Stuttering

Answer 1

Definition

Stuttering is a speech disorder that involves involuntary hesitation, repetition ("ca-ca-ca-can"), or prolongations ("llllllike") while speaking.

Alternative Names

Children and stuttering; Speech disfluency

Causes, incidence, and risk factors

About 5% of children aged 2 - 5 go through a short period of stuttering, but this phase is very brief. For a small percentage (less than 1%), the stuttering progresses from simple repetition of consonants to repetition of words and phrases. Later, vocal spasms develop with a forced, almost explosive sound to the speech.

Stuttering tends to run in families, but it is unclear to what extent genetic factors are important. There is also evidence that stuttering may be associated with some neurological events, such as stroke or traumatic brain injuries. Psychological components tend to make the symptoms worse or better within each case.

Stuttering is rarely considered a psychological problem. Stressful social situations and anxiety, however, can make symptoms worse. Surprisingly, people with significant speech difficulty often don't stutter when singing or when they are alone talking to themselves. Stuttering tends to persist into adulthood more frequently in boys than in girls.

Symptoms

Symptoms of stuttering may include:

• Hesitancy in starting sentences or phrases
• Prolonged pauses while speaking
• Repeating sounds, syllables, or words
• Very long sounds within words

Other symptoms that might be seen with stuttering include:

• Eye blinking
• Involuntary movements of the head or other body parts
• Jaw jerking

Children with mild stuttering are often unaware of their stuttering. In more severe cases, children may show greater awareness, accompanied by facial movements, anxiety, and increased stuttering when they are asked to speak.

Signs and tests

No testing is usually necessary. The diagnosis of stuttering may require consultation with a speech pathologist.

Treatment

There is no one best treatment for stuttering. Most early cases are short-term and resolve on their own. In persistent cases, speech therapy may help. Research on therapies is ongoing and should be investigated to determine what kinds of help may be most useful.

Drug therapy for stuttering has NOT been shown to be helpful.

Speech therapy may be helpful in the following if:

• Stuttering has lasted more than 6 - 12 months
• Stuttering happens most of the time the child is speaking
• The child or the family are very embarrassed by the stuttering or the child is afraid to speak

Research into therapies for stuttering is ongoing and should be investigated to determine what kinds of speech therapy may be most useful.

The way that family, friends, and teachers respond to a child's stuttering is very important:

• Avoid stressful social situations, whenever possible.
• Encourage slow speech by allowing the child plenty of time to talk.
• Use slow and relaxed speech when talking to the child.
• When the child appears frustrated, it is okay to gently acknowledge the stuttering and the frustration.

Some people who stutter find that they don't stutter when they read aloud or sing.

Expectations (prognosis)

In the majority of children who stutter, the phase passes and speech returns to normal within 3 or 4 years. Stuttering that begins after a child is 8 - 10 years old is more likely to last into adulthood.

Stuttering is most common between ages 3 and 5. Parents should avoid expressing too much concern or commenting too much, which can actually make matters worse by making the child more self-conscious.

Complications

Possible complications of stuttering include social problems caused by the fear of ridicule, which may make a child avoid speaking entirely.

Calling your health care provider

Call your provider if stuttering is interfering with your child's school work or emotional development, if the child seems anxious or embarrassed about speaking, or if the symptoms last for more than 3 - 6 months.

Prevention

There is no known prevention for stuttering.

Gentle attention from the parents without emphasis on the stuttering may help the child feel better about the problem.

Listen patiently to the child, make eye contact, don't interrupt, ignore the stuttering, and show love and acceptance. If the stuttering continues longer than 6 months, the "blocked" speech lasts several seconds, or the child shows obvious facial tensions when stuttering, seek professional help.

References

Prasse JE, Kikano GE. Stuttering: an overview. Am Fam Physician. 2008;77(9):1271-1276.

Answer 2

Definition

Stuttering is a speech disorder in which sounds, syllables, or words are repeated or last longer than normal. These problems cause a break in the flow of speech (called disfluency).

