA discipline. A former junior college wrestling national champion at Harper College, Blaydes’ one-dimensional fighting was quickly exposed in his UFC debut when he was TKO’d by Francis Ngannou.

After that fight, Blaydes moved to Colorado and began training with Elevation Fight Team at two different gyms, High Altitude Martial Arts in Denver and Vital Training Systems in Wheat Ridge. The move jump-started Blaydes’ evolution into a well-rounded mixed martial artist now capable of striking with the UFC’s best.

“He didn’t always have the best attitude when he first started training,” recalls Vinnie Lopez, the founder of Vital and one of Blaydes’ two coaches. “You could tell he was a guy who got by on strictly talent and talent alone. So trying to get him to understand that he’s now in a place where everyone’s talented, and everyone has the same physical attributes that you do, was a bit of a process.

“But now, he’s dominating big names in such a way that he’s starting to believe what could be possible for him. When you get a guy like that with that type of physical prowess and technical skill level, and now he’s got the belief to go along with it — now is when we’re going to see who Curtis Blaydes actually is.”

Blaydes’ shot at the belt

To Lopez’s point, Blaydes is on the doorstep of a crack at the interim title belt, currently held by Tom Aspinall.

Blaydes’ next fight — and whether he’ll get a shot at Aspinall, whose lone UFC defeat is to Blaydes — will be determined by a variety of factors.

For one, there’s the status of the heavyweight belt, currently held by UFC all-timer Jon Jones. “Bones” hasn’t fought since claiming the title in a win over Ciryl Gane in March 2023, as he’s undergone a pair of surgeries on a torn pectoral muscle as well as his elbow.

As he’s been working his way back, Jones tweeted his intention for his next fight is to take on another UFC legend in Stipe Miocic, who was scheduled to duel Jones in UFC 295 last November before he suffered his pectoral injury. UFC boss Dana White also said that Jones versus Miocic could happen this summer, though Jones recently teased the possibility of fighting Aspinall or reigning light heavyweight champion Alex Pereira.

All that uncertainty’s left Aspinall, who claimed the interim belt at UFC 295, playing the waiting game.

It’s possible Blaydes could get a rematch against Aspinall, who suffered a knee injury just 15 seconds into their first fight, at UFC 304 in Manchester, England, on July 27. Aspinall has said he wants that rematch.  Should Blaydes beat Aspinall there or on another card, he’d get the interim belt and would be first in line for a crack at the title. Should Blaydes fight someone else and win, he’d still be right in the mix for his fight after that to be for the belt.

Biggest fights ahead

As Blaydes’ coaches point out, the heavyweight’s stutter plays into all of these projections. They believe the UFC considers him less marketable than other fighters.

“These guys have to be entertaining, they have to have a fan base, they have to sell more tickets, and that will always be a factor in determining title fights,” said Cody Donovan, the owner of High Altitude and Blaydes’ other coach.

“You either have to have a big mouth, you have to be the most technical, or you have to create a spectacle of violence with brutal, bloody knockouts. Curtis has got one realm. He has to go out there and smash people, and it’s got to be violent. Because there’s no question, the UFC would rather have a Jones or an Aspinall behind that microphone. So Curtis has to focus on his performance.”

Blaydes, who has eight UFC victories by KO/TKO, has delivered. Especially since his first-round KO loss to Sergei Pavlovich last spring, when Blaydes admits he was “very distracted” during camp by a custody dispute over his 5-year-old daughter, who now lives in Texas.

The heavyweight says being separated from his daughter continues to be difficult, but he’s made a conscious decision to focus on what he can control in his everyday life. The result of that perspective shift was a bounce-back win in his last fight — a second-round KO of Jailton Almeida after Almeida took down Blaydes nine times in the first round.

“He saw the writing on the wall after the last loss,” said fighter Zac Pauga, Blaydes’ main training partner. “He’s been a guy who’s gotten near the top several times, and lost and fallen down and had to work his way back. So he knew the situation he was in: If he loses again, he’s on his way out (of the UFC). Maybe not immediately, but it would be a string of hard fights from there. That really lit a fire under him and gave him a level of focus and dedication to everything in and outside of the gym.”

Whatever comes next, “Razor” Blaydes believes he’s in the best position he’s ever been in to get an eventual title shot after being a highly ranked contender for the past six years. The 33-year-old’s biggest fights are in front of him. And that, of course, includes his ongoing effort to not let his stutter affect his willingness to open up to UFC fans.

“Him exposing his true self is a (barrier), and we’ve been encouraging him along that route,” Lopez said. “But we’ve also gone the other way, too, like, ‘Hey man, let them hear about you. Let them hear the (expletive) stutter. Show these kids that have the same hurdle as you do that anything is possible.’

“This thing that has held him up his whole life, I really believe it could be a superpower for him.”

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