A stammer (also called a stutter) is common, especially in young children. For most young children, the stammer goes away without any treatment. Older children and adults may have a stammer that doesn't go away. The most important part of treatment for the stammer is to help the person feel relaxed and confident. Speech and language therapists can provide a lot of advice and treatment.
What is a stammer?
A stammer is a disorder of speech. There are stoppages and disruptions which interrupt the smooth flow and timing of the speech. These stoppages may take the form of repetitions of sounds, syllables or words - like saying da-da-daddy. There may also be prolonged sounds - so that words seem to be stretched out - like saying mmmmmummy. It can also involve silent blocking of the airflow of speech, so that no sound is heard. As a result, the speech may sound forced, tense or jerky.
Stammering can be mild, and not cause much of a problem, or severe, when it becomes a serious communication disorder. The stammer can also vary for the same person. A person might find that they have periods of stammering, followed by times when they speak without a stammer.
People who stammer may avoid certain words or situations which they know will cause them difficulty. Some avoid or substitute words to such an extent that people in their lives may not realise they have a stammer. This is known as covert stammering. The affected person may even avoid talking whenever possible.
In the USA (and many other countries) stammering is known as stuttering.
What causes a stammer?
To speak in a flowing way (fluently), a child's brain must develop many different nerve pathways. These pathways must interact in very precise and rapid ways. Stammering usually emerges in childhood as a symptom that the brain's pathways for speech are not being wired normally. Most young children grow out of their stammer - but the longer the stammering symptoms persist, the more difficult it is to change the brain's wiring.
Stammering usually starts when a child is developing speaking skills, and is therefore referred to as developmental stammering. Family genetics are relevant in some cases - someone with stammering in the family seems more likely to develop their own stammer. In rare cases, stammering can start in adult life, when it is known as acquired or late-onset stammering, and is most commonly caused by a stroke, resulting in damage to the brain. It may also be caused by head injury or severe emotional upset.
People who stammer are no different in intelligence or intellectual or emotional ability. But they are often stereotyped as being nervous, shy, self-conscious, tense, sensitive, hesitant, introverted or insecure. There is no evidence to support this. However, many people who stammer are nervous about speaking, especially in public.
How common is having a stammer?
Stammering (stuttering) is common and can occur in childhood and persist into adulthood. It is estimated that about 1 in 20 children under school age may have a stammer at some time. Two out of three children who stammer will naturally grow out of it. One child in three will not. An estimated 1 in 100 adults stammer. Between 3-4 men stammer for every woman who stammers.
The number of people who stammer does not appear to be increasing or decreasing. Research studies indicate that these figures are the same worldwide and that stammering occurs across all cultures and in all social groups. In the UK, around 720,000 children and adults stammer.
Is there any treatment for a stammer?
For most preschool children with a developmental stammer (stutter), the stammer goes away without any treatment. If it is needed, treatment is much more effective for preschool children than for older children and adults. Stammering that persists into school age tends to be harder to treat.
How can you help your own child?
If you have any concerns about a young child’s speech, it is important to obtain advice as soon as possible. This is known as 'early intervention'. Speech therapists, who provide treatment for stammering, are based in local health centres and hospitals. You may be able to refer your child directly or you can ask your doctor or health visitor to do this for you.
It is reasonable to ask if the therapist specialises in stammering and what can be expected from therapy. If possible, see a specialist who works regularly with stammering and keeps up to date with the latest approaches to therapy. If there is no specialist available in your local NHS speech and language therapy department, it may be worth asking if you can be referred to another department nearby.
If you are told to wait to see if the stammer will go away, because your child will probably grow out of it, the person is unlikely to be experienced in stammering. It is true that the majority of children recover naturally from stammering, but you should still be given guidance on how to support your child, and they should be actively monitored.
You can help children who stammer by:
- Providing a relaxed home environment that allows many opportunities for your child to speak. This includes making time to talk to each another, especially when your child is excited and has a lot to say.
- Not reacting negatively when the child stammers. Give any corrections in a gentle way and give praise when your child speaks without a stammer.
- Speaking in a slightly slow and relaxed way.
- Listening carefully when your child speaks and waiting for them to say the intended word. Don't try to complete the sentences for them.
- Helping your child to be confident that they can communicate successfully even when they stammer.
- Providing consistent feedback to your child about their speech in a friendly, non-judgemental and supportive way.
- Talking openly about stammering if your child wants to talk about it.
What are the treatments that can be provided?
Treatment programmes for children involve further ways to help your child feel more relaxed and confident when speaking.
There are many different treatments for stammering. The choice of treatment will depend on the age of the person and their individual difficulties and needs. The different types of treatment for stammering include:
- Parental involvement (the Lidcombe approach), which involves the rest of the family helping the child to speak slowly, praising the child when they don't stammer and occasionally correcting when the child speaks with a stammer.
- Stuttering modification, which helps by reducing the fear of stammering and improves confidence.
- Psychological therapies, which can be used for adults and those with acquired stammering. These therapies don't treat the stammer. The treatment is designed to reduce stress and anxiety, which make the stammer worse.
- Feedback devices, which can help by changing the way the voice is heard. Electronic devices can help people control their speech by giving them sound feedback. These devices change the way the person speaks, such as slowing down the speed of speaking. The device may make the person speak more slowly to keep the speech they hear through the device sounding clear.
What is the outcome?
Without treatment, about 1 in 100 older children, teenagers and adults will have developed a persistent stammer (stutter). Many people with a stammer learn to control the stammer but still have problems if they feel stressed or speak in public.
EMIS would like to acknowledge the contribution of the British Stammering Association in the authoring of this leaflet.
Further reading and references
Prasse JE, Kikano GE; Stuttering: an overview. Am Fam Physician. 2008 May 177(9):1271-6.
Ashurst JV, Wasson MN; Developmental and persistent developmental stuttering: an overview for primary care physicians. J Am Osteopath Assoc. 2011 Oct111(10):576-80.
Howell P; Signs of developmental stuttering up to age eight and at 12 plus. Clin Psychol Rev. 2007 Apr27(3):287-306. Epub 2006 Dec 6.
Howell P, Davis S, Williams R; Late childhood stuttering. J Speech Lang Hear Res. 2008 Jun51(3):669-87. doi: 10.1044/1092-4388(2008/048).
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