View source for Stuttering

{{Short description|Speech disorder}}
{{Hatnote group|{{redirect-several|Stutter|Stammer}}
{{For|the film|Stutterer (film){{!}}''Stutterer'' (film)}}
{{For|the words|Dysphemism}}
}}
{{cs1 config|name-list-style=vanc}}
{{Infobox medical condition
| name = Stuttering
| synonyms = Stammering, alalia syllabaris, alalia literalis, anarthria literalis, dysphemia<ref name="GREENE pp. 74–82">{{cite journal |last1=Greene |first1=J. S. |title=Dysphemia and Dysphonia: Cardinal Features of Three Types of Functional Syndrome: Stuttering, Aphonia and Falsetto (Male) |journal=Archives of Otolaryngology–Head and Neck Surgery |date=July 1937 |volume=26 |issue=1 |pages=74–82 |doi=10.1001/archotol.1937.00650020080011 }}</ref>
| image = 
| alt = 
| caption = 
| pronounce = 
| field = [[Speech–language pathology]]
| symptoms = Involuntary sound repetition and disruption or blocking of speech
| onset = Sudden, 2–5 years old
| duration = Long term
| types = 
| causes = Neurological and genetics (primarily)
| risks = 
| diagnosis = 
| differential = [[Cluttering]]
| prevention = 
| treatment = [[Speech therapy]], community support
| medication = 
| prognosis = 75–80% developmental resolves by late childhood; 15–20% of cases last into adulthood
| frequency = About 1%
| deaths = 
}}

'''Stuttering''', also known as '''stammering''', is a [[speech disorder]] characterized externally by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses called blocks in which the person who stutters is unable to produce sounds.<ref>[http://apps.who.int/classifications/icd10/browse/2010/en#/F98.5 World Health Organization ICD-10 F95.8 – Stuttering] {{webarchive|url=https://web.archive.org/web/20141102133725/http://apps.who.int/classifications/icd10/browse/2010/en |date=2014-11-02 }}.</ref><ref>{{cite web | url=https://www.asha.org/public/speech/disorders/stuttering/ | title=Stuttering }}{{full citation needed|date=February 2025}}</ref> Almost 80 million people worldwide stutter, about 1% of the world's population, with a prevalence among males at least twice that of females.<ref>{{cite web | url=https://www.nidcd.nih.gov/health/statistics/prevalence-percent-stuttering-determined-examiner-young-african-american-black-and | title=Prevalence (In Percent) of Stuttering, as Determined by Examiner, in Young African American (Black) and European American (White) Boys and Girls in Illinois | date=7 June 2010 }}</ref> Persistent stuttering into adulthood often leads to outcomes detrimental to overall mental health, such as social isolation and [[suicidal ideation|suicidal thoughts]].<ref name="Carlson, N. 2013 pp. 497-500">{{cite book |last1=Carlson |first1=Neil R. |date=2013 |chapter=Human Communication |title=Physiology of Behavior |edition=11th |pages=497–500 |location=Boston |publisher=Allyn and Bacon |oclc=794965232 |isbn=978-0-205-87194-0 }}</ref>

Stuttering is not connected to the physical ability to produce [[phonemes]] (i.e. it is unrelated to the structure or function of the [[vocal cords]]). It is also unconnected to the structuring of thoughts into coherent sentences inside sufferers' brains, meaning that people with a stutter know precisely what they are trying to say (in contrast with alternative disorders like [[aphasia]]). Stuttering is purely a neurological disconnect between intent and outcome during the task of expressing each individual sound. While there are rarer [[neurogenic]] (e.g. acquired during physical insult) and [[psychogenic disease|psychogenic]] (e.g. acquired after adult-onset mental illness or trauma) variants, the typical etiology, development, and presentation is that of [[idiopathic]] stuttering in childhood that then becomes persistent into adulthood.{{citation needed|date=February 2025}}

Acute nervousness and stress do not cause stuttering but may trigger increased stuttering in people who have the disorder. There is a significant correlation between [[anxiety (mood)|anxiety]], particularly [[social anxiety]], and stuttering, but stuttering is a distinct, engrained neurobiological phenomenon and thus only exacerbated, not caused, by anxiety.<ref>{{cite journal |last1=Iverach |first1=Lisa |last2=Rapee |first2=Ronald M. |title=Social anxiety disorder and stuttering: Current status and future directions |journal=Journal of Fluency Disorders |date=June 2014 |volume=40 |pages=69–82 |doi=10.1016/j.jfludis.2013.08.003 |pmid=24929468 |doi-access=free }}</ref> Anxiety consistently worsens stuttering symptoms in acute settings in those with [[comorbidity|comorbid]] anxiety disorders.

Living with a stigmatized speech disability like a stutter can result in high [[allostatic load]] (i.e. adverse pathophysiological sequelae of high and/or highly variable [[nervous system]] stress). Despite the negative physiological outcomes associated with stuttering and its concomitant stress levels, the link is not bidirectional: neither acute nor chronic stress has been shown to cause a predisposition to stuttering.

{{TOC limit|3}}

==Characteristics==

===Audible disfluencies===
Common stuttering behaviors are observable signs of speech disfluencies, for example: repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds.   
*Repeated movements
** Syllable repetition—a single syllable word is repeated (for example: "on-on-on a chair") or a part of a word which is still a full syllable such as "un-un-under the&nbsp;..." and "o-o-open".
** Incomplete syllable repetition—an incomplete syllable is repeated, such as a consonant without a vowel, for example, "c-c-c-cold".
** Multi-syllable repetition—more than one syllable such as a whole word, or more than one word is repeated, such as "I know-I know-I know a lot of information."
* Prolongations
** With audible airflow—prolongation of a sound occurs such as "mmmmmmmmmom".
** Without audible airflow—such as a block of speech or a tense pause where no airflow occurs and no phonation occurs.
The disorder is ''variable'', which means that in certain situations the stuttering might be more or less noticeable, such as speaking on the phone or in large groups. People who stutter often find that their stuttering fluctuates, sometimes at random.<ref>{{cite web |last=Bowen |first=Caroline |title=Information for Families: Stuttering- What can be done about it? |url=http://speech-language-therapy.com/index.php?option=com_content&view=article&id=101:stuttering&catid=11:admin&Itemid=101 |url-status=live |archive-url=https://web.archive.org/web/20150402150955/http://speech-language-therapy.com/index.php?option=com_content&view=article&id=101:stuttering&catid=11:admin&Itemid=101 |archive-date=April 2, 2015 |access-date=June 19, 2013 |work=speech-language-therapy dot com}}</ref>

The moment of stuttering often begins before the disfluency is produced, described as a moment of "anticipation"—where the person who stutters knows which word they are going to stutter on. The sensation of losing control and anticipation of a stutter can lead people who stutter to react in different ways including behavioral and cognitive reactions. Some behavioral reactions can manifest outwardly and be observed as physical tension or struggle anywhere in the body.<ref name=":0">{{cite journal |last1=Tichenor |first1=Seth E. |last2=Yaruss |first2=J. Scott |title=Stuttering as Defined by Adults Who Stutter |journal=Journal of Speech, Language, and Hearing Research |date=18 December 2019 |volume=62 |issue=12 |pages=4356–4369 |doi=10.1044/2019_JSLHR-19-00137 |pmid=31830837 }}</ref>

=== Outward physical behaviors ===
People who stutter may have reactions, avoidance behaviors, or secondary behaviors related to their stuttering that may look like struggle and tension in the body. These could range anywhere from tension in the head and neck, behaviors such as snapping or tapping, or facial grimacing. <ref>{{Cite web |title=Secondary Characteristics Of Stuttering {{!}} AIS |url=https://www.stutteringtreatment.org/blog/secondary-characteristics-of-stuttering |access-date=2025-11-18 |website=www.stutteringtreatment.org |language=en}}</ref>

