Stuttering is an interruption in the flow of speaking characterized by atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. It is classified in the DSM IV TR (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision) as a communication disorder and is defined as a disturbance in the normal fluency and time patterning of speech (inappropriate for the individual’s age), with frequent occurrences  of sound and syllable repetitions, sound prolongations, interjections, broken words (e.g., pauses within a word), audible or silent blocking (filled or unfilled pauses in speech), circumlocutions (word substitutions to avoid problematic words), words produced with an excess of physical tension, or monosyllabic whole-word repetitions (e.g., “I-I-I-I see him.”).  It interferes with academic, occupational, or social functioning.

Although stuttering may occur with almost any word, it is particularly common in front of words beginning with B, D, K, P, or T. Patients know what they want to say, but they experience a “block” as they attempt to speak, which is typically followed by repetitive repronounciations of the blocking letter or syllable until it is finally overcome. These efforts are often accompanied by simultaneous grimacing, blinking, or forceful movements of the head and neck. After the stumbling block is breached, there often follows a cascade of normally pronounced words, which may continue until the next block arises.

Stuttering is worse when patients are rushed, under pressure, fatigued, anxious, or speaking in front of a group. Although it is not clear why, most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak in unison with someone else. Some of the famous people who have suffered from this disorder are Winston Churchill, Marilyn Monroe, and vice president Joseph Biden.

Developmental stuttering is common among children when they are learning to speak. It appears in 1 to 5% of young children, with a male to female ratio of 3-4:1. It has an insidious onset over several months, between the ages of 2 and 7; studies suggest that an interaction between genetic and environmental factors leads to stuttering in predisposed individuals. Spontaneous full remission occurs in approximately 60% of affected children, with another 20% experiencing a partial remission. By comparison, neurogenic stuttering is associated with neurologic disease (brain infarcts, tumors, or trauma). It is much less common, with an acute onset after age 10 and the lack of both associated movements and the “cascade” of normally produced words following the stutter.

Depression, low self esteem, social withdrawal, and academic difficulties are some of the common complications associated with stuttering.

Professional evaluation is recommended if stuttering lasts longer than 6 months or beyond age five, if the child exhibits associated struggle behaviors, and when there is a family history of stuttering or related communication disorders. The main treatment of stuttering is speech therapy, which often is successful. Parental involvement and support groups are important. In severe and resistant cases, consideration may be given to low dose psychotropic medications (antidepressants, antipsychotics).

Ana C Posada-Diaz, M.D.

Psychiatrist