Why do we stutter?

Why We Stutter

Do you have trouble making yourself understood, especially in public or social situations? If you’re a stutterer — faltering, halting, and hesitating as you speak — you’re not alone.

Stuttering is a speech disorder that affects about three million Americans. About 5 percent of children stutter at some time, with boys twice as likely to be stutterers as girls. Most kids “grow out” of their stutter by the time they become adults, but stuttering still affects about 1 percent of the adult population.

What’s the cause? It was once thought that the singular root of stuttering was anxiety, but today we know that’s not the case. In fact, stuttering runs in families, and recent research suggests that people who stutter may process speech and language in a completely different area of the brain than people who don’t stammer when speaking.

The case is far from closed, however. “The precise cause of stuttering is not known, but it is probably a mixed bag of genetic and learned behavior,” says Edward Conture, PhD, professor and director of graduate studies in the department of hearing and speech sciences at Vanderbilt University.

Stuttering and Stress: What’s the Connection?

But there is a link between stuttering and anxiety: In fact, the speech disorder can actually increase anxiousness. “If children become adults who stutter, anxiety and stress often become a part of the problem,” says Tedra Walden, PhD, a professor in the department of psychology and human development at Vanderbilt.

Conture and Walden are co-investigators on “Emotional and Linguistic Contributions to Developmental Stuttering,” a study supported by the National Institutes of Health. “The arrow goes both ways,” says Conture. “Anxiety contributes to stuttering and stuttering leads to anxiety.” It may even increase the risk of an anxiety disorder — anxiety that is excessive and present even without good reason.

“Children who stutter may show certain personality traits. These can include being overly emotional and having trouble adapting to their emotions,” notes Conture. Some research shows that people who stutter are socially anxious and that children with speech disabilities are at higher risk for anxiety disorder as adults.

“Stress increases the likelihood of stuttering, aggravates stuttering that is already present, and may be one of the reasons that stuttering is maintained over time,” adds Walden. Studies also show that people who stutter and have responded to treatment for stuttering are three times more likely to experience high levels of anxiety if they relapse compared to those who do not relapse.

How to Stop Stuttering — for Good

There are two general types of anxiety treatment for people who stutter. “Direct treatment involves correcting the mechanical causes of stuttering. Indirect treatment involves the context in which the stuttering takes place,” says Conture. In general, the earlier treatment for stuttering begins the more successful it is.

“There is no one-size-fits-all stuttering treatment. Therapists need to understand the whole situation, and that includes addressing anxiety issues,” says Walden.

Treatment strategies for stuttering include:

  • Learning how to control the anxiety, fear, and tension associated with social speaking
  • Teaching parents of children who stutter strategies, such as patient listening and positive reinforcement
  • Helping people who stutter to slow down their speech and regulate their breathing
  • Having people who stutter participate in self-help support groups

“We know a lot more about stuttering then we did before,” says Conture. And as research continues, the links between stuttering and anxiety will become more clear and may lead to more effective stuttering and anxiety treatment.

If you live with stuttering and anxiety or have a child who does, information and support are available at the Stuttering Foundation and the National Stuttering Association.

Adult Stuttering and Stammering (Adult Dysfluency)

Adult stuttering or stammering (dysfluency) is a common disorder and can have a major impact on the life and wellbeing of many adults. The term stutter and stammer will may be used interchangeably in this section, but means the same thing.

Dysfluency is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables or words, and involuntary silent pauses or blocks in which the dysfluent person is unable to produce sounds. Dysfluency in adulthood is something that has usually been present since the individual was a young child, but can present in adulthood as the result of a head injury or neurological event.

When the dysfluency remains unresolved through to adulthood it can cause individuals to be very embarrassed and self aware and affect their career progression and relationships. Many adult stammerers claim that the disorder has affected their lives making them avoid many social situations and affecting their confidence.

There are a number of different types of treatment, and a few treatments that claim to be “miracle cures”. For some people these treatments work, but sometimes only temporarily. Many experts in this field believe that unless you tackle underlying psychological issues of dysfluency you will not be able to address the problem thoroughly and make lasting changes.

What causes adult stammering / stuttering?

Brain scans have found interesting differences in brain activity between stammerers and non-stammerers. Stammerers showed more activity in their right hemispheres during speech. The right hemisphere is more associated with emotions, so it could be that the fear of speaking is causing anxiety which is causing the right hemisphere to become more involved. However, it could be that the left hemisphere is not functioning properly and the right hemisphere is trying to take on work that it is unsuited for.

