Is There a Cure for Stuttering? How Stuttering Therapy "Works" for Children, Teens, & Adults
October 31, 2020
American Institute for Stuttering
Picture it: The first day of school.
You nervously walk up to the front of your new classroom, try to introduce yourself, and nothing comes out. The silence is deafening, with tension and struggle painted all over your face. This is a scenario that can happen numerous times in a single day for those of us who stutter.
One of the most common (and understandable) questions that we get from people of all ages at the American Institute for Stuttering is "Can stuttering be cured?". After all, it is common for stuttering (or any other speech disorder) to create a great deal of stress, anxiety, struggle, and negative self image across all ages. It is human nature to want to stop suffering - seeking a cure makes sense!
Types of stuttering fall into three major categories: developmental stuttering, acquired stuttering, and psychogenic stuttering. It also reinforces the needs for a speech language pathologist to take a comprehensive health history to determine the most likely etiology of stuttering.
Developmental stuttering, also knows as childhood onset fluency disorder or stammering, refers to the most common type of stuttering that impacts the highest percentage of people with fluency differences. It typically begins in childhood (ages 2-6 is the most common period for onset), with varying degrees of repetitions (e.g., sound/syllable repetitions or repeating sounds, whole word repetitions, prolongations, and / or blocks in speech.
Further, a variety of differences in brain structure and function paired with genetic predisposition have been implicated in the underlying cause of developmental stuttering - it is not a sign of underlying mental health conditions.
Acquired (or neurogenic) stuttering refers to stuttering or stammering that occurs after an adverse neurological event, such as a traumatic brain injury or stroke. Acquired stuttering can occur at any age, and typically can be managed with speech therapy and various speech techniques based on the individual's preferences. In some cases, this type of stuttering may lessen as the brain heals from trauma.
Psychogenic stuttering refers to a rare form of stuttering that develops after a traumatic or psychologically disturbing life event. Collaboration between a speech therapist and a psychologist / mental health professional can often assist a person in significantly reducing the impact on their speech.
Stuttering research has consistently shown over the years that about 5% of all children in the general population go through a period of stuttering, marked by a variety of speech disfluencies. Sound or syllable repetitions (e.g., "b-b-ball or ba-ba-ba-ball), sound prolongations (e.g., ssssssssnake), or blocks in speech (e.g., ______ball) are all possibilities.
Additional behaviors may develop along with stuttering - these physical behaviors co-occur with the moment of stuttering as the body's way of trying to help push through or escape the moment of stuttering (e.g., head jerking, body movements, looking away, etc.).
Of this 5% of children, a subset of about 80% will spontaneously grow out of this disfluent period, while about 20% will continue persistent stuttering to varying degrees throughout life. This is why it is most likely that a young child who starts stuttering is more likely to stop stuttering than an older child, teen, or adult who has stuttered for many years.
When considering the overall trajectory of a child's likelihood of continuing to stuttering into adulthood, various factors are considered. These include family history of stuttering, sex assigned at birth (e.g., males are more likely to persist), consistent difficulties with speech sounds or language functioning, temperament, and types of disfluencies produced by the child.
Since persistent stuttering is a genetic, neurodevelopmental difference in brain structure and function, it is not possible to work to "cure" it. Further, it is important to highlight that parents do not cause stuttering.
However, with the help of a speech therapist who understands the lived experience of stuttering, it is possible to significantly reduce any negative physical, emotional, and / or mental impact that stuttering has on a person's everyday life.
So, if therapy does not focus on a "cure" for stuttering, what does the "best treatment" look like for stuttering?
It is common for those who stutter to experience various levels of physical struggle as they attempt to escape from moments of stuttering. Over many years, these struggle behaviors (e.g., pushing through with force, bodily movements meant to help escape, etc.) can become habitual, happening automatically as stuttering moments begin. These behaviors that co-occur with the moment of stuttering are known as secondary characteristics.
Speech therapy can assist through developing more curiosity about these secondary behaviors, raising proactive awareness / mindfulness in the moment of stuttering. Further, this process allows the individual to desensitize and tolerate moments of stuttering, thereby reducing any negative feelings and discomfort and making the person much less affected by physical struggle or tension in stuttering moments.
