Social Anxiety Disorder Coping What Is Stuttering? By Arlin Cuncic Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." Learn about our editorial process Updated on December 02, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print fizkes / Getty Images Table of Contents View All Table of Contents What Is Stuttering? Symptoms Diagnosis Causes Types Treatment Coping What Is Stuttering? Stuttering, also known as childhood-onset fluency disorder, is a type of speech disorder characterized by dysfluent or stammering speech. Dysfluency involves interruptions in the flow of speech. People who stutter may repeat words and syllables. They may also have an uneven rate of speech marked by frequent halts or hesitations. Stuttering is common in kids between the ages of 2 and 6 and often goes away on its own. However, people may also continue to be affected by the condition throughout life. There are effective treatments to help people overcome stuttering, as well as speech strategies to help improve fluency. Childhood fluency disorder affects approximately 5% to 10% of preschool-age children and approximately 1% of adults. Symptoms Stuttering is described as dysfluent speech involving overt and covert (hidden) symptoms. Examples include repeating certain sounds, having difficulty saying certain sounds, or struggling to start a word or sentence. Overt symptoms are obvious to other people and include: Repeating or prolonging soundsBlocks when speaking Covert symptoms may not be obvious to others and include: Omitting wordsSubstituting wordsCircumlocution (rearranging words in a sentence) In addition to the speech-related symptoms, stuttering is often accompanied by "struggle behaviors." People who stutter know what they want to say, but they have difficulty getting the words out in a normal flow of speech. When struggling to communicate, they might also display blinks, rapid eye movements, tremors, and other facial movements. Other examples of stress-related behaviors that may occur when trying to speak include: Adding extra sounds or speech fillers such as "um" or "uh"Elongating certain words or sounds Frustration when trying to talkHesitation before beginning to speakRefusing to speakStrained or tense voice Stuttering can also lead to feelings of embarrassment in social situations. If you stutter, you may also feel bad about your speech difficulty and experience anxiety, avoidance, low self-esteem, and embarrassment. Symptoms tend to become more pronounced in social settings or when a person is under stress. 9 Tips to Use Your Best Voice When You Have Social Anxiety Diagnosis Stuttering is generally diagnosed by a speech-language pathologist (SLP) or another health professional who has training in the evaluation of speech-language disorders. There is no specific test for stuttering. Instead, a speech professional will look at a child's behaviors and ask questions. During an evaluation, an SLP will look at a number of different factors including: A child's ageHow long symptoms have lastedHow symptoms impact the child's lifeStuttering behaviorsThe presence of other language problemsWhen symptoms first appeared The speech professional will try to determine if the stuttering is something that will continue or if the child is likely to outgrow it as they age. Once the professional has made a diagnosis, they will make treatment recommendations based upon the individual's needs. Causes The exact causes of stuttering are not known, but it may have a genetic link, since it appears to sometimes run in families. Some other possible causes or contributors include: Brain injuryNeurological conditionsNeurophysiological factors, including structural and connectivity differences in the brainSpeech motor control Stuttering may also sometimes occur when a person is under a great deal of emotional distress. For example, people with social anxiety disorder (SAD) may sometimes stutter when they are in stressful social situations. While people with stuttering may experience anxiety in social situations, this does not necessarily mean that they have social anxiety disorder. If you are only anxious because you stutter, you would not be diagnosed with SAD, because the fear is about stuttering, not social and performance situations. Signs That You May Have Social Anxiety Disorder Types There are two primary types of stuttering. These are: Developmental stuttering: This type of stuttering is most common and often takes place when young children are still developing speech skills. Children tend to outgrow this type of stuttering as they get older.Neurogenic stuttering: This type of stuttering begins following a brain injury, head trauma, or stroke. This type of stuttering occurs because the injury to the brain makes it difficult to coordinate the different regions of the brain involved in the production of speech. A third type known as psychogenic stuttering is believed to be the result of emotional trauma or severe stress, but experts now believe this type to be extremely rare. Stuttering and Social Anxiety Current research shows that there is likely a relationship between stuttering and social anxiety, but the nature of the relationship is not