Other brain scan data shows physiological differences in the brain, with different levels of activity between certain brain mechanisms when comparing stammerers and non-stammerers. However, this may just have been the way the dysfluent person’s brain has developed through childhood because of the stammerer. Whatever the cause, most dysfluent individuals have to live with their stammer and the anxiety and stress that they feel when they communicate with other people. The anxiety and stress itself, can often make the stammer worse.

To try and put yourself in the shoes of someone who stammers, imagine you have a stammer of which you are very aware. You are queuing in the post office, wanting to post a parcel to France and you want to buy some stamps. As you queue you feel nervous, you don’t want to annoy the post office clerk and you don’t want hold up the line behind you. You start to get increasingly nervous, and so you start to silently rehearse what you want to say to the clerk. The tension builds as you get closer to the front of the queue and you keep silently rehearsing what you want to say. When you get to the front of the queue you are so uptight you cannot remember what you rehearsed, your speech gets stuck, you struggle to say what you want to say. You are feeling more tense and embarrassed. Then the clerk asks you how many stamps you need. You had not rehearsed that answer so you blurt out “ten”. You only wanted six stamps but you know that sometimes you have more difficulty with words beginning with “s”.

If this is how someone feels when they go to the post office, imagine what it must be like to go to work, to go shopping, to catch a train, and to meet unfamiliar people every day.

There are a few other causes of adult dysfluency:

Neurogenic stuttering – following a strokes or head injury, stutter-like symptoms can present in adults. Neurogenic stuttering presents with repetitions, prolongations, and blocks.

Psychogenic stuttering – this rare condition often begins suddenly following an event causing extreme psychological stress. It is characterised by repetition of initial or stressed syllables.

Spastic dysphonia – this presents with a repeated blockage of the larynx and the onset is generally in middle age.

These other causes of dysfluency are relatively rare and sometimes do not have the same emotional impact on the individual. If you have concerns about a stammer or stutter, visit a qualified speech therapist /pathologist for assessment and speech therapy.

In Dysfluency Treatment Section, we discuss some of the options available to dysfluent adults.

For more information about communication difficulties, and ideas and strategies to help communication, see our Resources.

Recommended Reading

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Stuttering and stammering

  • What is stuttering?
  • How common is it?
  • Does stuttering have a physical or psychological cause?
  • Some related complaints and variants on stuttering.
  • Where can I get more information and help with stuttering?

What do Marilyn Monroe, Winston Churchill and Irish politician Proinsias de Rossa all have in common? At some time in their lives, they were people who stutter. Clearly their speech disorders did not hinder them in pursuing very successful lives. For many other people who stutter, however, the combination of embarrassment, loss of control, and being made to feel stupid by non-stutterers can be devastating to self-confidence.

What is stuttering?

Stuttering, also known as stammering, is primarily characterised by repetitions, pauses, and prolongations in speech. Stuttering usually occurs on the initial sound or syllable of a word, in the first word of a sentence, on accented syllables, and on ‘content’ words. ‘Content’ words carry the meaning of a sentence, which is why when listeners guess what a stutterer is trying to say, they often get it wrong.

Stuttering usually starts around the time that language skills are developing, and onset is generally gradual in nature. Late-onset developmental stuttering is rare. Some stutterers will be more fluent in some situations than others and the same person can be more fluent at some times than others. This variability can cause tremendous frustration on the part of the stutterer.

Studies have shown that stuttering increases when saying one’s name, speaking on the telephone, speaking to an authority figure, or speaking to an audience. Equally, stuttering decreases when saying a phrase repeatedly, speaking in chorus with another person, when speaking alone or to animals, when singing, using a lower pitch, using a different accent, using electronic anti-stuttering devices, and even when crawling on all fours.

How common is it?

Stuttering affects four times as many males as females. Some 25% of all children go through a stage of development during which they stutter. Around 4% may stutter for six months or more. As children get older, the prevalence drops to about 1% in primary and secondary school, and to about 1% for adults.

At two and three years of age, equal numbers of boys and girls stutter. The sex ratio becomes three males for every female by the age of five and four to one by the age of 10, the same ratio as adults. Of adult stutterers, 80% are men.

Does stuttering have a physical or psychological cause?

There is nothing wrong with stutterers’ tongues, vocal folds or breathing. Stutterers are not more nervous, do not necessarily have worse self-esteem, and are as likely to be intelligent and well-adjusted as non-stutterers.

Stuttering is a developmental disorder. Some experts believe that stuttering develops from the normal mistakes all children make when learning to talk. While most children can pick themselves up after a stumble, some children get into a vicious cycle of trying harder to talk, tensing their speech production muscles too much, and getting more stuck.

