Stuttering & Fluency

Stuttering is a speech fluency disorder affecting about 5-10% of children at some point, with approximately 1% of adults experiencing lifelong stuttering. It's a neurological condition—not caused by anxiety or nervousness, though these can be effects of stuttering. With appropriate support, most children achieve fluent speech, and people of all ages can learn to communicate effectively and confidently.

10 sections
4 pro tips
6 external resources

What is Stuttering?

Stuttering is a speech fluency disorder characterized by disruptions in the forward flow of speech. People who stutter know exactly what they want to say but have difficulty saying it smoothly. These disruptions—called disfluencies—are involuntary and can vary greatly in frequency and severity.

Stuttering is a neurological condition with genetic components. Brain imaging studies consistently show differences in the brains of people who stutter compared to those who don't, particularly in areas involved in speech planning and production. Researchers have identified four genes associated with stuttering.

Importantly, stuttering is NOT caused by anxiety, nervousness, or psychological problems—though living with stuttering can cause anxiety and emotional challenges. Stuttering is also not caused by how parents talk to their children or by traumatic events.


Types of Disfluency

Understanding the difference between typical disfluency (which most young children experience) and stuttering helps parents know when to seek help.

Normal/Typical Disfluency (Common Ages 2-5)

  • Whole-word repetitions: "I-I-I want that"
  • Phrase repetitions: "Can I—can I—can I go?"
  • Interjections: "I, um, want to go"
  • Hesitations and revisions (changing words mid-sentence)
  • Usually improves without intervention within 6-12 months
  • No physical tension or struggle
  • Child usually unaware of disfluencies

Stuttering Characteristics

  • Part-word repetitions: "B-b-b-ball" (sound or syllable repetitions)
  • Sound prolongations: "Sssssnake" (stretching sounds)
  • Blocks: Silent struggle, feeling 'stuck' getting words out
  • Physical tension visible in face, jaw, neck, or body
  • Secondary behaviors: Eye blinking, head movements, jaw tension
  • Avoidance: Substituting words, avoiding speaking situations
  • Negative reactions to speaking or awareness of difficulty

Who Stutters?

Approximately 5-10% of all children experience a period of stuttering, typically beginning between ages 2-4 when language is developing rapidly. About 75-80% of these children will recover naturally, usually within 12-24 months of onset. Approximately 20-25% will continue stuttering into adulthood.

Boys are 2-3 times more likely to stutter than girls, and this gender difference increases with age (boys are less likely to recover). Stuttering runs in families—children with a family history are more likely to stutter and more likely to persist.

  • 5-10% of children stutter at some point
  • 75-80% recover naturally, usually within 1-2 years
  • About 1% of adults stutter
  • Boys are 2-3 times more likely to stutter than girls
  • Stuttering runs in families (genetic component)
  • Stuttering occurs across all languages and cultures
  • Intelligence is not affected by stuttering

Risk Factors for Persistent Stuttering

While we cannot predict with certainty which children will recover and which will continue stuttering, certain factors are associated with increased risk of persistence. The presence of multiple risk factors suggests earlier intervention is warranted.

  • Family history of stuttering (especially persistent stuttering)
  • Male gender (boys are more likely to continue stuttering)
  • Stuttering persisting beyond 6-12 months after onset
  • Age of onset after 3.5 years
  • Presence of other speech or language concerns
  • Increasing severity or frequency of stuttering over time
  • Child showing awareness, frustration, or avoidance
  • No signs of improvement after several months

Evidence-Based Treatment Approaches

Several effective treatment approaches exist for stuttering, varying by age and individual needs. Early intervention for preschool-age children produces the best outcomes.

The Lidcombe Program (Preschool Children)

  • Evidence-based parent-implemented treatment for children under 6
  • Parents deliver treatment in daily life with SLP guidance
  • Uses verbal feedback (contingencies) for fluent and stuttered speech
  • Practice sessions structured to achieve high fluency in enjoyable activities
  • Children are NOT instructed to change their speech pattern
  • Endorsed by professional associations in multiple countries
  • Requires working with a Lidcombe-trained SLP

Palin Parent-Child Interaction Therapy

  • Indirect therapy approach for preschool children
  • Focuses on modifying parent interaction styles
  • Creates communication environment that supports fluency
  • Strategies: Slowing rate, reducing questions, following child's lead
  • Particularly helpful for children early in stuttering onset

Speech Modification Strategies (School-Age/Teens/Adults)

  • Techniques to produce smoother, more fluent speech
  • Easy onset: Gentle voice initiation on words
  • Light contacts: Reducing tension in articulatory contacts
  • Stretching: Prolonging sounds slightly for smoother transitions
  • Cancellations and pull-outs: Stopping and restarting smoothly after stuttering

Stuttering Modification Therapy

  • Developed by Charles Van Riper
  • Focuses on stuttering more easily rather than not stuttering
  • Reduces tension and struggle during stuttering moments
  • Helps develop acceptance and reduces avoidance
  • Often combined with speech modification techniques

Cognitive Behavioral Therapy (CBT)

  • Addresses anxiety and negative thoughts about stuttering
  • Does not treat stuttering itself but helps manage emotional impact
  • Particularly helpful for social anxiety related to stuttering
  • Often combined with speech therapy approaches
  • Helps develop confidence and reduce avoidance behaviors

What Parents Can Do

Helpful Strategies (Do's)

