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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Minding Your Mind Minding Your Mind

Stuttering -- A Surprisingly Common Problem

January 25, 2013

By Michael Craig Miller M.D.

Harvard Medical School

When The King's Speech won four Oscars in 2011, many people were quite happy, because of the excellent education the movie provided about stuttering.

The makers of The King's Speech seem to have done their homework. David Seidler, who wrote the script, had firsthand knowledge of the problem. In interviews, he described himself as a "profound stutterer." Born in England, he moved with his family to the United States at the start of World War II to escape the bombs. That's when his stuttering began.

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What is Stuttering?

In stuttering (or stammering, which may be the more common term in England), the normal flow of speech is interrupted. The speaker may repeat or prolong a sound. There may be unusual pauses at the beginning of words or syllables. Or the speaking rhythm may be unusual.

Often, there are physical signs that the person is "struggling" to get words out, such as:

  • Changes in breathing or voice quality
  • Pursing of the lips
  • Facial grimaces
  • Abnormal body movements

The person who stutters may fear saying certain words or sounds. To avoid them, he searches for word substitutes or talks around a word. The severity of symptoms may vary depending on the circumstances. Telephone calls and group settings can make speaking more difficult, as can stressful situations like job interviews or public speaking.

The problem is surprisingly common: Stuttering affects as many as 1 in 100 adults. It is more common in children. As many as 5% will stutter at some point; most (75%–80%) are boys.

Stuttering improves for most children as they enter adolescence, but the problem becomes harder to treat if symptoms continue after puberty.

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Factors that Contribute to Stuttering

As Oscar winner Colin Firth's performance shows, speech difficulties can be a great source of embarrassment. But you don't need to be a king to feel it.

Indeed, there are some notable success stories of public figures who have lived with the disorder: Winston Churchill, James Earl Jones and Carly Simon. But many stutterers feel that the problem significantly limits their life choices. Work and school performance can suffer. Many stutterers socialize as little as possible in order to avoid having to talk to people.

Experts believe that while emotional factors may make stuttering worse, stressful or traumatic events (like David Seidler's) usually do not cause it. According to recent research, there are likely to be several genetic and biologic factors that contribute to stuttering:

  • There is a strong family connection. (For example, identical twins are often both affected.)
  • Scientists have begun to identify genes linked to the disorder.
  • Neuroimaging shows subtle changes in the brain pathways that process speech and language.
  • Other characteristic brain areas also light up in people who stutter, for example, the areas that show a person's responses to hearing his or her own voice.

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Helpful Treatments

There is no cure for stuttering, but there are many helpful treatments. Getting help early in childhood may limit difficulties later in life. Goals depend upon a person's age and what he or she needs or wants to communicate.

Here are some approaches that people familiar with stuttering have found useful:

  • Practicing ways to be more fluent by changing the physical mechanics of a person's speech
  • Learning techniques that help manage the fear of speaking
  • Replacing critical and negative thoughts about oneself with more positive ones, particularly around interacting with people
  • Teaching parents to contain their anxiety about the problem, to relax more when listening and responding, to listen patiently rather than completing a child's sentences, and to talk about the problem in a matter-of-fact way.

As of now, no medications are approved to treat stuttering. Some stutterers have found it helpful to wear a device like a hearing aid to alter the feedback of their voice.

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Support groups can be very helpful and can be found online. Here are some website for further information:

The Stuttering Foundation

National Stuttering Association

American Speech-Language-Hearing Association

Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.

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