=== Behavioral reactions ===
These behavioral reactions are those that might not be apparent to listeners and only be perceptible to people who stutter. Some people who stutter exhibit covert behaviors such as avoiding speaking situations, substituting words or phrases when they know they are going to stutter, or use other methods to hide their stutter.<ref name=":0" />

===Feelings and attitudes===
Stuttering could have a significant negative cognitive and affective impact on the person who stutters. [[Joseph Sheehan]] described this in terms of an [[analogy]] to an iceberg, with the immediately visible and audible symptoms of stuttering above the [[waterline]] and a broader set of symptoms such as negative [[emotion]]s hidden below the surface.<ref>{{harvnb|Kalinowski|Saltuklaroglu|2006| p=17}}</ref> Feelings of [[embarrassment]], [[shame]], [[frustration]], [[fear]], [[anger]], and [[guilt (emotion)|guilt]] are frequent in people who stutter, and may increase tension and effort.<ref name="Guitar16–7">{{harvnb|Guitar|2005|pp=16–7}}</ref> With time, continued negative experiences may crystallize into a negative self-concept and self-image. People who stutter may project their own attitudes onto others, believing that the others think them nervous or stupid. Such negative feelings and attitudes may need to be a major focus of a treatment program.<ref name="Guitar16–7"/>

The impact of discrimination against stuttering can be severe. This may result in fears of stuttering in social situations, self-imposed isolation, anxiety, stress, shame, low self-esteem, being a possible target of bullying or discrimination, or feeling pressured to hide stuttering. In popular media, stuttering is sometimes seen as a symptom of anxiety, but there is no direct correlation in that direction.<ref>{{cite journal |last1=Constantino |first1=Christopher |last2=Campbell |first2=Patrick |last3=Simpson |first3=Sam |title=Stuttering and the social model |journal=Journal of Communication Disorders |date=March 2022 |volume=96 |article-number=106200 |doi=10.1016/j.jcomdis.2022.106200 |pmid=35248920 }}</ref>

Alternatively, there are those who embrace [[stuttering pride]] and encourage other stutterers to take pride in their stutter and to find how it has been beneficial for them.{{citation needed|date=February 2025}}

According to adults who stutter, however, stuttering is defined as a "constellation of experiences" expanding beyond the external disfluencies that are apparent to the listener. Much of the experience of stuttering is internal and encompasses experiences beyond the external speech disfluencies, which are not observable by the listener.<ref name=":0" />

=== Associated conditions ===
Stuttering can co-occur with other disabilities. These associated disabilities include:
{{div col|colwidth=22em}}
*[[attention deficit hyperactivity disorder]] (ADHD);<ref>{{cite journal |last1=Sroubek |first1=Ariane |last2=Kelly |first2=Mary |last3=Li |first3=Xiaobo |title=Inattentiveness in attention-deficit/hyperactivity disorder |journal=Neuroscience Bulletin |date=February 2013 |volume=29 |issue=1 |pages=103–110 |doi=10.1007/s12264-012-1295-6 |pmid=23299717 |pmc=4440572 }}</ref> the prevalence of ADHD in school-aged children who stutter is {{clarify span|text=around 4–50%|explain=4% to 50%, or 40% to 50%?|date=August 2022}}.<ref>{{cite journal |last1=Druker |first1=Kerianne |last2=Hennessey |first2=Neville |last3=Mazzucchelli |first3=Trevor |last4=Beilby |first4=Janet |title=Elevated attention deficit hyperactivity disorder symptoms in children who stutter |journal=Journal of Fluency Disorders |date=March 2019 |volume=59 |pages=80–90 |doi=10.1016/j.jfludis.2018.11.002 |pmid=30477807 }}</ref><ref>{{cite journal |last1=Donaher |first1=Joseph |last2=Richels |first2=Corrin |title=Traits of attention deficit/hyperactivity disorder in school-age children who stutter |journal=Journal of Fluency Disorders |date=December 2012 |volume=37 |issue=4 |pages=242–252 |doi=10.1016/j.jfludis.2012.08.002 |pmid=23218208 }}</ref><ref name="Concomitant Disorders in School-Age">{{cite journal |last1=Arndt |first1=Jennifer |last2=Healey |first2=E. Charles |title=Concomitant Disorders in School-Age Children Who Stutter |journal=Language, Speech, and Hearing Services in Schools |date=April 2001 |volume=32 |issue=2 |pages=68–78 |doi=10.1044/0161-1461(2001/006) |pmid=27764357 }}</ref><ref>{{cite journal |last1=Riley |first1=Jeanna |last2=Riley |first2=Johnetta G. |title=A Revised Component Model for diagnosing and Treating Children Who Stutter |journal=Contemporary Issues in Communication Science and Disorders |date=October 2000 |volume=27 |issue=Fall |pages=188–199 |doi=10.1044/cicsd_27_F_188 }}</ref>
*[[dyslexia]];<ref>{{cite journal |last1=Peterson |first1=Robin L |last2=Pennington |first2=Bruce F |title=Developmental dyslexia |journal=The Lancet |date=May 2012 |volume=379 |issue=9830 |pages=1997–2007 |doi=10.1016/s0140-6736(12)60198-6 |pmc=3465717 |pmid=22513218 }}</ref> the prevalence rate of childhood stuttering in dyslexia is around 30–40%, while in adults the prevalence of dyslexia in adults who stutter is around 30–50%.<ref>{{cite journal |last1=Blood |first1=Gordon W |last2=Ridenour |first2=Victor J |last3=Qualls |first3=Constance Dean |last4=Hammer |first4=Carol Scheffner |title=Co-occurring disorders in children who stutter |journal=Journal of Communication Disorders |date=November 2003 |volume=36 |issue=6 |pages=427–448 |doi=10.1016/S0021-9924(03)00023-6 |pmid=12967738 }}</ref><ref name="Concomitant Disorders in School-Age"/><ref>{{cite journal |last1=Elsherif |first1=Mahmoud M. |last2=Wheeldon |first2=Linda R. |last3=Frisson |first3=Steven |title=Do dyslexia and stuttering share a processing deficit? |journal=Journal of Fluency Disorders |date=March 2021 |volume=67 |article-number=105827 |doi=10.1016/j.jfludis.2020.105827 |pmid=33444937 |url=https://osf.io/grb54 }}</ref>
*[[autism]]<ref name="briley">{{cite journal |last1=Briley |first1=Patrick M. |last2=Ellis |first2=Charles |title=The Coexistence of Disabling Conditions in Children Who Stutter: Evidence From the National Health Interview Survey |journal=Journal of Speech, Language, and Hearing Research |date=10 December 2018 |volume=61 |issue=12 |pages=2895–2905 |doi=10.1044/2018_JSLHR-S-17-0378 |pmid=30458520 }}</ref> 
* intellectual disability<ref name="Healey">{{cite book |last1=Healey |first1=E Charles |last2=Reid |first2=Robert |last3=Donaher |first3=Joe |chapter=Treatment of the child who stutters with co-existing learning, behavioral, and cognitive challenges |pages=178–196 |chapter-url={{GBurl|drCkEAAAQBAJ|p=178}} |editor1-last=Lees |editor1-first=Roberta |editor2-last=Stark |editor2-first=Cameron |title=The Treatment of Stuttering in the Young School Aged Child |date=2005 |publisher=John Wiley & Sons |isbn=978-1-86156-486-3 |oclc=1072950273 }}</ref>
* language or learning disability<ref>{{cite journal |last1=Ntourou |first1=Katerina |last2=Conture |first2=Edward G. |last3=Lipsey |first3=Mark W. |title=Language Abilities of Children Who Stutter: A Meta-Analytical Review |journal=American Journal of Speech-Language Pathology |date=August 2011 |volume=20 |issue=3 |pages=163–179 |doi=10.1044/1058-0360(2011/09-0102) |pmid=21478281 |pmc=3738062 }}</ref>
* seizure disorders<ref name="briley" />
* [[social anxiety disorder]]<ref>{{Cite journal |last1=Iverach |first1=Lisa |last2=Rapee |first2=Ronald M. |date=June 2014 |title=Social anxiety disorder and stuttering: Current status and future directions |journal=Journal of Fluency Disorders |language=en |volume=40 |pages=69–82 |doi=10.1016/j.jfludis.2013.08.003|pmid=24929468 |doi-access=free }}</ref> 
* [[speech sound disorder]]s<ref>{{cite journal |last1=St. Louis |first1=Kenneth O. |last2=Hinzman |first2=Audrey R. |title=A descriptive study of speech, language, and hearing characteristics of school-aged stutterers |journal=Journal of Fluency Disorders |date=October 1988 |volume=13 |issue=5 |pages=331–355 |doi=10.1016/0094-730X(88)90003-4 }}</ref>
* other developmental disorders<ref name="briley" />
{{div col end}}