clear. The rate of overlap between social anxiety and stuttering is thought to be as high as 75%. However, studies have not been consistent in how they define social anxiety (e.g., stuttering-specific or general). Research has shown that the neurotransmitter dopamine plays a part in both stuttering and SAD. And, in fact, a higher rate of SAD has been found in people with Parkinson's disease, a disorder involving dopamine production and metabolism. Neuroimaging research has shown that people with SAD and those who stutter have differences in the dopamine D2 receptor, meaning that they process dopamine differently than people without these disorders. The amygdala has also been shown to be related to both stuttering and SAD. Treatment There is no cure for stuttering, but there are a number of treatments that can help. Treatment usually focuses on helping children and adults develop skills such as effective communication, participation in school and work, and speech fluency. In order to accomplish these goals, a number of treatment approaches may be used, including: Cognitive behavioral therapy (CBT): This form of therapy can help people learn to identify and change the types of thinking that can sometimes make stuttering worse. Negative thoughts, for example, can make people feel greater stress and anxiety, which can worsen stuttering in some situations. CBT can also be useful for addressing symptoms of stress, low self-esteem, anxiety, depression, and social anxiety disorder. Electronic devices: There are different types of electronic wearable devices that may aid in the treatment of stuttering, although further research is needed to determine how effective they may be. These devices are worn like hearing aids. Some play background noise, while others encourage the wearer to speak more slowly. Speech therapy: During speech therapy, people work with a speech professional to learn ways to minimize stuttering. Strategies such as regulating breathing and speaking slowly, for example, can often help. Speech therapy can also help people feel less anxious about speaking situations. Although medications such as selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating co-occurring conditions such as social anxiety disorder or depression, there is not enough research to support their use for stuttering. Coping If you or your child experience stuttering, there are some things that you can do to help. Some effective coping strategies include: Avoid criticisms or corrections. Even reminding a child or yourself to "slow down" whenever stuttering begins can focus negative attention on the behavior. It can lead to self-consciousness that can make stuttering worse. Be accepting and supportive: Don't reactive negatively if you or your child stutters. If your child has a stutter, focus on being positive and encouraging. If you stutter, practice self-compassion and acceptance. Create a relaxed environment. Make sure your immediate environment is calm and comfortable. Find support: It can often be helpful to learn from the experiences of other people who also stutter. Support groups, online forums, and local organizations can offer resources and coping tips that can help. Minimize distractions. Set aside time to have conversations with people when you can be free from distractions. Turn off the television and other devices. A Word From Verywell Stuttering is a common speech issue in children, but it can lead to feelings of frustration for those who continue to stutter into adolescence and adulthood. While it presents challenges, there are treatments that can help you manage the disorder and improve speech fluency. While stuttering can be embarrassing, it is possible to improve and feel better about the way that you talk. 12 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sander RW, Osborne CA. Stuttering: Understanding and treating a common disability. Am Fam Physician. 2019;100(9):556–560. PMID: 31674746 Brocklehurst PH, Corley M. Investigating the inner speech of people who stutter: Evidence for (and against) the covert repair hypothesis. J Commun Disord. 2011;44(2):246-60. doi:10.1016/j.jcomdis.2010.11.004 Perez HR, Stoeckle JH. Stuttering: Clinical and research update. Can Fam Physician. 2016;62(6):479-84. Guntupalli VK, Kalinowski J, Saltuklaroglu T. The need for self-report data in the assessment of stuttering therapy efficacy: Repetitions and prolongations of speech. 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Changes in dopamine D2-receptor binding are associated to symptom reduction after psychotherapy in social anxiety disorder. Transl Psychiatry. 2012;2:e120. doi:10.1038/tp.2012.40 Iverach L, Rapee RM. Social anxiety disorder and stuttering: Current status and future directions. J Fluency Disord. 2014;40:69-82. doi:10.1016/j.jfludis.2013.08.003 Canton J, Scott KM, Glue P. Optimal treatment of social phobia: Systematic review and meta-analysis. Neuropsychiatr Dis Treat. 2012;8:203-15. doi:10.2147/NDT.S23317 Additional Reading Irwin, M. What is stuttering? Defining stuttering from the speaker's viewpoint. By Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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