Stammering

Stammering is a break in the flow of speech: a sound repeats, stretches out, or a word simply jams, even though the speaker knows exactly what they want to say. It usually begins at three or four, in the very months when a child moves from single words to long sentences. In most children it goes away on its own. But the most useful thing to tell a parent is not "wait and see": drawing the wait out beyond a few months is a poor bargain, because help started in the preschool years works considerably better than the same help two years later.

What it actually looks like

Stammering is made of three things, and one person usually has all three in differing proportions:

• repetitions — "mu-mu-mu-mummy"; sometimes a whole short word is what repeats;
• prolongations — a sound stretched out far longer than it should be, "mmmmilk";
• blocks, the hardest of the three: the mouth is already set for the sound, no sound comes, and the pause runs a second, two seconds, sometimes longer.

Over time everything the person does to force the word out, or to cover the jam, gets added on top: screwing the eyes shut, a jerk of the head, a tap of the foot, filler words, swapping one word suddenly for another, looking away. In a child this is not messing about. It is effort.

Stammering comes and goes, which is what confuses families. It nearly disappears in singing, in a learned poem, in talking to the dog — and it worsens exactly where it matters: in front of the class, on the telephone, when saying your own name, when someone cuts in. Parents sometimes conclude from this that the child "can manage when he wants to". He cannot: the difference is not effort but how much attention is going into the speaking itself at that moment.

Why it starts

Speech takes several areas of the brain working in step with breathing, voice and articulation, and all of it has to land inside fractions of a second. In a small child that system is still being assembled: vocabulary and sentence length grow faster than the motor control of speech. Where the mismatch shows, repetitions and blocks appear.

Heredity is plain to see: most people who stammer have a close relative who stammered as a child or stammers now. Among preschoolers there are roughly twice as many boys as girls, and among adults the gap is wider still, because in girls speech more often settles by itself.

What does not cause stammering matters just as much, because it is still repeated:

• it is not the result of a fright. Coinciding with a house move, a fright or a new baby is common, but a fright does not create a stammer; at most it coincides with the start of one;
• it is not a consequence of anything the parents did wrong;
• it is not caught from a classmate who stammers;
• it is not a sign of low intelligence: language comprehension and reasoning are the same as in any other child.

Will it be outgrown, and how long can you wait

About one preschooler in twelve goes through a spell of disfluency, and in most of them speech settles unaided. The trouble is that there is no way to tell in advance whether a particular child is in that majority, and time works against waiting.

A sensible marker is this: if the stammer has lasted more than two or three months, see a speech and language therapist without waiting for school to start. Not because the case is severe, but because preschool speech is still pliable — at that stage the work takes less time and more often ends in ordinary speech. A stammer that survives into the school years is harder going and less often disappears altogether.

Do not put it off if any of the following applies:

• the stammer has lasted more than a few months, or is getting stronger rather than weaker;
• blocks have appeared with visible strain, grimacing, or breath held before the word;
• the child has noticed his own speech: he is upset, cross with himself, or has gone quiet where he used to talk;
• the stammer began late, after four or five years of age;
• someone in the family stammered and never grew out of it;
• you are worried yourself. That is reason enough: an assessment does no harm at all, and waiting can cost you the best window.

What helps at home

Home life does not create a stammer, but it makes a real difference to how hard speaking is right now. Everything below points one way: take the hurry and the marking out of talking.

• Slow your own speech down and keep it calm — not syllable by syllable, just unhurried. Children fall in with an adult's pace.
• Leave a second or two before you answer. It is almost invisible from outside and works better than nearly anything else.
• Hear the child out without finishing the word for him, even when it is obvious which word it is.
• Look at him exactly as you do when he is fluent, and answer what he said rather than how it came out.
• Keep the household to taking turns and not interrupting. This matters especially with several children.
• Set aside a little time each day for quiet one-to-one talk, with no television and no quiz questions.
• Ask fewer questions in a row: a question demands an immediate answer, and that is the hardest situation for speech.
• If the child raises his own speech, answer plainly: "yes, that word got stuck, it happens, I'm listening." That beats changing the subject.

What is better left alone

Almost all the familiar advice fails to help speech, and some of it hinders outright, because it shifts attention from what the child is saying to how he is saying it.

