Stuttering in Adults: Treatment, Diagnosis, Symptoms & Causes

by Team Stamurai

A significant number of adults have persistent stuttering characterized by repetitions, blocks and prolongations. Stuttering treatment for adults primarily consists of fluency enhancement and stuttering modification techniques alongside counseling sessions.

Although stuttering treatment for adults usually takes more time, it is also effective, since the treatment methods are direct. An adult client can take responsibility and track their progress during the course of the therapy.

Stuttering treatment is an intensive process. Advanced stuttering not only requires the attention of a good speech-language pathologist (SLP) but also a cognitive behavioural therapist (CBT) or psychological counsellor.

Symptoms of Stuttering

Repeated words, syllables or sounds along with the disruption of the normal rate of speech characterize stuttering. Repetitions, prolongations and blocks comprise the three core behaviors of stuttering.

The stress from stuttering may contribute to secondary behaviors like -

  • Physical symptoms like twitching of the lips, blinking of the eyes and tension in the face or upper body
  • Frustration or aversion towards face-to-face communication
  • Pausing before beginning to speak
  • Rearrangement  or replacement of words in a sentence
  • Pausing abruptly or hesitating before starting a dialogue
  • Difficulty starting a sentence or uttering particular sounds

Secondary behaviours of stuttering in adults are much more complex. Adults have acquired and perfected them through years of practice. Avoidance and escape are difficult to detect in adults who have been stuttering for more than a decade or two.

Most children who stutter are either unaware of their speech disfluencies, or do not feel frustrated by their stutter. Kids, especially preschoolers, hardly show any secondary behavior of stuttering.

In some cases, adults may even successfully suppress their stammering by using synonyms or reconstructing an entire sentence. While these are common among adults who stutter, these aren’t always intentional behaviors.

The negative emotions and attitudes are stronger in adults who stutter than in children. Negative reactions from listeners contribute to the increasing negativity among adults who stutter.

Negative attitudes may manifest in the form of withdrawal from social situations, damage of self-esteem and/or reduced self-confidence.

How Does an Expert Diagnose Stuttering?

The differential diagnosis of stuttering should only be made by professionals. Only a doctor, speech-language pathologist (SLP) or speech therapist can diagnose stuttering and its type.

Since stuttering may have different causes, it is important to consult a healthcare professional for the correct diagnosis.

An SLP may perform several assessments including speech rate analysis, stuttering severity tests and language skill tests before arriving at a conclusion. The diagnosis will depend upon multiple factors including the age of the individual, their family history and the severity of stuttering.

The SLP will also determine how the disorder affects the person’s mental health, social skills and their overall ability to function.

Stuttering is a childhood-onset fluency disorder. According to DSM V, it has a couple of diagnostic criteria.

  1. Disturbances in the flow of speech and interruptions that are unsuitable for the person’s age and/or linguistic skills. These should persist over time and should have one or more of the following traits -
  • Repetitions of sounds and syllables
  • Prolongations of vowels and consonants
  • Pauses within a word
  • Silent blocking and/or audible blocking
  • Excess physical tension while pronouncing words
  • Whole (monosyllabic) word repetitions
  • Substitutions of feared words (circumlocutions)
  1. Anxiety about speaking and limitations in social participation, effective communication, academic or occupational performances.
  2. Typically, the onset is early, in the developmental years (by 6 years of age).
  3. The disfluency is not due to sensory or speech-motor deficit, or neurological causes (like brain injury or stroke).

The SLP has to rule out sensory deficits, normal speech disfluencies, side effects of medication, adult-onset disfluency disorders and Tourette’s Syndrome during differential diagnosis.

What are The Available Stuttering Treatments for Adults?

Today, you can find several stuttering therapy techniques that may suit your needs. There are several ways to speech fluency. You may choose to visit a clinician or receive speech exercise updates on your mobile phone.

Either way, you should know about all the various stuttering treatments that you may consider before choosing one or more.

Stuttering Treatment for Adults - The Options

1. Speech Therapy

Speech therapists or clinicians can help you learn how to pace your words, cancel a block and pull out of it. A professional may help teach you how to manage situations that trigger stuttering.

You can learn fluency shaping and stuttering modification techniques, which you can apply to daily conversations.

Speech therapy is undoubtedly the best course of treatment for stuttering in adults. Whether you are receiving it from a SLP in-person, or via a cutting edge anti-stuttering app, speech therapy is undoubtedly the best long-term treatment for stuttering.

