What is stuttering?

There are many theories and popular beliefs about what causes stuttering. However, despite considerable scientific research from the second half of the 20th century, the full picture about what causes the disorder has not emerged. It seems that stuttering involves some problem with the neural processing – the brain activity – that supports speech production. But the exact nature of that neural speech processing problem is not currently clear. Stuttering tends to run in families because genetics is involved; however, the precise nature of genetic inheritance is currently unknown.

In short, stuttering is a physical disorder and is not caused by psychological factors such as nervousness or stress, or parenting practices, or the way parents communicate with their children when they are young. Although stuttering is not caused by psychological factors, such as anxiety or stress, they can make stuttering worse. 

A recent study that followed a group of Australian infants found that by three years of age 8% of them had begun to stutter, and 12% of them had begun by four years of age. Onset typically occurs as children are starting to put words together into short utterances. The onset of stuttering can be gradual or sudden, and, at onset, the severity of stuttering ranges from mild through to severe. In a few cases, onset can be so sudden and severe that parents think their child has a serious illness.

In most cases, the first sign of stuttering is the child repeating syllables such as "I… I… I… I… want…" or "Where… where… where….. where is… ?" Stuttering may change soon after it begins and the child may start to show fixed postures of the speech mechanism. For example, instead of repeating syllables, the child may hold the lips and tongue in one position for a while. This can seem to be a complete stoppage of speech as the child attempts to start a word, such as in "…………………can I have a drink." Soon after onset, sounds may be prolonged during moments of stuttering, such as in "wwwwwwwwhere is my drink?” Often, as stuttering develops, children show signs of effort and struggle while speaking.

Natural recovery from stuttering by adulthood, without therapy, occurs often. At present, it is not possible to say whether an individual child will recover naturally or will require therapy. We recommend that all children who begin to stutter during the pre-school years should receive therapy. There is evidence that if a child stutters for some years, it can be harmful, even if natural recovery does occur without therapy.

The impact of stuttering on people will differ. For example, someone who stutters only occasionally may experience extreme frustration and anxiety about speaking, while another person whose stuttering is more severe may not be affected in the same way. There is no doubt, though, that stuttering interferes with communication as soon as it begins in pre-school children. Sometimes, children show signs of frustration about their stuttering soon after onset. More commonly, school-age children report feelings of embarrassment about stuttering when answering questions or reading aloud in class. Adults whose work requires effective communication may find their stuttering prevents attainment of their vocational potential. 

Stuttering may interfere with social interactions and may lead to development of social anxiety. Social anxiety can significantly impact day-to-day life. More seriously, it is known that adults who come to speech clinics seeking help for their stuttering are greatly at risk of having social anxiety disorder, also known as social phobia. Social anxiety disorder is a debilitating condition. It involves constant fear of humiliation, embarrassment and negative evaluation in social situations. Sufferers experience extreme distress in social situations. They can experience difficulty participating in relationships at work, socially, and with partners and friends. This can make them become socially isolated.

Early intervention for stuttering during the pre-school years is particularly important because it is known that social anxiety disorder starts to emerge in children soon after seven years of age. That is why we recommend that all children who begin to stutter during the pre-school years should receive therapy.

As genetics is involved in stuttering it is not really right to think about a cure. It is better to think about effective intervention, and that certainly is possible. Clinical trials are showing that early intervention with the right treatment is successful, with an excellent chance that stuttering will not return. Treatment later in life is a different matter. Clinical trials have shown that teenagers and adults who stutter can learn to control stuttering if they want to, and that anxiety about speaking can be managed. But it is much simpler and more effective to have treatment during the pre-school years.

Clinical trials have shown that treatment before 6 years of age provides the best results. However, clinical trials also show that early intervention methods may, to some extent, be effective from 7–12 years of age, but this is not as certain.

Anxiety does not cause stuttering; stuttering can make people anxious. And anxiety can make stuttering worse, which can then make the anxiety worse. So this can become a really negative cycle of events.

At present it looks like stuttering involves some problem with the neural processing – the brain activity – that supports speech production. That just means that stuttering is a physical problem, not a psychological problem, as was once thought.

This can have serious consequences for a child who stutters – or any child – and needs to be stopped. It is best to get advice from a speech pathologist who specialises in stuttering. You also need to talk to your child's school teacher.

Currently, there are no drugs that can provide effective help with stuttering.

There is no surgery to help stuttering.