Other experts have found that severe stuttering can develop almost overnight in young children. They believe that stuttering may not develop gradually from normal disfluencies or language difficulties. Genes have been found associated with stuttering, so some experts believe that a genetic defect causes something in the child’s brain to trigger stuttering.

Although the origin of stuttering is not clear, everyone agrees that childhood stuttering can develop into a severe physical and psychological disability. Adults who stutter can have physical symptoms, including:

  • Breathing abnormalities during stuttering, especially upper chest tension.
  • Laryngeal blocks, which cut off airflow during stuttering.
  • Articulation problems, including tension in the lips, jaw and tongue, and prolonged or repeated sounds.
  • Secondary or ‘escape’ behaviours, such as twitching, head jerks, eye blinking, or facial grimaces.

The psychological symptoms of adult stuttering can include:

  • Avoidance of feared sounds, words, and speaking situations. For example, the stutterer may avoid making telephone calls.
  • Substitution of another word.
  • ‘Anti-expectancy’ speech behaviours to prevent stuttering such as speaking in a monotone, or affecting an accent.

Some stutterers are so good at avoidance that their co-workers and even their spouse or family don’t know that the individual stutters. Even though their speech sounds fine, these ‘covert’ stutterers can be crippled by severe psychological fear and anxiety.

Some related complaints and variants on stuttering

  • Cluttering
  • Neurogenic stuttering.
  • Psychgenic stuttering.
  • Spastic dysphonia.
  • Tourette’s syndrome

Cluttering

Cluttering is what happens when speech becomes literally cluttered with faulty phrasing and unrelated words to the extent that it is unintelligible. Unlike stuttering, which involves hesitation and repetition over key words, cluttering usually includes effortless repetition of syllables and phrases. The affected person is often not aware of any communication difficulties.

Cluttering is a disturbance in the fluency of speech. People who clutter often speak at a more rapid rate than normal, which causes them to stumble and double back in their attempt to impart meaning. It is characterised by a poor attention span, perceptual weakness and poorly organised thinking.

Neurogenic stuttering

Strokes and head injuries can cause stuttering-like symptoms in adults. Neurogenic stuttering has repetitions, prolongations, and blocks. Neurogenic stutterers lack the facial grimaces, eye blinking, and fears and anxieties of developmental stuttering.

Psychogenic stuttering

Adult psychogenic stuttering begins suddenly after an event causing extreme psychological stress. It is characterised by repetition of initial or stressed syllables, lack of conditions inducing fluency, an indifferent attitude toward the disorder, and maintenance of normal eye contact. Psychogenic stuttering is rare.

Spastic dysphonia

Spastic dysphonia is a repeated blockage of the larynx. The onset is in middle age, and the disorder affects an equal number of men and women.

Tourette’s syndrome

Tourette’s syndrome is akin to stuttering with your hands and feet. Touretters compulsively touch objects, and some have verbal symptoms such as barking or saying obscenities. Like stuttering, these behaviours are situational, but trying to not do the behaviours makes the behaviour stronger.

Where can I get more information and help with stuttering?

Speech therapy can aid people who suffer significantly. Your GP can refer you to a therapist. For information and support for people who stutter, there is the Irish Stammering Association, a registered Charity founded in 1994. The Association seeks better help for both children and adults who stammer. They can advise doctors, health officials and the general public on the facts of stuttering.

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Fluency Disorder

When you have a fluency disorder it means that you have trouble speaking in a fluid, or flowing, way. You may say the whole word or parts of the word more than once, or pause awkwardly between words. This is known as stuttering. You may speak fast and jam words together, or say “uh” often. This is called cluttering.

These changes in speech sounds are called disfluencies. Many people have a few disfluencies in their speech. But if you have a fluency disorder, you will have many disfluencies when you talk. For you, speaking and being understood may be a daily struggle.

Signs of a fluency disorder

A fluency disorder causes problems with the flow, rhythm, and speed of speech. If you stutter, your speech may sound interrupted or blocked, as though you are trying to say a sound but it doesn’t come out. You may repeat part or all of a word as you to say it. You may drag out syllables. Or you may talk breathlessly, or seem tense while trying to speak. If you clutter, you often speak fast and merge some words together or cut off parts of them. You may sound like you are slurring or mumbling. And you may stop and start speech and say “um” or “uh” often when talking.

