Stuttering - Adults

Stuttering is a fluency disorder that affects the flow of speech. Typically it appears during childhood, and can persist till adulthood in 1 child among 4. It is uncommon to see adults develop a stutter out of the blue, but when it happens, it is referred to as acquired stuttering. Also known as neurogenic stuttering, it is the result of an identifiable neuropathology in an adult with no history of fluency problems prior to occurrence of the pathology.

People who stutter know what they want to say, but have difficulty saying it. In other words, we can observe an abnormally high frequency and/or duration of interruptions in the forward flow of speech. These interruptions are called disfluencies, and can take the form of repetitions of monosyllabic words, syllables, and sounds, prolongations of sounds, or blocks of airflow or voicing in speech. A speaker who is stuttering may react to his disfluencies by trying to force words out to avoid getting stuck. He might become tense, blink rapidly, or his lips may tremble as he tries to communicate verbally. Stuttering often triggers negative feelings and attitudes (e.g. shame, embarrassment, low self-esteem…), which may cause the adult who stutters to limit himself in social situations and at work.

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What are the common signs of stuttering?

Adults who stutter have usually been living with their conditions for a while. With age, the disfluencies tend to be more complex, and the fears or apprehensions coming along with the speech tend to become chronic.

The common signs of stuttering in adulthood are blocks, broken words, prolongations of sounds, and repetitions of sounds, syllables and monosyllabic words.

Physical concomitants are also often observable, such as rapid eye blinks, tremors of the lips, facial grimaces, head jerks etc.

Finally, the negative emotions and cognitions often lead to negative reactions such as avoidance behaviors, leading to a limitation in their daily activities and in the development of relationships with others.

How is stuttering diagnosed?

If you are an adult who stutters, chances are that you have already been diagnosed in your childhood and probably went through speech therapy. However, stuttering is a persistent condition, and you might find yourself at a later age wanting to deal with it differently, with new goals to achieve based on your current needs.

Stuttering is diagnosed by a speech and language pathologist (SLP) trained to evaluate and treat adults who stutter. Typically, the SLP asks you questions about your health history, including stuttering onset and characteristics. It is important to rule out an underlying health condition that could have caused late-onset stuttering. The SLP may also go over the treatments you tried in the past to get a better understanding of your current demand. You will probably be asked to fill in a self-report questionnaire to understand how stuttering has impacted your relationships, career and other areas of your life. In addition to this, the SLP will make an in-depth analysis of your conversational and structured speech samples (e.g. frequency and types of disfluencies, rate speech, and physical concomitants).

Is stuttering caused by emotional or psychological problems?

Research has shown that stuttering has biological causes such as a genetic predisposition to speech disfluency. It is not a mental health diagnosis, and emotional or psychological problems are not the root causes of stuttering. However, emotional factors often accompany stuttering. For instance, anxiety can make stuttering worse, and this could create a vicious feedback loop in which the adult fears stuttering, triggering him to stutter even more.

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What are the factors that might increase or decrease my stuttering?

There are some external factors that impact the degree of stuttering both ways: causing it to increase or helping it to decrease.

Some of the main factors that can increase stuttering:

Negative feelings and attitudes towards communication: if you are frustrated, nervous, tense or angry, you may experience more disfluencies.
Being too self conscious while communicating: If you are bringing too much attention to your speech, or are trying not to stutter, you may also feel that your stutter is getting worse.
Being excited or feeling rushed may also contribute to an increase in your stutter.

On the other hand, following some of the below recommendation while communicating can have a positive effect on your fluency:

slowing down your speech rate
avoiding time pressure and other pressure when speaking
being comfortable in your environment
practicing mindfulness

How common is stuttering?

Research has shown that about 1% of the adult population stutters. It is also 3 to 4 times more common in males than females.

Is there a definite cure for stuttering?

There are no instant miracle cures for stuttering. Yet, many treatment approaches used in speech therapy have proven successful for helping adults who stutter, such as the “Stuttering modification approach”, “Speech restructuring techniques”, “Cognitive-behavioral therapy”, hybrid approaches etc.

