Stuttering is an interruption of the normal flow of speech, which takes on many different patterns. Commonly, it involves either saying a string of repeated sounds or making abnormal pauses during speech.

In early childhood, stuttering is sometimes part of normal speech development. In fact, about 5% of all young children go through a brief period of stuttering when they are learning to talk. Stuttering typically is first noticed between the ages of 2 and 5. It usually goes away on its own within a matter of months. In a small number of children (around 1%), stuttering continues and may get worse. Boys are more likely to stutter than girls.

Researchers still are trying to determine why stuttering occurs. It runs in families, and genetic (inherited) factors probably play a larger part than previously recognized.

Some studies suggest the problem may be due to subtle changes in the brain pathways that process speech and language. Emotional factors may make the stuttering more pronounced but are not the cause.

After age 10, it is unusual for someone to begin stuttering if he or she has never stuttered before. In rare cases, stuttering can develop after a stroke or brain injury, or rarely as a side effect of some drugs, especially those used to treat seizures or severe psychiatric illness.

Some characteristics of stuttering speech include:

• Repeating a sound ("c-c-c-cat"), a syllable ("ad-ad-ad-advice"), a whole word or a phrase
• Stretching out a sound ("r----ound") or a syllable ("ta-------ble")
• Long pauses or hesitations in the normal flow of speech
• Rushed sentences or phrases, as the child hurries to express a complete thought or idea before stuttering starts
• Physical signs that the child is struggling to "force out" words, including grimaces, tight facial muscles, quivering (tremors) around the mouth and eye blinking

It is important to note that most children repeat sounds or syllables and pronounce words incorrectly when they are learning to speak. This is referred to as normal dysfluency.

However, with true stuttering, these speech behaviors occur more often and repetitions of sounds or words last longer than half a second. In addition, normal problems with fluency tend to come and go, or happen only at certain times (such as when a child is tired or excited), but true stuttering is present most of the time.

Once a child begins to stutter, he or she may feel embarrassed, self-conscious or anxious when asked to speak. The child may find it hard to socialize with friends and also may intentionally avoid situations where talking is expected, such as telephone calls, classroom discussions and school plays.

Somewhat unexpectedly, many children who stutter have no problem when they sing. According to some experts, this is because speaking and singing often come from opposite sides of the brain, especially in right-handed people.

Although episodes of stuttering speech are usually easy to recognize, a diagnosis of true stuttering should always be made by a professional.

If you are concerned that your child seems to be stuttering, talk with your child's doctor. Occasionally, the doctor may refer you to a speech-language pathologist for further evaluation.

As part of your child's evaluation, the speech-language pathologist usually will ask questions about your child's history, including development, behavior and school performance. Then he or she will speak with your child to evaluate speech and language skills. Part of this interview may be recorded. A full evaluation can take several hours.

Many cases of stuttering last for only a few months and most children who stutter will stop completely before the end of their childhood. Only about 1% of children develop persistent stuttering that lasts into adulthood.

Because doctors do not know why children stutter, there is no way to prevent this speech disorder. However, early treatment of stuttering may prevent worsening of symptoms and long-term problems.

Currently, researchers at the U.S. National Institutes of Health and elsewhere are conducting genetic studies to find out whether some people inherit a risk of stuttering. If these studies identify a gene for stuttering, it may be possible to identify and treat high-risk children early in life.

If your child stutters, you can help by doing the following:

• Speak to your child slowly and clearly.
• Make eye contact with your child and use facial expressions and other body language in addition to words to communicate with your child.
• Be a patient, attentive listener.
• Do not finish your child's words or sentences and do not interrupt.
• Do not pressure your child to speak to strangers or perform in public.
• If your child's life is stressful at home or at school, work with family members or teachers to provide a more relaxed environment.

If your doctor refers you to a speech-language pathologist, discuss your expectations before treatment begins. Speech-language pathologists use many different types of speech therapy to treat stuttering, and the success of each type of therapy varies from person to person. Some of the most popular methods include:

• Modeling slower speaking
• Breath control exercises
• Using a computer or other devices to give immediate feedback on how the child is doing with various strategies
• Exercises to help reduce the tension on the vocal cords

In rare cases, doctors have tried using drugs to treat severe stuttering. But these drugs often have side effects that are worse than the speech disorder itself.

Call your doctor if your child:

• Develops frequent or long-lasting episodes of stuttering
• Has stuttering that lasts for more than a few months
• Stutters and is over age 5
• Shows physical signs that he or she is struggling to produce words
• Is afraid or embarrassed to speak in public because of the speech problem
• Clearly avoids situations where he or she is expected to speak
• Has other developmental or language difficulties

Most children who stutter eventually improve, even without therapy. Among those with more severe stuttering and those who continue to stutter as adults, speech therapy usually can keep these symptoms to a minimum.

National Institute on Deafness and Other Communication Disorders
NIDCD Information Clearinghouse
1 Communication Ave.
Bethesda, MD 20892
Phone: 301-496-7243
Toll-Free: 1-800-241-1044
Fax: 301-402-0018
TTY: 301-402-0252
http://www.nidcd.nih.gov/

American Speech-Language-Hearing Association (ASHA)
10801 Rockville Pike
Rockville, MD 20852
Phone: 301-897-5700Toll-Free: 1-800-498-2071
TTY: 301-498-2071
Fax: 301-571-0457
TTY: 301-897-0157
http://www.asha.org/

National Stuttering Association
4071 East La Palma Ave.
Suite A
Anaheim Hills, CA 92807
Toll-Free: 1-800-364-1677
http://www.nsastutter.org/