Some people have both stuttering and cluttering. They may also have what are known as “accessory” or “secondary” behaviors. These methods are used to try to avoid or cover up disfluencies. These behaviors can include:

  • Covering your mouth or pretending to cough or yawn to cover up stuttering

  • Not speaking, even when you want or need to

  • Not using certain words that seem to cause stuttering

  • Pretending to forget what you wanted to say

  • Rearranging words in sentences

  • Using “filler” sounds between words to make the rate of speech sound more normal

Children with fluency disorders also may develop beliefs that can hinder them later on. For example, a child who stutters may decide that speaking is difficult by nature. Fear, anxiety, anger, and shame involving speaking are also common.

What causes a fluency disorder?

The exact causes of fluency disorders are not known. It may be genetic and run in families. It can happen at the same time as another speech disorder. The signs of a fluency disorder can be made worse by emotions such as stress or anxiety.

Diagnosing and treating fluency disorders

Experts feel it is important to assess and address speech disorders early. Children who struggle with speech can find school and community activities challenging or painful because they are not able to communicate their thoughts. They might even have problems developing friendships.

A fluency disorder can be diagnosed by a speech-language pathologist (SLP). An SLP will ask about your medical history and listen to you speak. The SLP may do an oral-mechanism exam and testing of speech-language skills.

Once you are diagnosed, an SLP can use exercises and strategies to help you speak more fluently. A fluency disorder is not something that can be cured. But an SLP uses different kinds of methods to help you manage speech day-to-day. These methods can reduce the number of disfluencies in your daily speaking.

An SLP can help you lower your own stress around moments of fluency problems. The SLP will work on changing your negative feelings, thoughts, and beliefs about your speech. He or she will help you reduce the use of accessory behaviors. You will learn strategies such as speaking in shorter sentences, and control your breathing and the rate of your speech. An SLP will often talk with family, caregivers, and teachers about the disorder and how to help.

If someone you know has a fluency disorder:

  • Use available resources. Public schools are required to assess children with communication disorders and, if the child meets certain criteria, provide treatment services. If you have a child as young as age 3 with communication problems, contact your local public school’s office and talk to the principal about assessment options.

  • Be patient and supportive. As frustrating as it is for you to try to understand someone with a fluency disorder, it can be much more frustrating for that person who has it. Be as patient as you can while the person works on his or her speech.

  • Be kind. Making fun of a person with a fluency disorder is a form of bullying. It is destructive and may take away the person’s desire to communicate.

  • Join a support group. Many fluency disorders, such as stuttering, have support groups. Spending time with other families coping with fluency disorders can be helpful.

Stuttering

What is 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.

Who stutters?

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.

How is speech normally produced?

We make speech sounds through a series of precisely coordinated muscle movements involving breathing, phonation (voice production), and articulation (movement of the throat, palate, tongue, and lips). Muscle movements are controlled by the brain and monitored through our senses of hearing and touch.

What are the causes and types of stuttering?

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.

How is stuttering diagnosed?

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.

How is stuttering treated?

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.

What research is being conducted on 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.

Where can I find additional information about stuttering?

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:

  • Stuttering
  • Speech-language pathologists
  • Physician/practitioner referrals

People have found stuttering confusing for centuries, and as with so many mysteries, they have tried to explain it with folklore. For instance, people in some cultures once believed that a child stuttered because his mother saw a snake during pregnancy or because he ate a grasshopper as a toddler. We now know that stuttering is probably neurological in origin, may have genetic origins, and often results in emotional components.

However, myths about stuttering persist today. Here are just a few of them:

  • People stutter because they are nervous. Because fluent speakers occasionally become more disfluent when they are nervous or under stress, some people assume that people who stutter do so for the same reason. While people who stutter may be nervous because they stutter, nervousness is not the cause.
  • People who stutter are shy and self-conscious. Children and adults who stutter often are hesitant to speak up, but they are not otherwise shy by nature. Once they come to terms with stuttering, people who stutter can be assertive and outspoken. Many have succeeded in leadership positions that require talking
  • Stuttering is a psychological disorder. Emotional factors often accompany stuttering but it is not primarily a psychological condition. Stuttering treatment often includes counseling to help people who stutter deal with attitudes and fears that may be the result of stuttering.
  • People who stutter are less intelligent or capable. People who stutter are disproving this every day. The stuttering community has its share of scientists, writers, and college professors. People who stutter have achieved success in every profession imaginable.
  • Stuttering is caused by emotional trauma. Some have suggested that a traumatic episode may trigger stuttering in a child who already is predisposed to it, but the general scientific consensus is that this is not usually the root cause of the disorder.
  • Stuttering is caused by bad parenting. When a child stutters, it is not the parents’ fault. Stress in a child’s environment child can exacerbate stuttering, but is not the cause.
  • Stuttering is just a habit that people can break if they want to. Although the manner in which people stutter may develop in certain patterns, the cause of stuttering itself is not due to a habit. Because stuttering is a neurological condition, many, if not most, people who stutter as older children or adults will continue to do so—in some fashion—even when they work very hard at changing their speech.
  • Children who stutter are imitating a stuttering parent or relative. Stuttering is not contagious. Since stuttering often runs in families, however, children who have a parent or close relative who stutters may be at risk for stuttering themselves. This is due to shared genes, not imitation.
  • Forcing a left-handed child to become right-handed causes stuttering. This was widely believed early in the 20th century but has been disproven in most studies since 1940. Although attempts to change handedness do not cause stuttering, the stress that resulted when a child was forced to switch hands may have exacerbated stuttering for some individuals.
  • Identifying or labeling a child as a stutterer results in chronic stuttering. This was the premise of a famous study in 1939. The study was discredited decades ago, but this outdated theory still crops up occasionally. Today, we know that talking about stuttering does not cause a child to stutter.

