Stuttering  also called stammering or childhood-onset fluency disorder — is a speech disorder that involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say, but have difficulty saying it. For example, they may repeat or prolong a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they’ve reached a problematic word or sound.

Sometimes, however, stuttering is a chronic condition that persists into adulthood. This type of stuttering can have an impact on self-esteem and interactions with other people.

Children and adults who stutter may benefit from treatments such as speech therapy, using electronic devices to improve speech fluency or cognitive behavioral therapy.

Symptoms

Stuttering signs and symptoms may include:

• Difficulty starting a word, phrase or sentence
• Prolonging a word or sounds within a word
• Repetition of a sound, syllable or word
• Brief silence for certain syllables or words, or pauses within a word (broken word)
• Addition of extra words such as “um” if difficulty moving to the next word is anticipated
• Excess tension, tightness, or movement of the face or upper body to produce a word
• Anxiety about talking
• Limited ability to effectively communicate

The speech difficulties of stuttering may be accompanied by:

• Rapid eye blinks
• Tremors of the lips or jaw
• Facial tics
• Head jerks
• Clenching fists

Stuttering may be worse when the person is excited, tired or under stress, or when feeling self-conscious, hurried or pressured. Situations such as speaking in front of a group or talking on the phone can be particularly difficult for people who stutter.

However, most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak in unison with someone else.

When to see a doctor or speech-language pathologist

It’s common for children between the ages of 2 and 5 years to go through periods when they may stutter. For most children, this is part of learning to speak, and it gets better on its own. However, stuttering that persists may require treatment to improve speech fluency.

Call your doctor for a referral or contact a speech-language pathologist directly for an appointment if stuttering:

• Lasts more than six months
• Occurs with other speech or language problems
• Becomes more frequent or continues as the child grows older
• Occurs with muscle tightening or visibly struggling to speak
• Affects the ability to effectively communicate at school, at work or in social interactions
• Causes anxiety or emotional problems, such as fear or avoidance of situations where speaking is required
• Begins as an adult

Causes

Researchers continue to study the underlying causes of developmental stuttering. A combination of factors may be involved. Possible causes of developmental stuttering include:

• Abnormalities in speech motor control. Some evidence indicates that abnormalities in speech motor control, such as timing, sensory and motor coordination, may be involved.
• Genetics. Stuttering tends to run in families. It appears that stuttering can result from inherited (genetic) abnormalities.

Stuttering resulting from other causes

Speech fluency can be disrupted from causes other than developmental stuttering. A stroke, traumatic brain injury, or other brain disorders can cause speech that is slow or has pauses or repeated sounds (neurogenic stuttering).

Speech fluency can also be disrupted in the context of emotional distress. Speakers who do not stutter may experience dysfluency when they are nervous or feeling pressured. These situations may also cause speakers who stutter to be less fluent.

Speech difficulties that appear after an emotional trauma (psychogenic stuttering) are uncommon and not the same as developmental stuttering.

Risk factors

Males are much more likely to stutter than females are. Factors that increase the risk of stuttering include:

• Delayed childhood development. Children who have developmental delays or other speech problems may be more likely to stutter.
• Having relatives who stutter. Stuttering tends to run in families.
• Stress. Stress in the family, high parental expectations or other types of pressure can worsen existing stuttering.

Complications

Stuttering can lead to:

• Problems communicating with others
• Being anxious about speaking
• Not speaking or avoiding situations that require speaking
• Loss of social, school, or work participation and success
• Being bullied or teased
• Low self-esteem

Treatments:

After a comprehensive evaluation by a speech-language pathologist, a decision about the best treatment approach can be made. Several different approaches are available to treat children and adults who stutter. Because of varying individual issues and needs, a method — or combination of methods — that’s helpful for one person may not be as effective for another.

• Improve speech fluency
• Develop effective communication
• Participate fully in school, work and social activities

A few examples of treatment approaches — in no particular order of effectiveness — include:

• Speech therapy. Speech therapy can teach you to slow down your speech and learn to notice when you stutter. You may speak very slowly and deliberately when beginning speech therapy, but over time, you can work up to a more natural speech pattern.
• Electronic devices. Several electronic devices are available to enhance fluency. Delayed auditory feedback requires you to slow your speech or the speech will sound distorted through the machine. Another method mimics your speech so that it sounds as if you’re talking in unison with someone else. Some small electronic devices are worn during daily activities. Ask a speech-language pathologist for guidance on choosing a device.
• Cognitive behavioral therapy. This type of psychotherapy can help you learn to identify and change ways of thinking that might make stuttering worse. It can also help you resolve stress, anxiety or self-esteem problems related to stuttering.
• Parent-child interaction. Parental involvement in practicing techniques at home is a key part of helping a child cope with stuttering, especially with some methods. Follow the guidance of the speech-language pathologist to determine the best approach for your child.

Medication

Although some medications have been tried for stuttering, no drugs have been proved yet to help the problem.