Stuttering: Understanding and Treating a Common Disability

 

Am Fam Physician. 2019 Nov 1;100(9):556-560.

  Patient information: See related handout on stuttering, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Childhood-onset fluency disorder, the most common form of stuttering, is a neurologic disability resulting from an underlying brain abnormality that causes disfluent speech. Stuttering can lead to significant secondary effects, including negative self-perception and negative perception by others, anxiety, and occasionally depression. Childhood-onset fluency disorder affects 5% to 10% of preschoolers. Early identification of stuttering is important so that therapy can begin while compensatory changes to the brain can still occur and to minimize the chances of the patient developing social anxiety, impaired social skills, maladaptive compensatory behaviors, and negative attitudes toward communication. However, stuttering may be persistent, even with early intervention, and affects about 1% of adults. In patients with persistent stuttering, speech therapy focuses on developing effective compensatory techniques and eliminating ineffective secondary behaviors. The role of family physicians includes facilitating early identification of children who stutter, arranging appropriate speech therapy, and providing support and therapy for patients experiencing psychosocial effects from stuttering. Finally, physicians can serve as advocates by making the clinic setting more comfortable for people who stutter and by educating teachers, coaches, employers, and others in the patient's life about the etiology of stuttering and the specific challenges patients face.

Fluent speech is a complex process that combines word selection with the motor activities that allow the articulation of those words. This involves coordination of the respiratory, laryngeal, and articulatory muscles. Speech is a defining feature of human cognition1,2 and one of the principal developmental tasks for preschool children.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Referral to a speech-language pathologist should be considered for any child who exhibits stutter-like disfluencies, especially if there are parental concerns or the disfluency has remained unchanged for 12 months or is worsening in severity or frequency.1,19,20

C

Expert opinion and limited data from systematic review

Therapy for persistent stuttering should be individualized and focused on developing effective compensatory techniques and eliminating ineffective secondary behaviors.28

C

Systematic review of low-quality studies

Families should be reassured that stuttering is primarily the result of brain abnormalities and is not the fault of the patient or family.1,2,57

C

Meta-analysis, review, case-control observational studies

Patients with stuttering should be evaluated for secondary psychosocial effects and offered appropriate treatment.1,8,10,1416,22,28

C

Multiple studies show risk of psychosocial effects; qualitative studies show benefits of treatment


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Referral to a speech-language pathologist should be considered for any child who exhibits stutter-like disfluencies, especially if there are parental concerns or the disfluency has remained unchanged for 12 months or is worsening in severity or frequency.1,19,20

C

Expert opinion and limited data from systematic review

Therapy for persistent stuttering should be individualized and focused on developing effective compensatory techniques and eliminating ineffective secondary behaviors.28

C

Systematic review of low-quality studies

Families should be reassured that stuttering is primarily the result of brain abnormalities and is not the fault of the patient or family.1,2,57

C

Meta-analysis, review, case-control observational studies

Patients with stuttering should be evaluated for secondary psychosocial effects and offered appropriate treatment.1,8,10,1416,22,28

C

Multiple studies show risk of psychosocial effects; qualitative studies show benefits of treatment


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Types of Stuttering

Preschoolers often have difficulty mastering motor planning and execution as they struggle with the complex process of learning to speak. This is developmentally normal and formally labeled

The Authors

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ROBERT W. SANDER, MD, is a clinical assistant professor in the Department of Family and Community Medicine at the Medical College of Wisconsin-Central Wisconsin, Wausau....

CHARLES A. OSBORNE, MA, CCC-SLP, is a clinical professor in the School of Communication Sciences and Disorders at the University of Wisconsin, Stevens Point.

Address correspondence to Robert W. Sander, MD, 3951 Bentley Rd., Custer, WI 54423 (email: rwsander@gmail.com). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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