These are just a few of the common myths out there. Instead of perpetuating such myths, it is important to have the Facts About Stuttering!

Recently we received a tweet from a follower of @Duarte requesting advice to help a stuttering presenter. “The presenter is competent with the material,” the message said, “but gets nervous and begins to stutter on stage.”

As a speech-language pathologist, I immediately began thinking of stuttering from a clinical perspective. I had flashbacks of a project my professor assigned in graduate school. We were to go to a public place and speak with a stutter. Complete with hesitations, blocks, stops, and repetitions. We were asked to take note of the listeners’ reactions.

The range of reactions I received was fascinating. Yes, most people were visibly uncomfortable. But they gave encouraging smiles, tried to finish my sentences to help me, and overall displayed a tremendous amount of patience and empathy. I got the sense that people really felt for me.

As you can imagine, it’s incredibly frustrating to be unable to express yourself.

It was a valuable experience for me, as a communication professional, because I realize that while public speaking is in no way comparable to a clinical diagnosis of stuttering, the struggle to communicate is a common thread between them. As our tweeter shared, there are moments in public speaking when your nerves take over and your speech quality suffers.

Luckily, just as there are clinical therapy techniques to help a stutterer ease her speech, public speakers have options, too.

7 Tips for How to Stop Stuttering When You Give Presentations

Recognize that stuttered speech is really performance anxiety rearing its ugly head. Use the following tips to help you relax and speak clearly.

1. Visualize Something Positive

There are two types of visualizations you can try to reduce your performance anxiety during a presentation. The first is to visualize yourself successfully giving a smooth performance before you go on stage. Multiple studies have shown that people who visualize themselves delivering a smooth talk, perform better than those who don’t. You can also try visualizing something that makes you feel happy and relaxed. Or imagine someone or something you love—that’ll calm you down and comfort you. For example, I’ve seen great speakers use this technique with images of their children on the podium.

2. Get Familiar With the Presentation Space

Make sure you’re familiar with the space in which you’ll be delivering your talk. That way, there’s nothing surprising about it when it’s time to present. If possible, visit the venue a few days before your talk, practice as much as possible, and ask questions about the set-up so you feel well prepared. Stuttering often occurs when we’re distracted. Becoming familiar with the space and your surroundings will minimize those distractions and will reduce the fast heart rate and irregular breathing that can lead to stuttered speech.

3. Rehearse, Rehearse, Rehearse.

One of the ways to prevent stuttering in a presentation is to rehearse. Rehearsing is key to ensuring you’re familiar with your material before you go onstage. If you have the opportunity to rehearse in the venue where you’ll be delivering your talk, that’s ideal. If you can’t, try practicing in front of a comfortable audience, video record yourself, or even audio record yourself. Receiving some kind of feedback will help guide the way you rehearse. It’s difficult to memorize your entire presentation, but make sure you focus on your opening and closing. If you start off with smooth speech, you’re likely to continue in that pattern. And of course, you want to end with a bang. Even if you end up stuttering in the middle of your speech, your audience will remember your impressive intro and conclusion.

4. Take a Deep Breath or a Lot of Deep Breaths

Before you go on stage, focus on the pace of your breathing. Inhaling and exhaling long, slow breaths will calm you and reduce your heart rate. Once you get a good feel for this controlled rate of breathing, try to be conscious of it when you’re on stage. If the adrenaline kicks in, your heart races and your speech becomes stuttered, it will be difficult for your audience to understand you. Use deep breathing techniques to quell anxiety and get rid of its physical symptoms. In a study on performance anxiety, Australian researchers found that musicians who practiced deep breathing before performances were able to lower their blood pressure and increase blood-oxygen concentration. They recommend:

“Before reaching for the beta blockers anyone facing an anxiety-provoking situation might want to try an extremely low-cost alternative, guaranteed to not produce any negative side effects. Perhaps the simplest way to let go of fear is to slowly, mindfully exhale.”