  • Speak slowly and calmly—model easy, relaxed speech pace
  • Pause 1-2 seconds before responding—reduces time pressure
  • Maintain natural, warm eye contact when they speak
  • Really listen to WHAT they're saying, not HOW they're saying it
  • Let them finish their thoughts without interrupting
  • Acknowledge their feelings if they express frustration
  • Create unhurried 'special talking time' daily (5-10 minutes)
  • Praise their ideas, stories, and communication—not their fluency
  • Treat them the same as siblings who don't stutter
  • Read aloud together—it's low-pressure speaking practice
  • Reduce rapid-fire questions (comment more, question less)

Unhelpful Responses (Don'ts)

  • Don't say 'slow down,' 'relax,' or 'take a breath'
  • Don't complete their words or sentences for them
  • Don't look away or show discomfort when they stutter
  • Don't ask them to 'start over' or 'think about what you want to say'
  • Don't discuss their stuttering negatively in front of them
  • Don't let siblings tease, mock, or interrupt
  • Don't put them on the spot to perform verbally for others
  • Don't show impatience, even nonverbally
  • Don't make speaking a stressful experience

Talking About Stuttering

Many parents wonder whether they should talk about stuttering with their child. The answer is generally yes—in an age-appropriate, matter-of-fact way. Avoiding the topic can inadvertently communicate that stuttering is shameful or something to hide.

If your child mentions their stuttering, acknowledge it calmly: 'Sometimes words can feel tricky. Lots of people have times when talking feels harder. I always love hearing what you have to say.' This validates their experience while communicating unconditional acceptance.

  • It's okay to acknowledge stuttering matter-of-factly
  • Use calm, accepting language if your child brings it up
  • Avoiding the topic can suggest shame—open communication is better
  • Let your child know you're happy to listen, always
  • Answer questions honestly and simply
  • Model that stuttering doesn't change your love or attention

Stuttering at School

School can be challenging for children who stutter due to oral reading, class presentations, answering questions, and social interactions. Working with teachers proactively can make a significant difference in your child's experience and confidence.

Communicating with Teachers

  • Share basic information about stuttering (it's neurological, not nervousness)
  • Explain what helps your child specifically
  • Discuss alternatives to reading aloud or answering on the spot
  • Request extra time for oral responses when needed
  • Ask that your child not be penalized for disfluency in participation grades
  • Discuss peer education about stuttering if appropriate
  • Keep communication open throughout the year

Classroom Accommodations

  • Option to answer questions in writing or privately
  • Not being called on unexpectedly for oral reading
  • Extra time for oral responses
  • Alternative presentation formats if anxiety is severe
  • Safe signal to indicate readiness to respond
  • Peer education to promote understanding
  • Access to SLP services at school if eligible

Stuttering Across the Lifespan

Teens and Stuttering

  • Adolescence can intensify stuttering challenges due to social pressures
  • Peer relationships, dating, and self-identity all affected
  • Support groups (like FRIENDS) provide connection with other teens who stutter
  • Therapy may focus on both fluency techniques and confidence-building
  • College and career planning should include self-advocacy skills

Adults Who Stutter

  • Approximately 1% of adults stutter
  • Many successful people stutter (President Biden, James Earl Jones)
  • Therapy at any age can improve fluency and confidence
  • Workplace accommodations may be available
  • Support groups provide community and reduce isolation
  • Self-acceptance is a key component of successful management

The Emotional Side of Stuttering

Stuttering is often described as an 'iceberg'—the visible stuttering (above the surface) may be only a small part of the experience. Below the surface are the emotions, avoidance behaviors, and impact on daily life that others can't see.

Children and adults who stutter may experience anxiety, embarrassment, frustration, shame, and reduced confidence. They may avoid speaking situations, switch words, or limit participation in activities. Addressing these emotional aspects is an important part of comprehensive stuttering therapy.

  • Stuttering can affect self-esteem and confidence
  • Anxiety about speaking is common (but not the cause of stuttering)
  • Avoidance behaviors can significantly limit participation in life
  • Therapy should address both the stuttering and its emotional impact
  • Building self-acceptance is key to successful management
  • Connection with others who stutter reduces isolation
  • With support, people who stutter can achieve their goals

When to Seek Help

  • Stuttering continuing for 6+ months
  • Family history of persistent stuttering
  • Child showing awareness, frustration, or embarrassment
  • Physical tension or struggle when speaking
  • Avoidance of speaking situations or word substitution
  • Secondary behaviors (eye blinks, head movements)
  • Stuttering getting worse over time
  • Child asking why they 'can't talk right'
  • Any stuttering causing concern for you or your child

Expert Tips

Special Talking Time

Spend 5-10 minutes daily in one-on-one 'special talking time' with your child. Follow their lead, speak slowly, pause often, and give them your full attention. This reduces communication pressure and models relaxed speech.

It's Okay to Talk About It

If your child mentions their stuttering, acknowledge it calmly: 'Sometimes words can feel tricky. Everyone has times when talking feels harder. I always love hearing what you have to say.' This validates their experience while showing unconditional acceptance.

Seek Help Early

Early intervention produces the best outcomes for childhood stuttering. If you're concerned, don't 'wait and see'—get an evaluation from an SLP experienced with fluency disorders. Treatment for preschoolers is highly effective.

Model, Don't Instruct

Rather than telling your child to 'slow down' or 'take a breath,' simply model slow, relaxed speech yourself. Children learn more from what we do than what we say.

Still Have Questions?

Our team is here to help. Book a free consultation to discuss your concerns and learn how we can support you or your child.