All those approaches aim at reducing the frequency and severity of disfluencies in the patients speech, but most importantly at helping patients develop a positive attitude towards themselves as speakers, and to decrease or eliminate the negative reactions (e,g, avoidance behaviors) and improve their quality of life.

A speech therapy specialist in the field of stuttering can help adults make significant progress in their overall communication skills. He/she will help them feel less tense at work and in social settings, and face speaking situations which they fear and avoid (e.g. talking on the phone, ordering food, making an oral presentation etc.). Speech therapy is not an overnight process and some adults who stutter may need to see an SLP many times in their life span in order to talk about how stuttering is affecting their everyday life, and set up new therapeutic goals based on their latest needs.

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Is relapse common in stuttering?

Relapse is typically viewed as a reduction in speech fluency and is a common experience for the persons who have achieved increased fluency as a result of therapy. The relapse can happen several times in the lifespan of a person who stutters, and is dependent on each person’s experience and life conditions. However, relapse can also be manifested by an increase in the anxiety associated with speaking, a reappearance of some avoidance behaviors, which may lead to some limitations in the social interactions.

For younger persons, 2 phases have been identified as being more prone for a relapse in the lifetime of a person who stutters. The first one is the transition to primary school and the second one is the adolescence phase.

For adults, relapse can happen at any age. There are 2 common factors that tend to cause relapses even after a patient has done a successful speech therapy are:

Difficulty in adjusting to their new selves as fluent speakers: some people who stutter show a preference for the usage of speech restructuring techniques, which change their speech pattern, and make them sound fluent. However, maintaining progress is often difficult because it requires a constant focus on the way they are speaking, which can considerably affect their spontaneity. Over time, some people might stop using these techniques for the benefit of their spontaneity.
Increase in life’s pressure in the form of life challenges or successive major changes will cause some emotional fragility that could make the disfluencies reappear or become more frequent and severe.

The speech therapy treatment that not only targets the speech fluency itself, but also focuses on the emotional, behavioral and cognitive reactions that are associated with the experience of stuttering, will help the patient experience and understand better his pathways to “recovery” and “relapse”.

When these three important components are targeted in therapy, the patient will be desensitized from the fear of stuttering, will learn helpful modification techniques, will expand his comfort zone through exposure exercises, and will have to transfer his progress in different contexts besides the clinical setting.

The fluency specialist will give him the needed support to become a confident and assertive speaker, and will educate him about his condition in a way that will help him deal with possible relapses.

How can I prevent stuttering from affecting me at university / work?

Speech therapy treatment will definitely help you in managing your stutter and decreasing its negative effect on your academic and work life.

A well done speech therapy should help you establish and maintain positive feelings about communication in general and about yourself as a communicator. It will also help you develop resistance to potential fluency disruptors (such as: noise, interruption, time pressure, emotional topics and competition) and maintain the effects of treatment on your communication skills, as well as your behaviors, emotions and cognitions.

Gradually, your speech therapist will help you accept your stutter and gain confidence in your speaking abilities. Being able to talk about your stutter openly, without shame, and with confidence, will help you to assert yourself in society and be functional in your communication, which should support your social interactions at all levels.

Can I still benefit from speech therapy if I am an adult?

Of course! You can certainly benefit from speech therapy sessions at any age.

The SLP will determine jointly with you the goals that should be targeted in order to improve your communication skills, boost your self-confidence, and learn some coping strategies to manage your stutter positively.

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What can friends/family do to help the person who stutters?

Getting support from the environment is incredibly helpful to optimize the progress of the person who stutters.

First of all, refrain from comments such as “take it easy”, “just relax” or “take a breath” because these pieces of advice feel belittling.

Instead, listen the same way you would to someone who does not stutter, with interest, and wait patiently until he/she is finished talking.

It is also helpful to maintain eye contact throughout the communication process.

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