5. Channel Nervous Energy Through Body Movement

Think of the adrenaline your body gives you before a physical activity or competition. That adrenaline gives you the energy you need to perform. In sports, we’re trained to think of this as a good thing. Why are we trained to think this is bad in a business setting? Use it for good! If you need a more physical way to channel your energy, move around a bit onstage.

A slow, steady walk across the stage can set a rhythm that will slow down your thinking, set the speed of your speech, and reduce the confusion that often leads to stuttering. Make sure you’re not pacing constantly or quickly, however, as that will distract your audience. You can also channel that energy by using purposeful gestures that are varied and congruent with your content. Try not to use the same repetitive movements because that can distract your audience. Listeners will appreciate that you shared that great energy through natural, smooth movements and probably won’t even notice your nerves.

6. Slow Down

When stuttered speech occurs, it’s usually because your mind and mouth are not in sync. The obvious solution is for you to slow down. Easier said than done when you’re on stage and nervous. There are two easy solutions to reduce your speech pace. The first is to over-articulate. Use your lips, tongue, and jaw to exaggerate your word pronunciation. You’re going to feel as if you’re speaking to a group of non-native English speakers or to your grandmother who’s hard of hearing. That’s good! Over-articulating stretches out your words and slows you down. The second option is to pause. Speakers are so afraid of silence. A few seconds feels like forever to someone who’s nervous. But when you stop talking, you allow your brain to catch up. You’re able to think about your next thought and get back on track.

7. Get Some Sleep

Many speakers think if they cram lines and practice until the very last minute, the presentation will go more smoothly. While we absolutely suggest rehearsing, over preparation can harm you. In other words, please don’t stay up all night rehearsing and memorizing! That will not calm you and may, in fact, make you more nervous and cause stuttered speech. Instead, make sure you are well-rested for your talk. Studies show that people who skip sleep to study end up performing worse on tests and tasks than those who studied less but took the time to rest. Fatigue is just as likely to inhibit your performance as lack of preparation, because when we’re tired, it’s difficult to concentrate. Preparing isn’t only about practicing. It’s also about letting your mind take a well-deserved break.

We’ve worked with a wide variety of speakers. From first-timers all the way to experienced C-suite executives. At one point or another, they’ve all been nervous, and it’s affected the way they present. If you’ve suffered from stuttered speech, the above tips can help you when delivering a crucial presentation to your team or a high-stakes speech to a client. It’s normal to be nervous, but taking concrete steps to overcome your presentation fears will help you remain calm. By improving your physical anxiety symptoms, you may be able to eliminate stuttered speech once and for all.

Stuttering Myths, Beliefs and Straight Talk for Teens

There are also many cool people who stutter that are still being discovered. Taro Alexander is the founder and artistic director of the Our Time Theatre Company and Camp Our Time, an artistic home for people who stutter. Taro is an actor who has been in STOMP and Law and Order. Eric Jackson is a guitar player in three New York City bands, founder of a self-help group for people who stutter in Brooklyn, co-host of the StutterTalk podcast and is studying to be a speech pathologist. And Caryn Herring has been featured on MTV “s True Life series talking about stuttering and is studying to become a speech pathologist.

Resources

FRIENDS: The National Association of Young People Who Stutter – A self-help organization focusing on teenagers, children, families and professionals. Contact: 866-866-8335, www.FriendsWhoStutter.org, [email protected]

The National Stuttering Association (NSA) – A self-help organization for adults, teens and children who stutter, families and professionals with local chapters across the United States. Contact: 800-937-8888, www.WeStutter.org, [email protected]

The Stuttering Association for the Young (SAY) – Are comprised of young people who stutter ages 8-19, who study acting, singing, playwriting, drumming and dance with professional artists. Contact: 212-414-9696, www.say.org, [email protected]

Films, DVDs, Videos, Podcasts, and eBooks – A great way to view, hear and learn from other people who stutter.

  • Do You Stutter: A Guide for Teens (book; code 0021) – Solid and supportive information for teenagers who stutter. Available at www.stutteringhelp.org.
  • Self-therapy for the Stutterer (book; code 0012) – A classic written for teens and adults who stutter. Available at www.stutteringhelp.org as an eBook or for purchase.
  • If You Stutter: Advice for Adults – Available for viewing or purchase through the Stuttering Foundation at www.stutteringhelp.org.
  • Transcending Stuttering: The Inside Story (for mature teens and adults) – Available for viewing or purchase at www.stutteringmovie.com.
  • StutterTalk Podcast – Available for listening and download at www.StutterTalk.com and via iTunes. Episodes 46 and 47 feature teenagers who stutter.
  • YouTube.com – Offers many stuttering related videos which vary in range of content and quality.