Through this process, it is much easier for the person who stutters to "let go" of the need to suppress or escape from the moment, thereby finding more comfortable and efficient stuttering patterns to enhance communicative effectiveness and reducing any "stuttering symptoms" that make speaking more difficult.
Unfortunately, we live in a society where many myths and misinformation about stuttering and stuttering treatment are commonplace. There have been many quick fixes Many people may gave incorrect advice (e.g., "Take a deep breath") or hold inaccurate, stigmatizing views of those who stutter (e.g., stuttering is due to a mental health condition). Understandably, this can create stress, negative feelings, a sense of dread, an overvaluation of speech fluency, and ultimately, low self esteem in many people who stutter.
This also applies to an overly simplified view surrounding treatment for stuttering. Many people in the general public believe that goal of all speech language pathologists is to teach their clients who stutter speech techniques to stop stuttering.
There are also various tools that have been explored to assist people who stutter, such as electronic devices for altered auditory feedback / electronic devices that resemble a hearing aid (e.g., SpeechEasy device).
While these may offer some immediate, short term benefits, many clients find that they are not sufficient to offer lasting, sustainable benefits. In some cases, an over-focus on achieving fluency can even cause negative feelings and hopelessness for affected individuals.
It is crucial for the speech language pathologist to share proper education to those in the person who stutters' life. Helping stakeholders understand the affective, behavioral, and cognitive components of the stuttering experience are crucial to ensure that all people who stutter can speak freely and live without fear of judgment or discrimination, thereby making it much easier to live authentically and say what they want to say with confidence.
It is extremely common for children, teens, and adults who stutter to develop significant fears related to stuttering in public. This fear can extend to straightforward, routine situations like making a phone call, ordering at a restaurant, or raising your hand in class.
It can also appear in other situations that can be traditionally anxiety provoking and provide the same challenges as fluent speakers, such as public speaking, going on a first date, or going on a job interview.
A key part of successful treatment for stuttering is to develop effective ways to approach these feared situations with the support of the speech language pathologist and other support networks in order to reduce the fear, and in turn, enhance mental health and make an individual's ability to manage stuttering more effective and sustainable.
This further reduces any physiological arousal and makes it much easier to stay present during moments of stuttering, thereby making it easier to make choices to stutter more easily or confidently.
Some examples of desensitization activities include: Learning to talk about stuttering with others confidently, making phone calls focused on self-disclosure of stuttering and open stuttering, resisting time pressure, or even stuttering on purpose!
Most people who stutter report negative thoughts and attitudes towards their stuttering, some beginning in childhood. These thoughts and attitudes can transform into fundamental beliefs about stuttering limiting their lives in a variety of ways (e.g., career, romance, social, etc.), thereby having an extremely negative impact on an individual's quality of life.
It is crucial for effective speech language therapy for stuttering to identify these negative core beliefs, validate the reality that stuttering can be incredibly challenging at times, and take steps to challenge any assumptions that see stuttering as an inferior or "less than" way of communicating.
Through desensitization exercises, people who stutter are able to collect real world "data" to support the notion that stuttering can exist in any situation AND success is still entirely possible.
One tangible way to do this is to see that others who experience stuttering behaviors are confident and successful across all aspects of life - you are not alone.
When dealing with stuttering / stammering, we have found that support is crucial. It can be incredibly isolating to navigate stuttering, and sometimes, it is important to go beyond speech therapy to receive mutual understanding from others who just "get it" through lived experience.
There are a variety of national stuttering foundations and associations that exist to explicitly connect those who stutter and their families, such as Friends or the National Stuttering Association. The National Stuttering Association in particular has designated support group chapters all across the country.
Further, the Stuttering Foundation has great educational resources for people of all ages who stutter, and those who support them.
In this section, we will specifically discuss common approaches and outcomes in speech therapy to determine progress:
For young childhood stuttering, the following are common areas we integrate into therapy:
This involves open conversation and communication about stuttering with parents and families, thereby empowering the child to begin the process of self-advocacy. This goes beyond simply working on techniques to stutter less, and is grounded in treating children with respect and openness towards any feelings they want to discuss. It is always okay to talk about stuttering with children, as reminding silent about it can reinforce a negative association, or that stuttering is something that should not be mentioned across environments.