==Causes==
The cause of developmental stuttering is complex. It is thought to be neurological with a genetic factor.<ref name=":4">{{Cite book|title=A handbook on stuttering|last1=Bloodstein|first1=Oliver|last2=Ratner|first2=Nan Bernstein|publisher=Cengage Learning|year=2007|isbn=978-1-4180-4203-5|page=142}}</ref><ref>{{Cite web|date=2019-08-16|title=NIH study in mice identifies type of brain cell involved in stuttering|url=https://www.nidcd.nih.gov/news/2019/nih-study-mice-identifies-type-brain-cell-involved-stuttering|access-date=2021-05-16|website=NIDCD|language=en}}</ref>

Various hypotheses suggest multiple factors contributing to stuttering. There is strong evidence that stuttering has a genetic basis.<ref name="Guitar5–6">{{harvnb|Guitar|2005|pp= 5–6}}</ref> Children who have [[first-degree relative]]s who stutter are three times as likely to develop a stutter.<ref>{{harvnb|Ward|2006|p= 11}}</ref> In a 2010 article, three genes were found by [[Dennis Drayna]] and team to correlate with stuttering: [[GNPTAB]], [[GNPTG]], and [[NAGPA]]. Researchers estimated that alterations in these three genes were present in 9% of those who have a family history of stuttering.<ref>{{cite journal |last1=Kang |first1=Changsoo |last2=Riazuddin |first2=Sheikh |last3=Mundorff |first3=Jennifer |last4=Krasnewich |first4=Donna |last5=Friedman |first5=Penelope |last6=Mullikin |first6=James C. |last7=Drayna |first7=Dennis |title=Mutations in the Lysosomal Enzyme–Targeting Pathway and Persistent Stuttering |journal=New England Journal of Medicine |date=25 February 2010 |volume=362 |issue=8 |pages=677–685 |doi=10.1056/NEJMoa0902630 |pmid=20147709 |pmc=2936507 }}</ref><ref>{{cite web |url=http://children.webmd.com/news/20100210/genetic-mutations-linked-to-stuttering |title=Genetic Mutations Linked to Stuttering |publisher=Children.webmd.com |date=February 10, 2010 |access-date=August 13, 2012 |url-status=live |archive-url=https://web.archive.org/web/20121112104541/http://children.webmd.com/news/20100210/genetic-mutations-linked-to-stuttering |archive-date=November 12, 2012 }}</ref><ref name="west">{{cite journal |last1=West |first1=Robert |last2=Nelson |first2=Severina |last3=Berry |first3=Mildred |title=The heredity of stuttering |journal=Quarterly Journal of Speech |date=February 1939 |volume=25 |issue=1 |pages=23–30 |doi=10.1080/00335633909380434 }}</ref><ref>{{cite journal |last1=Frigerio-Domingues |first1=Carlos |last2=Drayna |first2=Dennis |title=Genetic contributions to stuttering: the current evidence |journal=Molecular Genetics & Genomic Medicine |date=March 2017 |volume=5 |issue=2 |pages=95–102 |doi=10.1002/mgg3.276 |pmid=28361094 |pmc=5370225 }}</ref>

There is evidence that stuttering is more common in children who also have concurrent speech, language, learning or motor difficulties. For some people who stutter, congenital factors may play a role. In others, there could be added impact due to stressful situations. However there is no evidence to suggest this as a cause.<ref name="Guitar5–6"/>

Less common causes of stuttering include neurogenic stuttering (stuttering that occurs secondary to brain damage, such as after a stroke) and psychogenic stuttering (stuttering related to a psychological condition).<ref name="Sander and Osborne" />

===History of causes===

Auditory processing deficits were proposed as a cause of stuttering due to differences in stuttering for deaf or Hard of Hearing individuals, as well as the impact of auditory feedback machines on some stuttering cases.<ref>{{harvnb|Ward|2006|pp= 46–58}}</ref>

Some possibilities of linguistic processing between people who stutter and people who do not has been proposed.<ref>{{harvnb|Ward|2006|p= 43}}</ref> Brain scans of adult stutterers have found greater activation of the right hemisphere, than of the left hemisphere, which is associated with speech. In addition, reduced activation in the left auditory cortex has been observed.<ref name="gordon"/>

The 'capacities and demands model' has been proposed to account for the heterogeneity of the disorder. Speech performance varies depending on the 'capacity' that the individual has for producing fluent speech, and the 'demands' placed upon the person by the speaking situation. Demands may be increased by internal factors or inadequate language skills or external factors. In stuttering, severity often increases when demands placed on the person's speech and language system increase.<ref>{{harvnb|Ward|2006|pp= 16–21}}</ref> However, the precise nature of the capacity or incapacity has not been delineated. Stress, or demands, can impact many disorders without being a cause.

Another theory has been that adults who stutter have elevated levels of the neurotransmitter [[dopamine]].<ref name=":4"/><ref name="watkins">{{cite journal |last1=Watkins |first1=K. E. |last2=Smith |first2=S. M. |last3=Davis |first3=S. |last4=Howell |first4=P. |title=Structural and functional abnormalities of the motor system in developmental stuttering |journal=Brain |date=3 December 2007 |volume=131 |issue=1 |pages=50–59 |doi=10.1093/brain/awm241 |pmid=17928317 |pmc=2492392 }}</ref>

It was once thought that forcing a left-handed student to write with their right-hand due to [[bias against left-handed people]] caused stuttering, but this myth died out.<ref>{{cite journal |last1=Lewis |first1=Ruth |title=The psychological approach to the preschool stutterer |journal=Canadian Medical Association Journal |date=May 1949 |volume=60 |issue=5 |pages=497–500 |pmid=18125462 |pmc=1591462 }}</ref><ref>{{cite journal |last1=Bryngelson |first1=Bryng |last2=Clark |first2=Thomas B |title=Left-Handedness and Stuttering |journal=Journal of Heredity |date=October 1933 |volume=24 |issue=10 |pages=387–390 |doi=10.1093/oxfordjournals.jhered.a103681 }}</ref><ref>{{cite journal |last1=Johnson |first1=Wendell |last2=Duke |first2=Lucile |title=Changes in Handedness Associated with Onset or Disappearance of Stuttering: Sixteen Cases |journal=The Journal of Experimental Education |date=December 1935 |volume=4 |issue=2 |pages=112–132 |doi=10.1080/00220973.1935.11010003 }}</ref>

== Diagnosis ==
Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a licensed [[speech–language pathology|speech–language pathologist]] (SLP). Diagnosis of stuttering employs information both from direct observation of the individual and information about the individual's background, through a case history.<ref>{{Cite web|url=https://www.nidcd.nih.gov/health/stuttering|title=Stuttering|date=2015-08-18|website=NIDCD|language=en|access-date=2020-01-29|archive-url=https://web.archive.org/web/20180520055057/https://www.nidcd.nih.gov/health/stuttering|archive-date=2018-05-20}}</ref> The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents.<ref name="cirrie.buffalo.edu">{{Cite web | url=http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International | title=Stuttering | archive-url=https://web.archive.org/web/20131110190444/http://cirrie.buffalo.edu/encyclopedia/en/article/158/ |archive-date=2013-11-10 }} Fibiger S. 2009. Stuttering. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation.</ref> The overall goal of assessment for the SLP will be (1) to determine whether a speech disfluency exists, and (2) assess if its severity warrants concern for further treatment.