2. Psychological Counseling and CBT

Coupling traditional speech therapy with CBT can increase the efficacy of the stuttering treatment. CBT for adults who stutter may address -

  • Educating and informing the person about stuttering
  • Giving them a new perspective to their problems
  • Helping them adopt a positive attitude
  • Assisting and supporting the adults find their own solutions
  • Challenging and resolving the unhelpful and negative thoughts
  • Teaching relaxation techniques to combat anxiety and stress
  • Improving their communication skills

Combining CBT or counseling with speech therapy offers a holistic approach for the treatment of stuttering in adults.

CBT may help counter the negative feelings and attitudes that adults typically garner from years of rejection or refusal. In fact, it is the only way to address the secondary behaviors.

3. Support Groups

When the world seems bleak, nothing helps more than reaching out to people who may be going through something similar.

Support groups are instrumental in helping people who stutter. These groups provide a safe-zone for sharing life experiences, fears, expectations, dreams and treatment progress for everyone who stutters.

You can find a stuttering support group in your locality, or find one online. Participating in group meetings, or simply observing others journey through stuttering can imbibe confidence and hope.

Sharing with like-minded individuals can reduce stress, anxiety and fear. It may even open new avenues for therapy, and self-treatment.

Support groups offer the opportunity to connect and communicate with real people without the fear of being judged or bullied.

4. Electronic Devices

For years, researchers have been working on electronic devices like DAF (delayed auditory feedback) and FAF (frequency altered feedback) to assist those who stutter. Modern-day speech therapy apps also include such tools.

Many of such devices assist the speakers in slowing their speech down. There are others that provide a “choral effect”, so the speaker hears their own voice as if they are speaking in unison with others.

They work best when the user receives guidance from a clinician while using them. SLPs may change the frequency of the feedback depending on the progress of the speaker.

These devices are indeed effective for adults who stutter. However, they come with their own sets of limitations since the user has to wear headphones/earphones for DAF or FAF to work.

Stuttering Treatment for Adults - What You Must Know

The therapist must understand that the adult with advanced stuttering may not fear the situations and words only, but also the stuttering itself.

Here are a few facts about the treatment of advanced stuttering every adolescent and adult must remember –

It Can Be A Lengthy Process

The treatment of adolescents and adults who stutter can take a long time since it needs to focus on many aspects such as -

  • The emotions of the individual
  • Integral beliefs associated with stuttering
  • The secondary behaviours

While preschool children may take only a couple of months or a year to show marked improvement in fluency, adults must remember that patience and persistence are going to be their only friends in the long journey towards fluency.

Thus, it is of utmost importance for adults to work with their SPLs to set realistic goals before they begin working on his/her speech. An integrated approach that includes exploring their nature and severity of stuttering, learning controlled fluency and increasing approach behaviour.

An adult has to unlearn a significant amount of coping behaviour they have learned over the years they have been stuttering. It requires hard work on the part of the therapist, counsellor and their client.

There Is No One-size-fits-all Treatment

Each client comes with different levels of stuttering severity, emotional turmoil and stuttering related beliefs. Therefore, it is impossible to stretch one particular stuttering treatment to every adult.

The treatments vary according to their experience related to stuttering, their upbringing, traumas related to stuttering, and even their perception of the listener when they stutter. Of all treatment processes, controlled fluency is most important. The performance of the patient during controlled stuttering sessions will dictate the future of their treatment.

Integrated treatment should always include an increase in approach behaviour and reduction in avoidance over the years. SLPs have associated low levels of avoidance and increase in approach behaviour with an improvement in the fluency of speech.

An integrated approach pays attention to the negative emotions, attitudes, and avoidances of the client. The use of controlled fluency or superfluency can positively influence the attitude and emotions via recurring experiences of fluency.

Neurologically speaking, it can kindle speech regulation and emotional regulation by stimulating the left hemisphere. At the same time, it can dampen avoidance behaviour in the same person. The skills acquired after integrated therapy can include slowed speech rate, easy phonation onset, proprioception, pausing, and light articulatory contact.

Treatment May Not Remove Speech-processing Deficits Completely

Adults who stutter may continue to possess some speech-processing deficits even after the completion of successful treatment. Brain imaging studies show that adults with stuttering may continue to display lower-than-average left-brain activity, despite receiving complete speech therapy sessions by an expert.

Dealing with residual stuttering is a long-term commitment and it can be a continuing task for the client and his/her therapist. A study conducted recently where a majority of the 216 participants chose fluency over freedom from stuttering as their therapy goal.

Keeping Yourself Motivated

You need to keep a measure of your progress and the result of the regular therapy. Make a note of the percentage of syllables stuttered to capture the snapshot of progress before and after speech therapy. Your therapist should be able to help you learn how to measure stuttering severity using easy-to-track methods.

