Facts and causes

Stammering or stuttering?

Stammering and stuttering both mean the same thing. We use stammering in the UK while in other parts of the world people refer to stuttering.

Facts about stammering

Onset

Stammering is a neuro-developmental issue that typically emerges between 2;6 and 3 years of age. Onset can be gradual or sudden. There is no association between severity of stammering at onset and risk of persistence.

Gender

The same number of boys and girls start to stammer but girls are more likely to stop stammering so that in the adult population there is a ratio of 4-5 men for every woman who stammers.

Incidence and prevalence

Research has shown that 5% of children will stammer at some point however one recent Australian study reported 8%). Approximately 1% of the adult population stammers.

Persistence

Many young children stop stammering within a year or so of starting (up to 85%) however not all do. Some children are more highly predisposed to continue stammering.

Variability

Stammering is highly variable. It is likely that you will not see a representative sample during a brief GP consultation. It is important to ask parents/clients about their general experience of stammering.

Early intervention

A ‘wait and see’ approach should not be taken, especially if parents are worried.

Therapy for young children has been shown to be effective and early referral to a speech and language therapist is strongly recommended if parents are concerned.

Wider impact of stammering

Stammering creates considerable anxiety for parents, particularly worry about their child’s future.

Children who stammer are more likely to be bullied at school than children who don’t stammer.

Children and adults who stammer are more at risk of developing social anxiety related to stammering.

Stammering potentially has a life-long cost in terms of quality of life, educational and vocational achievement, and ability to communicate in everyday life.

These points should be used to support early intervention or access to specialist services.

Accessing specialist services

Services for children, young people and adults who stammer in the UK are variable.

There may be a local NHS speech and language therapy service available and this should be explored first. (Exception is residents of Camden or Islington where referrals can be made directly to the MPC).

If there is no local service, or if parents are requesting a referral to the MPC then read how to do that here.

Read information about referring an adult to the MPC for individual therapy here.

Adults who stammer who are interested in group therapy can be directed to the speech therapy department at the City Lit in Holborn.

Where to go for advice

There is information and advice for children, young people and adults who stammer, as well as for parents and teachers on this website.

Other resources:

The Michael Palin Centre helpline: 020 3316 8100 (speak to an expert clinician)

Causes

Stammering is not caused by anything that parents have done or not done.

Genetics

Stammering is largely but not entirely accounted for by genetic predisposition. Approximately 2/3 of the time there will be a family history of stammering.

There is likely to be more than one gene involved in stammering.

Stammering is epigenetic and other factors influence the degree to which stammering is expressed.

Brain structure and function

There are subtle structural and functional differences in the brain which has been shown in children who stammer as young as three years of age.

Genetics is likely to contribute to these differences in brain structure and function associated with stammering. (Chang, Erickson, Ambrose, Hasegawa-Johnson & Ludlow, 2008)

Speech motor skills

Adults who stammer have been shown to have less efficient speech motor skills and this is thought to be a contributing factor.

One hypothesis is that this is that children who stammer also have less efficient and possibly less stable speech motor patterns that children who do not stammer. Research in this area is ongoing.

If speech-motor capacity is a factor then this explains why speaking rapidly exacerbates stammering and why instinctively parents often want to tell their child to slow down.

Language skills

Children who stammer may have delayed, advanced or a mixed profile of language skills.

Stammering emerges at a time of rapid language expansion from single word to multiword utterances. This may result in an increased load in terms of language and speech motor planning that the developing child is unable to accommodate.

Stammering is not caused by being bi or multilingual. Advice to parents of bilingual or multilingual children is to continue to speak to them in the language that they would naturally wish to.

Temperament and emotion

Stammering is not caused by anxiety but children can become more anxious due to their experience of stammering if they receive negative reactions to it.

Measurement of risk for anxiety or other emotional vulnerabilities is recommended as part of an assessment by a specialist speech and language therapist.

Some research has found that some young children who stammer are more emotionally reactive and less able to regulate their emotions than children who do not stammer.

Environmental factors

Children, young people and adults are likely to stammer more when under time or performance pressure.

Oral exams are often challenging for young people and support for special consideration for oral exams should be given.

Summary

Stammering is a neuro-developmental issue which is largely, but not entirely genetically linked. Parents do not cause stammering. Stammering is epigenetic and various other factors influence the degree to which a genetic vulnerability is expressed. These factors include: language skills, temperament and environmental factors.

Early intervention for young children is effective however we do not refer to “curing” stammering as some children will continue to stammer into adulthood.

Call your local speech and language therapist or the MPC if you need more information or advice.