• "Slow down", "take a breath and say it calmly", "start again" — these sound supportive and make the next attempt harder.
• Finishing his sentence, feeding him the word, nodding him along.
• Asking him to repeat it, to say it properly, to "practise" the difficult word.
• Mimicking and laughing, older siblings included: this needs stopping straight away and in plain terms.
• Making him perform, recite for visitors or speak on the telephone when he is avoiding it.
• Introducing "breathing patterns" or singing instead of speaking off your own bat. Related techniques do exist in therapy, but they are chosen case by case, and at home they turn into one more demand on speech.

What a speech therapist does

There is no medicine for stammering; speech and language therapy is what deals with it. The plan depends on age.

With preschoolers the usual starting point is indirect work: what changes is not the child's speech but the talking environment around him — broadly what is listed above, but fitted to that particular family and often worked out from video of an ordinary conversation at home. If that is not enough, or the stammer is building, the work becomes direct. Its best-known form is a programme in which the parent, following the therapist's instructions, comments briefly and warmly on the child's fluent speech each day during play. The treatment is delivered by the parent at home rather than by a specialist once a week, and that is where its strength lies.

With school-age children and teenagers a second half of the job appears. By then fear of speaking, avoidance and shame have attached themselves to the disfluency, and working on fluency alone stops making sense. Sessions cover techniques that ease speech, an examination of what actually happens during a block, practice in real settings — ordering in a café, asking directions — and, separately, an arrangement with the school: no surprise questions, no reading aloud against the clock, time allowed to answer.

Complete disappearance of the stammer is not the only possible outcome and not always the main one. For some people the disfluencies remain but stop getting in the way: the fear goes, and the telephone, the presentations and the jobs that involve talking come back. That counts as a good result, and it is worth knowing in advance, so that anything short of perfectly smooth speech is not treated as failure.

Adults who stammer

A stammer in an adult is nearly always the same childhood stammer that never left. It persists in roughly one person in a hundred.

It comes with a stubborn misunderstanding worth stating outright: stammering is not a sign of anxiety, of shyness, or of "bad nerves". Cause and effect run the other way here. Years of conversations in which a word may jam in front of other people genuinely do produce a fear of speaking — and that fear is real enough. The person plans the sentence ahead, swaps words for less accurate but more passable ones, gives up on phone calls, and stays quiet where they would rather speak. From outside it looks like reserve; in fact it is a detour.

Adults are treated too, and not only for fluency. A therapist works on speech technique, while the accumulated fear and avoidance respond to psychological therapy — usually the kind that teaches you to test habitual thoughts and return gradually to the situations you have been dodging. Groups help separately, where people talk to each other without hiding the disfluency: a good deal of the fear rests on the feeling of being the only one.

When a stammer points to something else

Everything above concerns a stammer that began in childhood. Disfluency appearing for the first time in an adult is a different story, and it is a reason to see a doctor rather than a therapist first.

Call an ambulance (in Europe, the single number 112) if speech has changed suddenly and any of this comes with it:

• the face has dropped on one side, an arm will not lift, one half of the body has gone weak or numb;
• speech has become slurred, the person muddles words or cannot follow what is said to them;
• sudden severe headache, double vision, loss of balance.

That is what a stroke looks like, and here it is counted in minutes. Do not drive yourself and do not wait for morning.

Not urgent, but see a doctor without fail if speech has started catching:

• after a head injury, even an old one that seemed slight at the time;
• gradually, alongside tremor, stiffness, changed handwriting, clumsy hands or unsteadiness on the feet;
• soon after starting a new medicine or changing the dose: some drugs acting on the brain have this side effect. It is dealt with by changing the treatment, never by stopping it on your own;
• in a child, alongside loss of skills already learned, seizures, or an obvious delay in development.

Telling an acquired stammer from a returning childhood one by ear is hard even for a specialist, so what guides the decision is not how it sounds but when it started and what came with it.

Online consultation

A remote appointment settles precisely the questions people put off longest. The doctor will go through how long the child has been stammering and in what way, what you have already tried at home, whether this fits ordinary speech development or it is time for a speech therapist and how soon, and will help you word what to ask of the nursery or school. For an adult it is worth discussing the fear of speaking and the avoidance: what is done about them and where it starts. It is also a straightforward way to get a second opinion if you were told he would grow out of it and you have now been waiting six months. Speech problems of sudden onset with neurological signs are not assessed remotely — those mean an ambulance straight away.

This material is for information only and does not replace medical advice.