During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech (''Riley's Stuttering Severity Instrument Fourth Edition (SSI-4)'').<ref name="cirrie.buffalo.edu" /> They might also employ a test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future.<ref>[http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International Encyclopedia of Rehabilitation] {{webarchive|url=https://web.archive.org/web/20131110190444/http://cirrie.buffalo.edu/encyclopedia/en/article/158/ |date=2013-11-10 }}</ref>

Stuttering is a multifaceted, complex disorder that can impact an individual's life in a variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of the speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)).<ref>{{cite web| url = http://www.latrobe.edu.au/health/downloads/star-stutteringresource.pdfLa| title = Trobe University School of Human Communication Disorders}}</ref>

[[Clinical psychology|Clinical psychologists]] with adequate expertise can also diagnose stuttering per the [[DSM-5]] diagnostic codes.<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.</ref> The DSM-5 describes "Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However, the specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms ''fluency'' and ''disfluency''.{{Citation needed|date=February 2024}}

===Other disfluencies===
Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies").<ref name="Sander and Osborne" /> This type of disfluency is a normal part of speech development and temporarily present in preschool-aged children who are learning to speak.<ref name="Sander and Osborne" /><ref>{{cite journal |last1=Ambrose |first1=Nicoline Grinager |last2=Yairi |first2=Ehud |title=Normative Disfluency Data for Early Childhood Stuttering |journal=Journal of Speech, Language, and Hearing Research |date=August 1999 |volume=42 |issue=4 |pages=895–909 |doi=10.1044/jslhr.4204.895 |pmid=10450909 |quote=Stuttering is shown to be qualitatively as well as quantitatively different from normal disfluency even at the earliest stages of stuttering. }}</ref>

=== Classification ===
"Developmental stuttering" is stuttering that has its onset in early childhood when a child is learning to speak. "Neurogenic stuttering" (stuttering that occurs secondary to brain damage, such as after a stroke) and "psychogenic stuttering" (stuttering related to a psychological condition) are less common and classified separately from developmental.<ref name="Sander and Osborne" />

====Developmental (and persistent)====
"Developmental stuttering" is a sometimes transient period of stuttering that has its onset in early childhood, i.e. when a child is learning to speak. About 5-7% of children are said to stutter during this period. Despite its name, the onset itself is often sudden. This type of stutter may persist after the age of 7, which is then classified as "persistent stuttering", which is the typical aetiology, pathogenesis, and presentation of adult stuttering.<ref name="gordon">{{cite journal |last1=Gordon |first1=Neil |title=Stuttering: incidence and causes |journal=Developmental Medicine & Child Neurology |date=April 2002 |volume=44 |issue=4 |pages=278–282 |doi=10.1111/j.1469-8749.2002.tb00806.x |pmid=11995897 }}</ref><ref name="craig2005">{{cite journal |last1=Craig |first1=A |last2=Tran |first2=Y |title=The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan |journal=Advances in Speech Language Pathology |date=March 2005 |volume=7 |issue=1 |pages=41–46 |doi=10.1080/14417040500055060 }}</ref><ref name="Sander and Osborne" />

====Neurogenic (or "acquired")====
"Neurogenic stuttering", which may also be called "acquired stuttering", typically appears following some sort of injury or disease to the [[central nervous system]]. Injuries to the brain and spinal cord, including the [[neocortex|cortical]]  and [[subcortex|subcortical]] regions, [[cerebellum]], and even the [[neural pathway]] regions (i.e. the deepest clusters - tracts - of nerves and nerve cells).<ref name="Carlson, N. 2013 pp. 497-500"/> It may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback are not effective with the acquired type.<ref name="gordon"/><ref name="craig2005"/><ref>{{harvnb|Ward|2006|pp= 4, 332–335}}</ref>

====Psychogenic====
"Psychogenic stuttering", which accounts for less than 1% of all stuttering cases, may arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker.<ref>{{harvnb|Ward|2006|pp= 4, 332, 335–337}}</ref>

===Differential diagnosis===
Other disorders with symptoms resembling stuttering, or associated disorders include [[autism]], [[cluttering]], [[Parkinson's disease]], [[essential tremor]], [[palilalia]], [[spasmodic dysphonia]], [[selective mutism]], and [[Childhood apraxia of speech|apraxia of speech]].{{citation needed|date=February 2025}}

==Treatment==
{{main|Stuttering therapy}}

While there is no cure for stuttering, several treatment options exist and the best option is dependent on the individual.<ref>{{cite journal |last1=Yaruss |first1=J. Scott |title=One Size Does Not Fit All: Special Topics in Stuttering Therapy |journal=Seminars in Speech and Language |date=2003 |volume=24 |issue=1 |pages=003–006 |doi=10.1055/s-2003-37381 |pmid=12601580 }}</ref> Therapy should be individualized and tailored to the specific and unique needs of the client. The speech–language pathologist and the client typically work together to create achievable and realistic goals that target communication confidence, autonomy, managing emotions and stress related to their stutter, and working on disclosure.<ref>{{Cite journal |last1=Perez |first1=Hector R |last2=Stoeckle |first2=James H |date=June 2016 |title=Stuttering: Clinical and research update |journal=Canadian Family Physician |language=en |volume=62 |issue=6 |pages=479–484 |pmid=27303004 |pmc=4907555 }}</ref>

; Fluency shaping therapy 
: Fluency shaping therapy trains people who stutter to speak less disfluently by controlling their breathing, phonation, and articulation (lips, jaw, and tongue). It is based on [[operant conditioning]] techniques.<ref>{{harvnb|Ward|2006|p= 257}}</ref> This type of therapy is not considered best practice in the field of speech and language pathology and is potentially harmful and traumatic for clients.<ref>{{cite journal |last1=Sisskin |first1=Vivian |title=Disfluency-Affirming Therapy for Young People Who Stutter: Unpacking Ableism in the Therapy Room |journal=Language, Speech, and Hearing Services in Schools |date=17 January 2023 |volume=54 |issue=1 |pages=114–119 |doi=10.1044/2022_LSHSS-22-00015 |pmid=36279203 }}</ref><ref>{{cite journal |last1=Tichenor |first1=Seth E. |last2=Constantino |first2=Christopher |last3=Yaruss |first3=J. Scott |title=A Point of View About Fluency |journal=Journal of Speech, Language, and Hearing Research |date=9 February 2022 |volume=65 |issue=2 |pages=645–652 |doi=10.1044/2021_JSLHR-21-00342 |pmid=34982943 |pmc=9135003 }}</ref>

; Stuttering modification therapy
: The goal of stuttering modification therapy is not to eliminate stuttering but to modify it so that stuttering is easier and less effortful.<ref>{{harvnb|Ward|2006|p= 253}}</ref> The most widely known approach was published by [[Charles Van Riper]] in 1973 and is also known as block modification therapy.<ref>{{harvnb|Ward|2006|p= 245}}</ref> Stuttering modification therapy should not be used to promote fluent speech or presented as a cure for stuttering. 
:
: Avoidance Reduction Therapy for Stuttering (ARTS) is an effective form of modification therapy. It is a framework based on theories developed by professor Joseph Sheehan and his wife Vivian Sheehan. This framework focuses on self-acceptance as someone who stutters, and efficient, spontaneous and joyful communication, essentially, minimizing quality-of-life impact due to stuttering.<ref>{{Cite journal|title=Graphique 1.3 Avantages sanitaires de la lutte contre le changement climatique|doi=10.1787/888932428576 | language=fr | trans-title=Figure 1.3 Health benefits of combating climate change}}</ref>

; Electronic fluency device
{{main|Electronic fluency device}}
: Altered auditory feedback effect can be produced by speaking in chorus with another person, by blocking out the voice of the person who stutters while they are talking (masking), by delaying slightly the voice of the person who stutters (delayed auditory feedback) or by altering the frequency of the feedback (frequency altered feedback). Studies of these techniques have had mixed results.