Alternative Names

Children and stuttering; Speech disfluency; Stammering

Causes, incidence, and risk factors

About 5% of children (1 out of every 20 children) aged 2 - 5 will develop some stuttering during their childhood. It may last for several weeks to several years.

For a small number of children (less than 1%), stuttering does not go away and it may get worse. This is called developmental stuttering, and it is the most common type of stuttering.

Stuttering tends to run in families. Genes that cause stuttering have been identified.

There is also evidence that stuttering may be a result of some brain injuries, such as stroke or traumatic brain injuries.

Stuttering may rarely be caused by emotional trauma (called psychogenic stuttering).

Stuttering is more common in boys than girls. It also tends to persist into adulthood more often in boys than in girls.

Symptoms

Stuttering may start with repeating consonants (k, g, t). If stuttering becomes worse, words and phrases are repeated.

Later, vocal spasms develop. There is a forced, almost explosive sound to speech. The person may appear to be struggling to speak.

Stressful social situations and anxiety can make symptoms worse.

Symptoms of stuttering may include:

• Feeling frustrated when trying to communicate
• Pausing or hesitating when starting or during sentences, phrases, or words, often with the lips together
• Putting in (interjecting) extra sounds or words ("We went to the...uh...store")
• Repeating sounds, words, parts of words, or phrases ("I want...I want my doll," "I...I see you," or "Ca-ca-ca-can")
• Tension in the voice
• Very long sounds within words ("I am Booooobbbby Jones" or "Llllllllike")

Other symptoms that might be seen with stuttering include:

• Eye blinking
• Jerking of the head or other body parts
• Jaw jerking

Children with mild stuttering are often unaware of their stuttering. In more severe cases, children may be more aware. Facial movements, anxiety, and increased stuttering may occur when they are asked to speak.

Some people who stutter find that they don't stutter when they read aloud or sing.

Signs and tests

No testing is usually necessary. The diagnosis of stuttering may require consultation with a speech pathologist.

Treatment

There is no one best treatment for stuttering. Most early cases are short-term and resolve on their own.

Speech therapy may be helpful if:

• Stuttering has lasted more than 3 - 6 months, or the "blocked" speech lasts several seconds
• The child appears to be struggling when stuttering, or is embarrassed
• There is a family history of stuttering

Speech therapy can help make the speech more fluent or smooth, and can help the child feel better about the stuttering.

Parents are encouraged to:

• Avoid expressing too much concern about the stuttering, which can actually make matters worse by making the child more self-conscious
• Avoid stressful social situations whenever possible
• Listen patiently to the child, make eye contact, don't interrupt, and show love and acceptance. Avoid finishing sentences for them.
• Set aside time for talking
• Talk openly about stuttering when the child brings it up, letting them know you understand their frustration
• Talk with the speech therapist about when to gently correct the stuttering

Drug therapy has NOT been shown to be helpful for stuttering.

It is not clear whether electronic devices help with stuttering.

Self-help groups are often helpful for both the child and family.

Expectations (prognosis)

In most children who stutter, the phase passes and speech returns to normal within 3 or 4 years. Stuttering that begins after a child is 8 - 10 years old is more likely to last into adulthood.

Complications

Possible complications of stuttering include social problems caused by the fear of ridicule, which may make a child avoid speaking entirely.

Calling your health care provider

Call your provider if:

• Stuttering is interfering with your child's school work or emotional development
• The child seems anxious or embarrassed about speaking
• The symptoms last for more than 3 - 6 months

Prevention

There is no known way to prevent stuttering.

References

Prasse JE, Kikano GE. Stuttering: an overview. Am Fam Physician. 2008;77(9):1271-1276.

Stuttering. National Institute on Deafness and Other Communication Disorders. NIDCD. NIH Pub. No. 10-4232. Updated March 2010. Reviewed OCtober 2008.

Reviewed By

Review Date: 05/13/2010

Benjamin W. Van Voorhees, MD, MPH, Assistant Professor of Medicine, Pediatrics and Psychiatry, The University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.