Finding a Speech-Language Pathologist (SLP)

Stuttering Foundation ” Go to www.stutteringhelp.org and click on “Resources” or call (800) 992-9392.
Contact FRIENDS or the NSA for help finding an SLP near you (contact info above).

Stuttering Foundation Tools

Advice to Those Who Stutter – Helpful information and suggestions for people who stutter.
Stuttering: Straight Talk for Teens – Available for viewing or purchase through the Stuttering Foundation at www.stutteringhelp.org.

The overt symptoms of stuttering sometimes cause observers to make assumptions about stuttering that are incorrect. For example, the nervousness and rapid speaking rate often seen in children who stutter is not the cause of their stuttering. Rather, it is a symptom of trying to cope with stuttering. Consequently, advice to “just relax” or “slow down” may sometimes address the behavioral symptoms of speaking, but it does not affect the stuttering itself. In other words, the nervousness and rapid rate of speech result from the fear of stuttering and being embarrassed.

Current theories point to a complicated interaction between children’s language development and their motor abilities for producing speech, combined with the multiple influences of the child’s personality and the child’s communicative and social environment. In other words, there is no single cause for stuttering, so simple explanations such as “he’s talking too fast” or “he’s nervous” do not adequately explain this complicated disorder. Recent research on a number of fronts supports this idea of stuttering as a multifactorial disorder. For example:

  • Neuroimaging studies using PET scans or functional MRI to examine adults who stutter have shown different patterns of brain activation when they stutter, with more activation of right hemisphere areas and differing patterns of usage of left hemisphere, subcortical, and cerebellar structures.
  • Many people who stutter perform less well on various measures of auditory processing, motor timing, integrating complex motor tasks, and some neuropsychological measures of hemispheric dominance.
  • Stuttering tends to run in families, and recent research appears to indicate a genetic link for at least some individuals. Most theorists believe that a predisposition to stuttering may be heritable but its expression may be largely determined by the environment.
  • Many children have concomitant problems besides stuttering, such as other speech or language development problems, learning disabilities, ADHD, etc., that may contribute to the disorder or indicate a more pervasive underlying etiological factor.

What can be said with a least some degree of empirical support is that NO single factor has been shown to be THE cause of stuttering.

  • Stuttering is not caused by children’s parents
  • Stuttering is not caused by drawing attention to a child’s normal disfluencies
  • Stuttering is not a psychological problem (though it can have psychological consequences)
  • Stuttering is not a sign of reduced intelligence, motor weakness, or neurological injury
  • Stuttering is not simply a bad habit

Note: Original material provided by Larry Molt, PhD, CCC-SLP (Auburn University).

It seems stammering is having a moment: Early this morning, “The King’s Speech” received 12 Academy Award nominations, more than any other film this year. One of those nods went to Colin Firth, who many expect to win for his portrayal of King George VI, the English king with a debilitating stammer. Now the speech impediment is allthe Internetcan talk about.

But one type of stammer that’s not being widely discussed is sudden onset stuttering. For most, stuttering begins in childhood, while children are developing language skills – but in rare cases, it can come come on suddenly, mangling the speech of adults who’d never struggled with the problem before.

The cause of sudden onset stuttering is either neurogenic (meaning the brain has trouble sending signals to nerves, muscles or areas of the brain that control speaking) or psychogenic (caused by emotional problems). A sudden stutter can be caused by a number of things: brain trauma, epilepsy, drug abuse (particularly heroin), chronic depression or even attempted suicide using barbiturates, according to the National Institutes of Health.

In sudden cases sparked by underlying psychological issues, “often times, you can find that it’s not so sudden; there might be a history of stuttering that had been outgrown,” says Dr. Tommie L. Robinson, former president of American Speech-Language-Hearing Association and director of the speech and hearing program at Children’s Nation Medical Center in Washington, D.C.

According to one 1998 case report, a 30-year-old woman hit her head in a car crash, and the trauma to her brain appeared to cause a temporary stutter. And in a 1982 case, a 28-year-old man developed a stutter after a suicide attempt; his doctors believe his sudden speech impediment was the result of psychological distress.

The movie hints that the king’s trouble with speech may have been psychogenic, as it may have been the result of the extreme pressure he felt from his father. (When he begins to have trouble getting out the words, his father demands, “Get it out, boy!” Not exactly helpful.) Experts once believed all cases of stuttering were psychogenic, but that particular cause is actually known to be very rare. In fact, last year scientists isolated three genes that cause stuttering.