; Medications
: No medication is currently FDA-approved for stuttering. Some research suggests that dopamine antagonists such as [[ecopipam]] and [[deutetrabenazine]] may have therapeutic potential.<ref name="pmid32292321">{{cite journal |last1=Maguire |first1=Gerald A. |last2=Nguyen |first2=Diem L. |last3=Simonson |first3=Kevin C. |last4=Kurz |first4=Troy L. |title=The Pharmacologic Treatment of Stuttering and Its Neuropharmacologic Basis |journal=Frontiers in Neuroscience |date=27 March 2020 |volume=14 |page=158 |doi=10.3389/fnins.2020.00158 |pmid=32292321 |pmc=7118465 |doi-access=free }}</ref> More recently, psychedelics have been proposed as potential therapeutic agents for developmental stuttering, based on their ability to modulate brain metabolism and neural networks such as the default mode and social-cognitive networks. These systems are thought to contribute to the persistence of stuttering and its associated features, including social anxiety. While clinical trials are currently lacking, anecdotal reports and parallels with other psychiatric conditions have prompted calls for formal investigation.<ref name="Pasculli2024">{{cite journal |last1=Pasculli |first1=Giuseppe |last2=Busan |first2=Pierpaolo |last3=Jackson |first3=Eric S. |last4=Alm |first4=Per A. |last5=De Gregorio |first5=Danilo |last6=Maguire |first6=Gerald A. |last7=Goodwin |first7=Guy M. |last8=Gobbi |first8=Gabriella |last9=Erritzoe |first9=David |last10=Carhart-Harris |first10=Robin L. |title=Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective? |journal=Frontiers in Human Neuroscience |date=19 June 2024 |volume=18 |doi=10.3389/fnhum.2024.1402549 |doi-access=free |hdl=11573/1712146 |hdl-access=free }}</ref>

=== Support ===
Self-help groups provide people who stutter a shared forum within which they can access resources and support from others facing the same challenges of stuttering.{{citation needed|date=February 2025}}

===Prognosis===
Among ages 3–5, the [[prognosis]] for spontaneously recovery is about 65% to 87.5%. By 7 years of age or within the first two years of stuttering,<ref name="Sander and Osborne">{{cite journal |last1=Sander |first1=Robert W. |last2=Osborne |first2=Charles A. |title=Stuttering: Understanding and Treating a Common Disability |journal=American Family Physician |date=November 2019 |volume=100 |issue=9 |pages=556–560 |pmid=31674746 |url=https://www.aafp.org/link_out?pmid=31674746 }}</ref><ref name="fn 30">{{cite journal |last1=Yairi |first1=Ehud |last2=Ambrose |first2=Nicoline |title=Onset of Stuttering in Preschool Children: Selected Factors |journal=Journal of Speech, Language, and Hearing Research |date=August 1992 |volume=35 |issue=4 |pages=782–788 |doi=10.1044/jshr.3504.782 |pmid=1405533 }}</ref><ref name="fn 31">{{cite journal |last1=Yairi |first1=Ehud |title=Epidemiologic and other considerations in treatment efficacy research with preschool age children who stutter |journal=Journal of Fluency Disorders |date=June 1993 |volume=18 |issue=2–3 |pages=197–219 |doi=10.1016/0094-730X(93)90007-Q }}</ref> and about 74% recover by their early teens. In particular, girls are shown to recover more often.<ref name="Ward16">{{harvnb|Ward|2006|p= 16}}</ref><ref name="fn 34">{{cite journal|author= Yairi, E|title=On the Gender Factor in Stuttering|journal=Stuttering Foundation of America Newsletter|date=Fall 2005|page= 5}}</ref>

Prognosis is guarded with later age of onset: children who start stuttering at age 3½ years or later,<ref name="Yairi2005"/> and/or duration of greater than 6–12 months since onset, that is, once stuttering has become established, about 18% of children who stutter after five years recover spontaneously.<ref name="fn 32">{{cite journal |last1=Andrews |first1=Gavin |last2=Hoddinott |first2=Susan |last3=Craig |first3=Ashley |last4=Howie |first4=Pauline |last5=Feyer |first5=Anne-Marie |last6=Neilson |first6=Megan |title=Stuttering: A Review of Research Findings and Theories circa 1982 |journal=Journal of Speech and Hearing Disorders |date=August 1983 |volume=48 |issue=3 |pages=226–246 |doi=10.1044/jshd.4803.226 |pmid=6353066 }}</ref> Stuttering that persists after the age of seven is classified as persistent stuttering, and is associated with a much lower chance of recovery.<ref name="Sander and Osborne" />

==Epidemiology==
The lifetime [[prevalence]], or the proportion of individuals expected to stutter at one time in their lives, is about 5–6%,<ref name="Mansson2000">{{cite journal |last1=Månsson |first1=Hans |title=Childhood stuttering |journal=Journal of Fluency Disorders |date=March 2000 |volume=25 |issue=1 |pages=47–57 |doi=10.1016/S0094-730X(99)00023-6 }}</ref> and overall males are affected two to five times more often than females.<ref name="Yairi96">{{cite journal |last1=Yairi |first1=Ehud |last2=Ambrose |first2=Nicoline |last3=Cox |first3=Nancy |title=Genetics of Stuttering: A Critical Review |journal=Journal of Speech, Language, and Hearing Research |date=August 1996 |volume=39 |issue=4 |pages=771–784 |doi=10.1044/jshr.3904.771 |pmid=8844557 }}</ref><ref name="fn 28">{{cite journal |last1=Kloth |first1=S.A.M. |last2=Janssen |first2=P. |last3=Kraaimaat |first3=F.W. |last4=Brutten |first4=G.J. |title=Speech-motor and linguistic skills of young stutterers prior to onset |journal=Journal of Fluency Disorders |date=June 1995 |volume=20 |issue=2 |pages=157–170 |doi=10.1016/0094-730X(94)00022-L |hdl=2066/21168 |hdl-access=free }}</ref> As seen in children who have just begun stuttering, there is an equivalent number of boys and girls who stutter. Still, the sex ratio appears to widen as children grow: among preschoolers, boys who stutter outnumber girls who stutter by about a two to one ratio, or less.<ref name="fn 28"/> This ratio widens to three to one during first grade, and five to one during fifth grade,<ref>{{harvnb|Guitar|2005|p= 22}}</ref> as girls have higher recovery rates.<ref name="Ward16"/><ref name="Yairi99">{{cite journal |last1=Yairi |first1=Ehud |last2=Ambrose |first2=Nicoline Grinager |title=Early Childhood Stuttering I: Persistency and Recovery Rates |journal=Journal of Speech, Language, and Hearing Research |date=October 1999 |volume=42 |issue=5 |pages=1097–1112 |doi=10.1044/jslhr.4205.1097 |pmid=10515508 }}</ref> the overall prevalence of stuttering is generally considered to be approximately 1%.<ref name="Craig">{{cite journal |last1=Craig |first1=Ashley |last2=Hancock |first2=Karen |last3=Tran |first3=Yvonne |last4=Craig |first4=Magali |last5=Peters |first5=Karen |title=Epidemiology of Stuttering in the Community Across the Entire Life Span |journal=Journal of Speech, Language, and Hearing Research |date=December 2002 |volume=45 |issue=6 |pages=1097–1105 |doi=10.1044/1092-4388(2002/088) |pmid=12546480 }}</ref>

