Girl is next to her therapist on a speech therapist session working on stuttering

Angeliki Chatzaki

Stuttering is a disorder of the flow of speech, a so-called fluency disorder. A person who stutters knows exactly what he or she wants to say, but has trouble producing a normal flow of speech.

Stuttering

Core symptoms

We all have times when we do not speak smoothly. We may add "uh" or "you know" to what we say. Or, we may say a sound or word more than once. These are called disfluencies.

People who stutter may have more disfluencies and different types of disfluencies. They may repeat parts of words (repetitions), stretch a sound out for a long time (prolongations), or have a hard time getting a word out (blocks).

The following types of disfluencies happen when someone stutters:

  • Part-word repetitions – "I wa-wa-wa-want a cookie."

  • One-syllable word repetitions – “My-my-my name is.”

  • Prolonged sounds – “Fffffffrank is nice."

  • Blocks or stops – "I want a (pause) glass of water."

These core symptoms can vary in frequency and severity and the individual's situation and personal condition.

Accompanying symptoms

Many people who stutter develop accompanying symptoms. They can be visible, for example tension of the facial muscles or body movements. Invisible are accompanying symptoms such as fear of speaking or the avoidance and concealment of stuttering. Words are exchanged at lightning speed, filler words are used or speaking situations are generally avoided.

Accompanying symptoms can be extremely stressful for people who stutter in everyday life, become more severe and lead to social withdrawal.

Why does one stutter?

Speaking itself is a highly complex process. Our brain must receive and process a multitude of impulses in order for the speech process to work. Some of these processes are impaired in people who stutter. The area of the brain responsible for controlling the speech muscles is not supplied without interference by the other areas involved. Thus, the preparation for the upcoming speech task fails - the person stutters.

According to current knowledge, the main cause of stuttering is seen in an inherited predisposition to it, which does not necessarily, but with a high probability, lead to the occurrence of stuttering. Stuttering is therefore a neurologically caused disturbance of the flow of speech. It does not allow any conclusions to be drawn about the intelligence, character or origin of the person affected.

According to the NIDCD, 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 3 to 4 times larger than the number of girls.

Treatment

Speech Therapy

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.

Basically, there are two different therapy approaches used by speech therapists: Stuttering Modification on the one hand, and Fluency Shaping on the other. Both therapy programs last several weeks and especially Fluency Shaping requires intensive practice of the new speech patterns, as well as regular sessions after the end of therapy in order to avoid relapses.

  1. Stuttering Modification/Non-Avoidance Approach:

Stuttering modification is not about trying to avoid stuttering, but learning how to deal with it better. The therapy approach is divided into 4 phases:

  • Phase 1- Identification: the person who stutters observes when stuttering events occur and how they feel about them.

  • Phase 2- Desensitization: Stuttering is intentionally observed in order to reduce negative feelings about stuttering by becoming accustomed to it and to notice during practical exercises that the listeners usually react very tolerantly to stuttering.

  • Phase 3- Modification: Techniques are learned to make stuttering more fluent - pauses are inserted, stuttered words are repeated slowly or are pronounced more slowly in the first place.

  • Phase 4- Stabilization: Finally, the fluent stuttering and the more relaxed way of dealing with it are stabilized and adopted into everyday life.

  1. Fluency Shaping:

Fluency shaping is the systematic development of a fluent way of speaking. The main focus of fluency shaping intervention is to increase fluent speech through teaching, for example, one or more of the following: easy onsets, loose contacts, changing breathing, prolonging sounds or words, pausing, as well as other methods that reduce speaking rate. The overall goal is to encourage spontaneous fluency where possible and controlled fluency when it is not.

Through Synopsis app the speech therapist can find very quickly fluency goals, in order to plan her therapy treatment in a more efficient way.

Cognitive Behavioual Therapy: This type of psychotherapy can help the person who stutters learn to identify and change ways of thinking that might make stuttering worse. It can also help resolve stress, anxiety or self-esteem problems related to stuttering.

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.


There is no known cure for stuttering, and like any other speech disorder, it requires therapy and practice to treat or manage it.

Approximately 75% of children recover from stuttering. For the remaining 25% who continue to stutter, stuttering can persist as a lifelong communication disorder.

From the Synopsis Team