Stammering

Stammering, also sometimes referred to as stuttering, affects speech and is relatively common in childhood. It can also can persist into adulthood.

What is stammering?

Stammering is when:

• you repeat sounds or syllables – for example, saying "mu-mu-mu-mummy"
• you make sounds longer – for example, "mmmmmmummy"
• a word gets stuck or does not come out at all

Stammering varies in severity from person to person, and from situation to situation. Someone might have periods of stammering followed by times when they speak relatively fluently.

Find out more about how stammering can affect you.

Types of stammering

There are 2 main types of stammering:

• developmental stammering – the most common type of stammering that happens in early childhood when speech and language skills are developing quickly
• acquired or late-onset stammering – is relatively rare and happens in older children and adults as a result of a head injury, stroke or progressive neurological condition. It can also be caused by certain drugs, medicines, or psychological or emotional trauma

The information here focuses on developmental stammering.

What causes stammering?

It is not possible to say for sure why a child starts stammering, but it is not caused by anything the parents have done.

Developmental and inherited factors may play a part, along with small differences in how efficiently the speech areas of the brain are working.

Speech development

Speech development is a complex process that involves communication between different areas of the brain, and between the brain and the muscles responsible for breathing and speaking.

When every part of this system works well, the right words are spoken in the right order, with correct rhythm, pauses and emphasis.

A child learning to construct simple sentences needs practice to develop the different speech areas in the brain and create the "wiring" (neural pathways) needed for the different parts to work well together.

Stammering can happen if some parts of this developing system are not co-ordinated. This can cause repetitions and stoppages, particularly when the child has lots to say, is excited, or feels under pressure.

As the brain continues to develop, stammering may resolve or the brain can compensate, which is why many children stop stammering as they get older.

Sex differences and genes

Stammering is more common in boys than girls. It is unclear why this is.

Genes are also thought to have a role. Around 2 in 3 people who stammer have a family history of stammering, which suggests the genes a child inherits from their parents might make them more likely to develop a stammer.

Treatments for stammering

There are different speech and language therapy approaches that can help people who stammer to speak more easily.

You'll work with a therapist to choose a suitable plan tailored to your child or you.

This may involve:

• creating an environment where your child feels more relaxed and confident about talking
• strategies to increase fluency and develop communication skills
• working on feelings associated with stammering, such as fear and anxiety

Find out more about treating stammering.

Who's affected

Studies suggest around 1 in 12 young children go through a phase of stammering.

Around 2 in 3 children who stammer will go on to speak fluently, although it's difficult to predict when this will happen in a particular child.

It's estimated that stammering affects around 1 in 50 adults, with men being around 3 to 4 times more likely to stammer than women.

 How it can affect you Stammering 

Stammering usually becomes apparent while your child is still learning to speak, between the ages of 2 and 5.

As a child gets older and becomes more aware of their stammering, they may also change their behaviour in certain ways to hide their speech difficulties.

Stammering may develop gradually, although it often starts suddenly in a child who has previously been talking well.

Typical features

Stammering can involve:

• repeating certain sounds, syllables or words when speaking, such as saying "a-a-a-a-apple" instead of "apple"
• prolonging certain sounds and not being able to move on to the next sound – for example, saying "mmmmmmmilk"
• lengthy pauses between certain sounds and words, which can seem as though a child is struggling to say the right word, phrase or sentence
• using a lot of "filler" words during speech, such as "um" and "ah"
• avoiding eye contact with other people while struggling with sounds or words

Stammering is also more likely when a young child has a lot to say, is excited, is saying something that's important to them, or wants to ask a question.

Stammering can be worse in situations where a child feels self-conscious about their speech and so they may be trying hard not to stammer.

These situations might include:

• talking to a person in authority, such as a teacher
• saying something in front of the class
• reading aloud
• speaking on the telephone
• saying their name in registration at school

Behaviours associated with stammering

A child who stammers can also develop involuntary movements like eye blinking, quivering lips, grimacing, tapping their fingers or stamping their feet.

They may also:

• avoid saying certain sounds or words that they usually stammer on
• adopt strategies to hide their stammering, such as claiming to have forgotten what they were trying to say when they have trouble getting words out smoothly
• avoid social situations because of a fear of stammering, such as not asking for items in shops or going to birthday parties
• change the style of speech to prevent stammering – for example, talking very slowly or softly, or speaking with an accent
• feel fear, frustration, shame or embarrassment because of their stammering

 Treatment Stammering 

There are different treatments available for stammering, depending on a person's age and their circumstances.

A speech and language therapist (SLT) will work with you, your child, and educational staff to make a suitable treatment plan for your child.

An SLT can also work with adults who stammer, to find ways to improve the fluency of their speech and reduce the impact stammering has on their lives.

You may be able to access psychological therapy to help with any emotional problems linked to speech difficulties.

Indirect therapy

Indirect therapy is where parents make changes to the way they communicate and the home environment, rather than focusing directly on their child's talking.

If your child is under 5, this is probably the approach your therapist will suggest you try first.

However, if a young child has been stammering for several months and it seems to be getting worse, it may be best to start direct therapy straight away.

Indirect approaches are often based on the concept that children start to stammer when they cannot keep up with the demands made on their language skills.

These "demands" may come from other people around them or from a child's own enthusiasm and determination to communicate. 

The aim of indirect therapy is to create an environment where a child feels less pressure when speaking. 

This may involve:

• speaking slowly and calmly to your child
• encouraging taking turns and listening within the family
• doing more of what seems to help your child's fluency – for example, chatting about what you and your child are doing together, such as playing, cooking, walking to pre-school, or looking at favourite books
• not interrupting or criticising your child
• making the family environment as relaxing and calm as possible

Direct therapy

Younger children

The Lidcombe Program is a widely used direct behavioural therapy for the treatment of stammering in young children.

It's designed to be done by the child's parents under the guidance of a speech and language therapist (SLT).

The Lidcombe Program is based on the principle of providing consistent feedback to your child about their speech in a friendly, non-judgemental and supportive way.

Older children

Stammering that persists until a child is old enough to go to school is significantly more challenging to treat.

As time passes, the effects of stammering can cause problems. These include anxiety about speaking, fear of stammering, and feelings of embarrassment.

Therapy with older children and adults will often take account of both the speaking behaviours and the social, emotional and psychological aspects of stammering.

With school-age children, direct therapy is often used to:

• help improve fluency
• help the child understand more about stammering
• share experiences with others who stammer
• work on feelings associated with stammering, such as fear and anxiety
• improve communication skills
• develop self-confidence and positive attitudes

Other treatment options

In addition to direct and indirect therapy, there are other options that can help people who stammer, particularly older children and adults with persistent stammering and those who develop stammering later in life (acquired or late-onset stammering).

Psychological therapies

These include solution-focused brief therapy (SFBT), personal construct therapy, neurolinguistic programming (NLP) and cognitive behavioural therapy (CBT).

These therapies do not treat stammering directly, but can be helpful if you experience negative feelings as a result of your stammering.

Speaking to someone who stammers

When talking to someone who stammers, try to:

• avoid finishing their sentences if they're struggling to get their words out
• give them enough time to finish what they're saying without interrupting
• avoid asking them to speak faster or more slowly
• show interest in what they're saying, not how they're saying it, and maintain eye contact

Speak slowly and calmly when talking to a young child who stammers. Use short sentences and simple language to reduce the communication demands on the child.

Do not overwhelm your child by talking too quickly. Make sure you give them time to understand and process what you've said, and work out their response.