===Cross cultural===
Cross-cultural studies of stuttering prevalence were very active in early and mid-20th century, particularly under the influence of the works of [[Wendell Johnson]], who claimed that the onset of stuttering was connected to the cultural expectations and the pressure put on young children by anxious parents, which has since been debunked. Later studies found that this claim was not supported by the facts, so the influence of cultural factors in stuttering research declined. It is generally accepted by contemporary scholars that stuttering is present in every culture and in every race, although the attitude towards the actual prevalence differs. Some believe stuttering occurs in all cultures and races at similar rates, about 1% of general population (and is about 5% among young children) all around the world.<ref name="Guitar5–6"/><ref name="craig2005"/> A US-based study indicated that there were no racial or ethnic differences in the incidence of stuttering in preschool children.<ref name="Proctor">{{cite journal |last1=Proctor |first1=A |last2=Duff |first2=M |last3=Yairi |first3=E |title=Early childhood stuttering: African Americans and European Americans |journal=ASHA Leader |date=2002 |volume=4 |issue=15 |page=102 |url=https://www.sid.ir/paper/661746/en }}</ref><ref name="Yairi2005">{{cite book |last1=Yairi |first1=Ehud |last2=Ambrose |first2=Nicoline G. |title=Early Childhood Stuttering |date=2004 |publisher=Pro Ed |isbn=978-0-89079-985-7 }}{{page needed|date=February 2025}}</ref>

Different regions of the world are researched unevenly. The largest number of studies has been conducted in European countries and in North America, where the experts agree on the mean estimate to be about 1% of the general population.<ref>{{Cite book |last=Bloodstein |first=Oliver |title=A Handbook on Stuttering |date=1995 |publisher=Singular Pub. Group |location=San Diego}}{{isbn missing}}{{page needed|date=February 2025}}{{Obsolete source|date=March 2024}}</ref> African populations, particularly from West Africa, might have the highest stuttering prevalence in the world—reaching in some populations 5%, 6% and even over 9%.<ref>{{cite journal |last1=Nwokah |first1=Evangeline E. |title=The imbalance of stuttering behavior in bilingual speakers |journal=Journal of Fluency Disorders |date=October 1988 |volume=13 |issue=5 |pages=357–373 |doi=10.1016/0094-730X(88)90004-6 }}</ref> Many regions of the world are not researched sufficiently, and for some major regions there are no prevalence studies at all.<ref name="reese">{{cite journal|author= Sheree Reese, [[Joseph Jordania]]|title= Stuttering in the Chinese population in some Southeast Asian countries: A preliminary investigation on attitude and incidence|journal= "Stuttering Awareness Day"; Minnesota State University, Mankato|year= 2001|url= http://www.mnsu.edu/comdis/isad4/papers/reese2.html|url-status= live|archive-url= https://web.archive.org/web/20110606033525/http://www.mnsu.edu/comdis/isad4/papers/reese2.html|archive-date= 2011-06-06}}</ref>

=== Bilingual stuttering ===

==== Identification ====
[[Bilingualism]] is the ability to speak two languages. Many bilingual people have been exposed to more than one language since birth and throughout childhood. Since language and culture are relatively fluid factors in a person's understanding and production of language, bilingualism may be a feature that impacts speech fluency. There are several ways during which stuttering may be noticed in bilingual children including the following.{{citation needed|date=February 2025}}

* The child is mixing vocabulary ([[code-mixing]]) from both languages in one sentence. This is a normal process that helps the child increase their skills in the weaker language, but may trigger a temporary increase in disfluency.<ref name="Stuttering and the Bilingual Child">{{Cite web|url=https://www.stutteringhelp.org/stuttering-and-bilingual-child|title=Stuttering and the Bilingual Child|website=Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter|date=6 May 2011 |access-date=2017-12-18|url-status=live|archive-url=https://web.archive.org/web/20170926020934/http://www.stutteringhelp.org/stuttering-and-bilingual-child|archive-date=2017-09-26}}</ref>
* The child is having difficulty finding the correct word to express ideas resulting in an increase in normal speech disfluency.<ref name="Stuttering and the Bilingual Child"/>
* The child is having difficulty using grammatically complex sentences in one or both languages as compared to other children of the same age. Also, the child may make grammatical mistakes. Developing proficiency in both languages may be gradual, so development may be uneven between the two languages.<ref name="Stuttering and the Bilingual Child"/>

It was once believed that being bilingual would 'confuse' a child and cause stuttering, but research has debunked this myth.<ref>{{cite journal |last1=Kornisch |first1=Myriam |title=Bilinguals who stutter: A cognitive perspective |journal=Journal of Fluency Disorders |date=March 2021 |volume=67 |article-number=105819 |doi=10.1016/j.jfludis.2020.105819 |pmid=33296800 }}</ref>

Stuttering may present differently depending on the languages the individual uses. For example, morphological and other linguistic differences between languages may make presentation of disfluency appear to be more or less depending on the individual case.<ref>{{Cite book|url=https://books.google.com/books?id=aAbPBQAAQBAJ&q=bilingual+stuttering+wiki&pg=PA362|title=Multilingual Aspects of Fluency Disorders|last1=Howell|first1=Peter|last2=Borsel|first2=John Van|date=2011|publisher=Multilingual Matters|isbn=978-1-84769-358-7}}</ref>

==History==
[[File:LewisCarrollSelfPhoto.jpg|thumb|[[Lewis Carroll]], the well-known author of'' [[Alice's Adventures in Wonderland]]'', had a stammer, as did his siblings.]]
Because of the unusual-sounding speech that is produced and the behaviors and attitudes that accompany a stutter, it has long been a subject of scientific interest and speculation as well as discrimination and ridicule. People who stutter can be traced back centuries to [[Demosthenes]], who tried to control his disfluency by speaking with pebbles in his mouth.<ref name="brosch">{{cite journal |last1=Brosch |first1=Sibylle |last2=Pirsig |first2=Wolfgang |title=Stuttering in history and culture |journal=International Journal of Pediatric Otorhinolaryngology |date=June 2001 |volume=59 |issue=2 |pages=81–87 |doi=10.1016/S0165-5876(01)00474-8 |pmid=11378182 }}</ref> The [[Talmud]] interprets [[Bible]] passages to indicate that [[Moses]] also stuttered, and that placing a burning coal in his mouth had caused him to be "slow and hesitant of speech" (Exodus 4, v.10).<ref name="brosch"/>

[[Galen]]'s humoral theories were influential in Europe in the Middle Ages for centuries afterward. In this theory, stuttering was attributed to an imbalance of the [[four bodily humors]]—yellow bile, blood, black bile, and phlegm. [[Hieronymus Mercurialis]], writing in the sixteenth century, proposed to redress the imbalance by changes in diet, reduced libido (in men only), and [[vomiting|purging]]. Believing that fear aggravated stuttering, he suggested techniques to overcome this. Humoral manipulation continued to be a dominant treatment for stuttering until the eighteenth century.<ref name="rieber">{{cite journal |last1=Rieber |first1=R.W. |last2=Wollock |first2=Jeffrey |title=The historical roots of the theory and therapy of stuttering |journal=Journal of Communication Disorders |date=March 1977 |volume=10 |issue=1–2 |pages=3–24 |doi=10.1016/0021-9924(77)90009-0 |pmid=325028 }}</ref> Partly due to a perceived lack of intelligence because of his stutter, the man who became the [[Roman emperor]] [[Claudius]] was initially shunned from the public eye and excluded from public office.<ref name="brosch"/>

In and around eighteenth and nineteenth century Europe, surgical interventions for stuttering were recommended, including cutting the tongue with scissors, removing a triangular wedge from the posterior tongue, and cutting nerves, or neck and lip muscles. Others recommended shortening the [[uvula]] or removing the [[tonsil]]s. All were abandoned due to the danger of bleeding to death and their failure to stop stuttering. Less drastically, [[Jean Marc Gaspard Itard]] placed a small forked golden plate under the tongue in order to support "weak" muscles.<ref name="brosch"/>