Don’t forget that speech therapy is a long journey for adolescents and adults. Therefore, it is important to stick to your exercises and attend the appointments with your therapist for continuing improvement of your speech fluency.

Adults who stutter can seek out online forums or communities near their location to share their feelings and emotions about stuttering. Finding a safe space to share life experiences that may have occurred due to stuttering can help one find confidence.

It will help you set realistic goals for your speech, as well as to measure the progress once you begin attending the therapy sessions with your SLP.

Understanding the Main Causes of Stuttering

Developmental stuttering begins early and typically coincides with the period of rapid linguistic development of a child. Stuttering is a heterogeneous childhood disfluency disorder. Therefore, one or many of the following factors can cause stuttering -

1. Genetics

Stuttering tends to cluster in families. A child who has a close blood-relative who stutters, may continue to stutter as an adult. Genes influence a person’s predisposition towards stuttering.

2. Neurology

Genetics also influence the neural network and activities of a person. People who stutter have distinct differences in the right and left hemisphere activities in their brains. Their right hemispheres are more active than the left, which might explain their speech disfluency to a certain extent.

3. Cellular Factors

Recent studies have shown that mouse models with a deficiency of astrocytes (star-shaped cells) in their corpus callosum show stuttering-like vocalizations. Scientists led by Dr Dreyna postulate that people who stutter may have a lower density of astrocytes in their corpus callosum as compared to those who don't stutter.

4. Childhood Stress

It is important to remember that children who have family members who stutter have a higher risk of developing stuttering from sudden childhood stress. Several children go through highly stressful situations but do not show lasting effects on speech.

5. Environmental Changes

Similarly, children genetically predisposed to stuttering have a higher chance of developing speech disfluency as a result of these changes. Environmental changes may include moving to a new and unknown neighborhood, losing friends, separation of parents or getting a new sibling.

You can find out more about the causes of stuttering right here.

Types of Stuttering

Genetic predisposition, emotional trauma, physical trauma, and several neurodegenerative diseases may contribute to stuttering. Currently, experts have described four different types of stuttering based on the probable causes.

1. Developmental

Developmental stuttering is the most common type. It begins in early childhood as toddlers begin to acquire new speech and language skills.

2. Neurogenic

Sudden changes in the neurological pathways or activities associated with the brain centres for speech process and development may lead to neurogenic stuttering. There is no particular age-barrier for this type of stuttering. Neurogenic stuttering may be a result of stroke, brain trauma, neurodegenerative diseases and/or brain tumor(s).

3. Psychogenic

Diagnosing psychogenic stuttering is challenging. It may result from severe emotional trauma and distress. Post-traumatic stress disorder (PTSD), severe anxiety, and/or chronic depression may manifest in the form of stuttering along with other symptoms in adolescents and adults.

4. Drug-induced

Drug-induced stuttering is typically seen in adults. It may result from a sudden change in medication or its dosage. A new medicine or even the use of a recreational drug may induce stuttering in adults with no prior history of speech disfluencies. Typically, reverting to the older dosage or replacing the new medicine with another one stops drug-induced stuttering.

What are the Available Medicines for Stuttering Treatment?

Currently, there is no FDA-approved medicine for stuttering. There are a few psychoactive compounds that induce fluency in patients/clients.

Drugs like haloperidol, risperidone, olanzapine, ziprasidone and clonidine can contribute to reduced stuttering and increased fluency in adults who stutter.

New-age medication that may inhibit the vesicular monoamine transporter 2 (VMAT2) may help reduce stuttering. New research shows that drugs that decrease dopamine synthesis may help in inducing fluency.

What Kind of Research Is Being Conducted on Stuttering?

In the last few years research on stuttering has progressed significantly.

In 2021, Dr Maguire led the study of risperidone action on increasing the activity of the astrocytes in the striatum. Risperidone can reduce stuttering by boosting the metabolism or activity of the striatum.

In 2019, Dr Drayna and his team genetically modified mice with a Gnptab mutation. These genetically engineered mice had a reduced density of astrocytes in the corpus callosum. These mice made abnormally long pauses in vocalizations which the team considered similar to those in people with the same mutation.

NIDCD researchers have identified four genes and their mutants that are directly linked to stuttering. Dr Drayna has contributed significantly to the current knowledge on the role of genetics in stuttering. Genetic factors play an important role in at least 50% of the cases.

Currently, research is also ongoing to determine which children will outgrow stuttering and who are at risk for persistent stuttering.

Scientists are now using fMRI, MRI and PET scans to determine the differences in the brain structure and function of people who stutter.

A combination of genetic engineering, drug studies and imaging techniques may soon be used in the future to help and treat people who stutter.

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