Oh, and in case you were wondering: stuttering and stammering are synonymous, Robinson says. “‘Stammering’ is more of a British thing,” he explains.

Some quick facts on stuttering from the National Institute on Deafness and Other Communication Disorders:

  • Stuttering affects people of all ages, but it most often begins in children ages 2 to 5, as they develop language skills.
  • About 5 percent of all children stutter at some point in their life.
  • Boys are twice as likely to stutter as girls – and as they grow up, the number of boys who continue to stutter is three to four times larger than the number of girls.
  • Most children grow out of their stutter. Only about 1 percent of adults stutter.

You can find The Body Odd on Twitter and Facebook, and follow Melissa Dahl @melissadahl.

Overview


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.

Talking problems 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, some of these problems resolve or the brain can compensate, which is why many children “grow out” of stammering.

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.

Variations & Complications

Types of acquired stammering

Below are the main types of acquired stammering.

1. Neurogenic stammering

Neurogenic stammering is the most common type of acquired stammering. It is caused by some kind of brain trauma such as a stroke, head injury or brain tumour. Other causes include Alzheimer’s disease and Parkinson’s disease.

Having a stroke is the most frequent cause of neurogenic stammering – a stroke is a blood clot or bleeding in the brain, resulting in damage to a specific part of the brain. Stammering is one of several different speech problems which can occur as a result of a stroke or brain injury. Speech problems associated with a stroke may only last a few hours, but they should not be ignored, so seek medical advice immediately.

Check out Stroke Association’s website for information about communication problems after a stroke and about speech and language therapy for stroke patients.

2. Drug-related stammering

Stammering can sometimes occur as part of an adverse reaction or side-effect whilst taking medication or other drugs. If you are taking a prescribed medicine and find you are affected by any sort of speech problem, consult your doctor immediately. They may be able to prescribe an alternative medicine or adjust the dosage so that side-effects are minimised.

Drug-related stammering will almost certainly disappear completely if you stop using the drug but this might not always be an option.

3. Psychogenic stammering

A stressful event, or a series of events that affects you psychologically, can sometimes result in stammering. This is known as ‘psychogenic stammering’. Common sources of stress include a major bereavement or loss of a relationship. A reaction to stress can also follow after an accident, for example a car crash. In this sort of situation it’s not always easy to work out if the stammer is stress-related or has a neurogenic cause, for example a head injury which may have gone undiagnosed (see above for neurogenic stammering).

Psychogenic stammering is likely to improve when the event or situation no longer causes you stress or anxiety. Some sources of stress, such as a bereavement, may be long-lasting and in these situations counselling can help. Cruse is a national charity offering counselling to the bereaved. Visit the Cruse website here.

Sometimes stress-related stammering does not disappear once the cause of stress has been removed or overcome. In any case, it’s best to get help from a speech and language therapist.

4. Re-occurrence of a childhood stammer

Some people start stammering in early childhood then stop as they grow up, but find it re-occurs at some point in adulthood. This is a complex area for several reasons. Firstly, you may have gone through a period of stammering when you were very young but don’t remember it.

Secondly, stammering can sometimes be almost completely covert or hidden. Some people who stammer cope with it by avoiding particular words, sounds or speaking situations from an early age so that hardly any stammering is noticeable (see our information on covert stammering below). These habits can become so ingrained that you no longer think of yourself as someone who stammers. However, these ways of coping can sometimes break down without warning, perhaps as a result of added pressure in your life, or for reasons which can’t be explained.

If a childhood stammer re-occurs and you would like to do something about it, try speech and language therapy. Even if you had speech and language therapy when you were younger but it didn’t help, it is worth trying again because you may have changed and therapy has certainly changed.

5. Individual causes of stammering

Sometimes it may not be possible to find out what has caused acquired stammering. When no cause is identified, this is known as as ‘idiopathic stammering’, which means it relates purely to the person concerned and does not fall into any of the above categories.

Getting help

If you start stammering as an adult and would like to get help, start by going to your GP. It is also useful to see a speech and language therapist. In most parts of the UK you can refer yourself directly to your local NHS speech and language therapy department. Search online for ‘adult speech and language therapy + your location’ or call the Stamma helpline on 0808 802 0002 and we’ll help. If you can afford it, you can also see a private speech and language therapist – contact the Association of Speech and Language Therapists in Independent Practice.

Meeting other people who stammer is a good way of getting support. See if there is a group near you by going to our Local groups page.

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