[[File:Notker Balbulus 2.jpg|thumb|left|[[Notker the Stammerer|Notker Balbulus]], from a medieval manuscript]]
Italian [[pathologist]] [[Giovanni Battista Morgagni|Giovanni Morgagni]] attributed stuttering to deviations in the [[hyoid bone]], a conclusion he came to via [[autopsy]].<ref name="rieber"/> Blessed [[Notker of St. Gall]] ({{circa|840}} – 912), called Balbulus ("The Stutterer") and described by his biographer as being "delicate of body but not of mind, stuttering of tongue but not of intellect, pushing boldly forward in things Divine," was invoked against stammering.<ref>{{Cite journal |last=Townsend |first=Anselm |date=December 1928 |title=The Christmas Sequence |url=https://archive.org/details/sim_dominicana_1928-12_13_4/ |journal=[[Dominicana (journal)|Dominicana]] |location=Washington, D.C. |volume=13 |issue=4 |page=281 |via=[[Archive.org]]}}</ref>

A royal Briton who stammered was King [[George VI]]. He went through years of speech therapy, most successfully under Australian speech therapist [[Lionel Logue]], for his stammer. The Academy Award-winning film ''[[The King's Speech]]'' (2010) in which [[Colin Firth]] plays George VI, tells his story. The film is based on an original screenplay by [[David Seidler]], who also stuttered until age 16.<ref>{{Cite web |last=Smith |first=Harrison |date=20 March 2024 |title=David Seidler, Oscar-winning writer of 'The King's Speech,' dies at 86 - The Boston Globe |url=https://www.bostonglobe.com/2024/03/20/metro/david-seidler-oscar-winning-writer-kings-speech-dies-86/ |url-status=live |archive-url=https://web.archive.org/web/20240322005446/https://www.bostonglobe.com/2024/03/20/metro/david-seidler-oscar-winning-writer-kings-speech-dies-86/ |archive-date=22 March 2024 |access-date=2025-06-13 |website=BostonGlobe.com |language=en-US}}</ref>

Another British case was that of Prime Minister [[Winston Churchill]]. Churchill claimed, perhaps not directly discussing himself, that "[s]ometimes a slight and not unpleasing stammer or impediment has been of some assistance in securing the attention of the audience&nbsp;..."<ref name="fn 10">{{cite web | title=Churchill: A Study in Oratory | publisher=The Churchill Centre | url=http://www.winstonchurchill.org/i4a/pages/index.cfm?pageid=814 | access-date=2005-04-05 | archive-url=https://web.archive.org/web/20050419061110/http://www.winstonchurchill.org/i4a/pages/index.cfm?pageid=814 | archive-date=2005-04-19 }}</ref> However, those who knew Churchill and commented on his stutter believed that it was or had been a significant problem for him.<ref>{{Cite web |url=http://www.utstat.utoronto.ca/sharp/Churchill.htm |title=Churchill Stutter |access-date=2012-01-28 |archive-date=2012-01-13 |archive-url=https://web.archive.org/web/20120113145826/http://www.utstat.utoronto.ca/sharp/Churchill.htm }}</ref> His secretary [[Phyllis Moir]] commented that "Winston Churchill was born and grew up with a stutter" in her 1941 book ''I was Winston Churchill's Private Secretary''. She related one example, "'It's s-s-simply s-s-splendid,' he stuttered—as he always did when excited." Louis J. Alber, who helped to arrange a lecture tour of the United States, wrote in Volume 55 of ''The American Mercury'' (1942) that "Churchill struggled to express his feelings but his stutter caught him in the throat and his face turned purple" and that "born with a stutter and a [[lisp]], both caused in large measure by a defect in his palate, Churchill was at first seriously hampered in his public speaking. It is characteristic of the man's perseverance that, despite his staggering handicap, he made himself one of the greatest orators of our time."{{quote without source|date=February 2025}}

For centuries "cures" such as consistently drinking water from a snail shell for the rest of one's life, "hitting a stutterer in the face when the weather is cloudy", strengthening the tongue as a muscle, and various [[Herbalism|herbal remedies]] were tried.<ref name="fn 6">{{cite web | author = Kuster, Judith Maginnis | title = Folk Myths About Stuttering | publisher = [[Minnesota State University, Mankato|Minnesota State University]] | date = 2005-04-01 | url = http://www.mnsu.edu/comdis/kuster/Infostuttering/folkmyths.html | access-date = 2005-04-03 | url-status = live | archive-url = https://web.archive.org/web/20050419090029/http://www.mnsu.edu/comdis/kuster/Infostuttering/folkmyths.html | archive-date = 2005-04-19 }}</ref> Similarly, in the past people subscribed to odd theories about the causes of stuttering, such as [[tickling]] an infant too much, eating improperly during [[breastfeeding]], allowing an infant to look in the mirror, cutting a child's hair before the child spoke his or her first words, having too small a tongue, or the "work of the devil".<ref name="fn 6"/>

==Society and culture==

===In popular culture===
{{See also|Stuttering in popular culture|List of stutterers}}

===Stuttering community===
Many countries have regular events and activities to bring people who stutter together for mutual support. These events take place at regional, national, and international levels. At a regional level, there may be stuttering support or chapter groups that look to provide a place for people who stutter in the local area to meet, discuss and learn from each other.<ref>{{Cite web |title=Stammering Groups {{!}} STAMMA |url=https://stamma.org/connect/local-groups |access-date=2023-07-23 |website=stamma.org |language=en}}</ref><ref name=":5">{{Cite web |title=Local NSA Chapters {{!}} Stuttering Support Groups |url=https://westutter.org/chapters/ |access-date=2023-07-23 |website=National Stuttering Association |language=en-US}}</ref>

At a national level, stuttering organizations host conferences. Conferences vary in their focus and scope; some focus on the latest research developments,<ref>{{Cite web | title=Research on Incidence and Prevalance {{!}} Stuttering Foundation: A Nonprofit Organization Helping Those Who Stutter | url=https://www.stutteringhelp.org/research-incidence-and-prevalance#:~:text=In%20a%20recent%20conference%20on%20stuttering%20sponsored,(d)%20genetics%2C%20(e)%20stressors%2C%20(f)%20concomitant%20disorders%2C | access-date=2025-08-04 | website=www.stutteringhelp.org}}</ref> some focus on stuttering and the arts,<ref name="westutter.org">{{Cite web | url=https://www.westutter.org/conference#:~:text=For%20decades%2C%20the%20National%20Stuttering,a%20kid%20or%20an%20adult!&text=Here's%20what%20you%20can%20look,of%20people%20who%20get%20it| title=NSA 2026 Community Summit | website=www.westutter.org}}</ref> and others simply look to provide a space for stutterers to come together.<ref name="westutter.org"/><ref>{{Cite web | title=Stuttering Events Near You {{!}} NSA Workshops & Webinars | url=https://www.westutter.org/our-events#:~:text=Special%20events%20like%20the%20annual%20conference%20bring,valuable%20tools%20for%20navigating%20the%20stuttering%20journey. | access-date=2025-08-04 | website=www.westutter.org}}</ref>

There are two international meetings of stutterers. The [[International Stuttering Association]] World Congress primarily focuses on individuals who stutter. Meanwhile, the Joint World Congress on Stuttering and Cluttering brings together academics, researchers, speech-language pathologists, as well as people who stutter or clutter, with a focus on research and treatments for stuttering.{{citation needed|date=February 2025}}

=== Historic advocacy and self-help ===
Self-help and advocacy organisations for people who stammer have reportedly been in existence since the 1920s.&nbsp;In 1921, a Philadelphia-based attorney who stammered, J. Stanley Smith, established the Kingsley Club.&nbsp;<ref>{{cite magazine |last1=Thurber |first1=James |title=Stammerers' Club |url=https://www.newyorker.com/magazine/1930/05/03/stammerers-club |magazine=The New Yorker |date=25 April 1930 }}</ref> Designed to support people with a stammer in the Philadelphia area, the club took inspiration for its name from [[Charles Kingsley]].&nbsp;Kingsley, a nineteenth-century English social reformer and author of ''Westward Ho!'' and ''The Water Babies'', had a stammer himself.<ref>{{cite book |doi=10.7135/upo9781843317562.019 |chapter=Fraser's Magazine for Town and Country, ''1830–1882'' |title=Perceptions of the Press in Nineteenth-Century British Periodicals |date=2012 |pages=261–299 |isbn=978-1-84331-756-2 }}</ref>