The focus is also placed on reducing any environmental demands that may make communication more of a struggle in the home (e.g., constant interrupting, fast rate of speech, high level questioning, using complex sentence structures or vocabulary, etc.).
This also helps to clarify helpful things to say (e.g., "I love hearing you talk" or "I am so proud of you for saying what you wanted to say!") vs. unhelpful things to say (e.g., "Take a deep breath" or "Try that again without stuttering". )
This looks like "playing" with different types of stutters, stuttering on purpose, and identifying ways to stutter more openly and easily that reduce any struggle or tension (based on the child's stuttering pattern and their specific preferences). Most children find this process to be therapeutic, and even fun!
For older children and teens, the following are common areas we integrate into therapy:
Sometimes, it can be hard for older children and teens to see the benefits of expending effort in speech therapy, so it is important to make sure they are free to share their own goals and hopes for the stuttering therapy process. After all, the child's stuttering or teen's stuttering experience is THEIRS, and treating children as the experts promotes greater rapport with the therapist.
Since stuttering is variable, praising or reinforcing speech fluency or avoidance behaviors is not typically helpful, and at worst, can promote the hiding of stuttering or reducing communication output during more difficult moments. This also helps parents understand the power of praising and reinforcing participation, fear facing, and engagement.
Developing these participation-based goals, such as public speaking, introductions, or raising their hand can serve to promote desensitization and confidence building. "Avoiding avoidance" is a process, but over time, can serve a client's confidence and self-worth in a much more sustainable way.
Since it is common for older children and teens to view stuttering as a taboo or shameful topic, curiosity is the last thing that many young people feel in relation to understanding stuttering - they just want it to go away!
However, developing curiosity surrounding their speech pattern can assist them in the process of desensitization and awareness building around unhelpful struggle behaviors or secondary characteristics that have become habitual and automatic.
With more conscious awareness, it becomes possible to reduce any secondary behaviors that promote struggle, while also learning ways to manage stuttering more openly, easily, and confidently. Talking about talking is important!
As mentioned earlier, it is very common for older children and teens to work hard to suppress or avoid the topic of stuttering. However, we find that slowly introducing language for talking about their experience in the speech therapy room can provide a structure for learning that it is helpful and empowering to talk about it outside of the therapy room as well.
It is well-documented that openness about stuttering can promote enhanced well-being. This applies to conversations with friends, teachers, and any other communication partner that the child or teen encounters.
Further, the speech language pathologist can work on roleplaying different scenarios that may come up in the client's life, such as a stranger asking about stuttering with curiosity, or different ways that a teen may deal with teasing about stuttering.
For adults who stutter, the following are common areas we integrate into the therapy process:
It can be a common occurrence for adults who stutter to have years of experiences hiding stuttering, or even being told that it is something they should work hard to eliminate. They may have fears that relate to certain syllables or speech sounds, an incorrect belief that they did something "wrong" to cause stuttering to happen, or have tried multiple techniques to stop stuttering with no sustainable change. Naturally, this can result in significant negative feelings, both towards stuttering and any kind of stuttering treatment.
It is crucial for the speech therapy room to be a safe, nonjudgmental place for a person who stutters to share their story, learn the most accurate information about stuttering and effective treatment, and process the negative relationship with speech that may have formed over time.
Similar to the above section, it is vital to ground therapy in realistic places in the client's life. The best treatment focuses on communication situations at work (e.g., meetings, presentations, interviews, phone calls) or across social settings (e.g., meeting new people, speaking up at a restaurant, dating, etc.).
After many years of feeling like the "only one", meeting others who stutter and gaining support can be life changing. Processing the complex feelings that often go along with being a person who stutters can be extremely cathartic, and in many cases, can help the affected individual feel that anything is possible. After all, adults who stutter are employed in every industry, have meaningful relationships and friendships, and are capable of anything they desire - seeing that in action can be incredibly motivating, and as we often say at AIS, "if you can see it, you can be it".
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AIS’s certified speech-language pathologists provide individualized stuttering therapy for preschoolers, kids, teens, and adults — with options for online sessions and supportive groups to practice real-world speaking. Call us today at 212-633-6400 or contact us online to learn how we can help you speak freely, and live fearlessly.
Worried about the cost of therapy? Our Freeing Voices, Changing Lives Scholarship Fund offers need-based financial assistance, thanks to generous donors.