Whilst Kingsley himself did not appear to recommend self-help or advocacy groups for people who stammer, the Kingsley Club promoted a positive mental attitude to support its members in becoming confident speakers, in a similar way discussed by Charles Kingsley in ''Irrationale of Speech''.{{citation needed|date=February 2025}}

Other support groups for people who stammer began to emerge in the first half of the twentieth century. In 1935 a Stammerer's Club was established in Melbourne, Australia, by a Mr H. Collin of Thornbury.<ref>{{Cite news |date=1935-05-23 |title=STAMMERERS' CLUB. |work=Sydney Morning Herald |url=http://nla.gov.au/nla.news-article17146929 |access-date=2023-08-01}}</ref>&nbsp;At the time of its formation it had 68 members. The club was formed in response to the tragic case of a man from Sydney who "sought relief from the effects of stammering in suicide".&nbsp;As well as providing self-help, this club adopted an advocacy role with the intention of appealing to the Government to provide special education and to fund research into the causes of stammering.<ref>{{Cite news |date=1936-10-10 |title=THE STAMMERERS' CLUB OF QUEENSLAND. |work=Cairns Post |url=http://nla.gov.au/nla.news-article41779262}}</ref><ref>''Bermuda Reporter''{{full citation needed|date=February 2025}}</ref>

=== Disability rights movement ===

Some people who stutter, and are part of the [[disability rights movement]], have begun to embrace their stuttering voices as an important part of their identity.<ref>{{Cite web|title = Did I Stutter?|url = http://didistutter.org/|website = Did I Stutter?|access-date = 2015-10-05|url-status = live|archive-url = https://web.archive.org/web/20151006092633/http://www.didistutter.org/|archive-date = 2015-10-06}}</ref><ref>{{Cite web|title = How To Stutter More|url = http://stuttermore.tumblr.com/|website = stuttermore.tumblr.com|access-date = 2015-10-05|url-status = live|archive-url = https://web.archive.org/web/20151029165325/http://stuttermore.tumblr.com/|archive-date = 2015-10-29}}</ref> In July 2015 the UK Ministry of Defence (MOD) announced the launch of the Defence Stammering Network to support and champion the interests of British military personnel and MOD civil servants who stammer and to raise awareness of the condition.<ref>{{cite web |url=https://www.gov.uk/government/news/defence-stammering-network-launched |title=Defence Stammering Network launched |access-date=2015-07-25 |url-status=live |archive-url=https://web.archive.org/web/20150825135116/https://www.gov.uk/government/news/defence-stammering-network-launched |archive-date=2015-08-25 }}</ref>

Although the [[Americans with Disabilities Act of 1990]] intended to cover speech disabilities, it was not explicitly named and lawsuits increasingly did not cover stuttering as a disability. In 2009, additional amendments were made to the ADA, and it now specifically covers speech disorders.<ref>{{cite journal |last1=Weiner |first1=Charles |last2=Tetnowski |first2=John A. |title=Stuttering Discrimination Under the Law: Here's a look at how the law applies. |journal=The ASHA Leader |date=July 2016 |volume=21 |issue=7 |pages=52–57 |doi=10.1044/leader.FTR2.21072016.52 }}</ref><ref>{{Cite web |title=The Americans with Disabilities Act: How it relates to stuttering |url=https://www.stutteringtreatment.org/blog/the-americans-with-disabilities-act-what-it-means-to-people-who-stutter |access-date=2024-11-11 |website=www.stutteringtreatment.org |language=en}}</ref>

=== Stuttering pride ===
{{Main|Stuttering pride}}
[[Stuttering pride]] (or stuttering advocacy) is a [[social movement]] repositioning stuttering as a valuable and respectable way of speaking. The movement seeks to counter the societal narratives in which temporal and societal expectations dictate how communication takes place.<ref name="Stammering Pride and Prejudice">{{cite book |last1=Campbell |first1=Patrick |last2=Constantino |first2=Christopher |last3=Simpson |first3=Sam |title=Stammering Pride and Prejudice: Difference Not Defect |date=2019 |publisher=J & R Press Limited |isbn=978-1-907826-36-8 |oclc=1121135480 }}{{page needed|date=February 2025}}</ref> In this sense, the stuttering pride movement challenges the pervasive societal narrative of stuttering as a defect and instead positions stuttering as a valuable and respectable way of speaking in its own right. The movement encourages stutterers to take pride in their unique speech patterns and in what stuttering can tell us about the world. It also advocates for societal adjustments to allow stutterers equal access to education and employment opportunities, and addresses how this may impact [[stuttering therapy]].<ref name="Stammering Pride and Prejudice"/>

==Associations==
{{div col|colwidth=22em}}
* [[All India Institute of Speech and Hearing]]
* [[American Institute for Stuttering]]
* [[British Stammering Association]]
* [[European League of Stuttering Associations]]
* [[International Stuttering Association]]
* [[Israel Stuttering Association]]
* [[Michael Palin Centre for Stammering]]
* [[National Stuttering Association]], United States
* Philippine Stuttering Association
* Taiwan Stuttering Association 
* [[Stuttering Foundation of America]]
* [[The Indian Stammering Association]]
{{div col end}}

==See also==
{{div col|colwidth=22em}}
* [[Cluttering]]
* [[Fluency]]
* [[International Stuttering Awareness Day]]
* [[List of stutterers]]
* [[Monster Study]]
* [[National Stuttering Awareness Week]]
* [[Speech and language impairment]]
* [[Speech disorder]]
* [[Speech disfluency]]
* [[Speech–language pathology]]
* [[Speech processing]]
* [[Stuttering in popular culture]]
* [[Stuttering therapy]]
{{div col end}}

==Notes==
{{Reflist}}

==Sources==
* {{Cite book | last =Guitar | first =Barry | title =Stuttering: An Integrated Approach to Its Nature and Treatment | publisher =[[Lippincott Williams & Wilkins]] | year =2005 | location =[[San Diego]] | isbn = 978-0-7817-3920-7 }}
* {{Cite book | last1 =Kalinowski |first1=JS |last2= Saltuklaroglu |first2=T | title =Stuttering | publisher =Plural Publishing | year =2006 | location =[[San Diego]] | isbn = 978-1-59756-011-5 }}
* {{Cite book | last =Ward | first =David | title =Stuttering and Cluttering: Frameworks for understanding treatment | publisher =Psychology Press | year =2006 | location =[[Hove]] and [[New York City]] | isbn =978-1-84169-334-7 }}

==Further reading==
{{Spoken Wikipedia|date=2006-01-16|en-Stuttering(part1of3).ogg|en-Stuttering(part2of3).ogg|en-Stuttering(part3of3).ogg}}
{{Wiktionary|stammering|stuttering}}
* {{cite book |last1=Rockey |first1=Denyse |title=Speech Disorder in Nineteenth Century Britain: The History of Stuttering |date=1980 |publisher=Croom Helm |isbn=978-0-85664-809-0 }}
* {{cite book |doi=10.4324/9780203961421 |title=Sounding off: Theorizing Disability in Music |date=2006 |isbn=978-0-203-96142-1 |editor-last1=Lerner |editor-last2=Straus |editor-first1=Neil |editor-first2=Joseph |last1=Goldmark |first1=Daniel |chapter=Stuttering in American Popular Song, 1890–1930 |pages=91–105 |chapter-url={{GBurl|hKQUQgZAlqYC|p=91}} }}

{{Medical resources
|  DiseasesDB     =
| ICD11          = {{ICD11|6A01.1}}, {{ICD11|MA81}}
|  ICD10          = {{ICD10|F|98|5|f|90}}
|  ICD9           = {{ICD9|307.0}}
|  ICDO           =
|  OMIM           = 184450
|  OMIM_mult      = {{OMIM|609261||none}}
|  MedlinePlus    = 001427
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D013342
}}
{{Stuttering}}

[[Category:Stuttering]]
[[Category:Speech disorders]]