This is a guide to treating stuttering in the adult population. Use these stuttering exercises for adults to facilitate smoother speech and a better quality of life.

In this article, you’ll learn:

• Speech modification strategies
• Stuttering modification strategies
• How to reduce negative reactions
• Counseling and mindfulness approaches

Keep scrolling!

For hundreds of evidence-based handouts and worksheets, check out the bestselling Adult Speech Therapy Starter Pack!

Stuttering Treatment For Adults

We’ll refer to people who stutter as PWS.

Fluency impairments treated by speech therapy include:

• Neurogenic stuttering. Stuttering caused by a brain injury, like a stroke or TBI
• Developmental stuttering. Stuttering developed in childhood

Adults with developmental stuttering may have had speech therapy for their stutter as kids—with varying results.

Do a thorough assessment and interview to understand what stuttering strategies worked (or didn’t work) for them in the past.

Throughout treatment, offer plenty of information, discuss the reasons for your treatment decisions, and be willing to adjust your plan of care to meet them where they’re at.

Types of Stuttering Treatment

Most of the stuttering therapy activities will fall into these 4 categories of stuttering treatment:

1. Speech Modification

Speech modification strategies aim to change the timing and tension of speech.

Patients use these strategies with all speech, not just when they stutter.

The ultimate goal of speech modification strategies is more fluent speech overall.

Speech modification strategies include:

• Prolonged speech
• Easy onset
• Light articulatory contact

More on these below.

2. Stuttering Modification

Stuttering modification strategies target the stutter (disfluency) itself.

To do this, the PWS must first understand what’s happening in their bodies during both fluent and disfluent speech.

Stuttering modification helps PWS to:

• Identify their core stuttering behaviors
• Recognize physical behaviors that come when they stutter
• Locate the point of physical tension and struggle when they stutter
• Reduce that physical tension

(adapted from American Speech-Language-Association, n.d.)

Examples of stuttering modification strategies are:

• Cancellation
• Pull-out
• Preparatory sets

These are covered below.

3. Address Negative Reactions

These treatments address the negative reactions that come with stuttering.

Some stuttering treatments are focused entirely on replacing negative thoughts or finding acceptance around stuttering. While others include it as one of several goals.

Stuttering therapies that address negative reactions include:

• Self-disclosure
• Voluntary stuttering
• Mindfulness
• Acceptance and Commitment Therapy (ACT)

Refer out to mental health professionals as appropriate.

4. Increase Participation

These treatments help the PWS become a more active participant in their lives. This includes speaking up more often and overcoming barriers to participation.

Treatment examples are:

• Outings
• Phone calls
• Strategies to overcome workplace challenges

Read More Practical Speech Therapy Tips!

• Goal Bank for Adult Speech Therapy
• Aphasia Treatment Approaches
• How To Make A Memory Book (Free Template)

How To Teach Stuttering Strategies

PWS often adopt several stuttering strategies. But be sure to introduce only one at a time.

How to teach a speech or stuttering modification strategy:

• First, the patient learns the strategy while reading aloud or copying what you say
• Next, they progress to using the strategy with more complex reading material (sentences loaded with trigger sounds/words, etc.)
• Then, they use the strategy in simple conversations with a familiar conversation partner

More ways to increase complexity:

• More complex conversations with a familiar partner
• Introduce background noise
• Speak in different settings
• Speak with different conversation partners

If a speech or stuttering modification strategy doesn’t reduce stuttering after three sessions (or the patient doesn’t like it), move on!

23 Stuttering Exercises for Adults

Here are 23 stuttering treatment ideas for adults, with tons of helpful videos, graphics, and links.

1. Teach Anatomy & Physiology

Teach your patients the anatomy and physiology of speaking before starting treatment.

This improved body awareness can make their stuttering treatment more effective.

Feel free to copy and paste the script below to make a patient handout. Or check out the Fluency Workbook for premade PDFs.

Anatomy & Physiology of Speaking

To speak, you must coordinate breathing, making sounds, and shaping sounds. Stuttering can happen when any of these are interrupted.

Respiration (Breathing for Speech)

• When you breathe in, your vocal cords open, and your lungs expand and fill with air.
• When you breathe out, air rushes out from your lungs and between your vocal folds.

Phonation (Creating Sounds)

• Just before you speak, you exhale and your vocal cords close.
• Sound is created when air rushes through your closed vocal folds.

Articulation (Shaping Sounds into Speech)

• The sound created by your vocal folds travels up your throat and out of your mouth and/or nose.
• You move your tongue, lips, jaw, and palate (back of the roof of the mouth) to shape all the speech sounds.

Resources

1. Video reviewing how we speak (by Sierra Speech)

2. Reduced Speech Rate While Reading

Help your patient slow down their speech rate by practicing while reading aloud.

Start by reading at a rate of around 1 syllable per second.

Have them stretch out each sound, adding pauses between syllables and words. You can use a metronome or even a pacing board to help keep a slow rate.

How to progress this activity:

• Read aloud in unison with your patient, using a slow rate
• Slowly fade out the amount you read aloud in unison
• Eventually, model reading aloud at a slow rate then ask the patient to copy you

3. Prolonged Speech

This strategy is also known as ‘smooth speech.’

Prolonged speech reduces speech rate and stuttering behaviors by prolonging each syllable.

• “Miii-crooo-waaave”
• “Hoooow aaaare yoooou?”

While this strategy may feel and sound unnatural at first, assure patients that you’ll work towards speaking at a normal rate as their speech becomes more smooth.

4. Breath Curve

Print the breath curve to use with patients. Or see the Fluency Pack for a print-and-go version.

The breath curve is a simple image that helps PWS visualize how to coordinate respiration with phonation.

How to Use the Breath Curve:

1. Trace the curve with your finger
2. Inhale on the up-curve
3. Exhale on the down-curve
4. Say, “Haaa” shortly after exhalation begins
5. Gradually say longer words and sentences whenever your finger traces over the ‘speak’ line

5. Easy Onsets

Avoid hard vocal attacks by using /h/. This is a phoneme that allows for maximum, easy airflow.

• Start by breathing out a soft /h/ sound
• Slowly turn on your voice with a vowel: hhhaaa, hhheee, hhhiii, hhhooo
• Follow with /h/ initial words
• Then /h/ initial sentences
• Then phrases that begin with vowel sounds

6. Light Articulatory Contacts

The goal of this strategy is to reduce tension by having the articulators move and touch lightly.

Teach your patient the difference between a hard versus a light contact.

For example, teach the difference between saying /h/ and /p/. Ask the patient to use light contacts while completing the following contact drills:

Light vs. Hard Sounds

For more light vs. hard sounds, /h/ word lists, reading material, breath curve, etc. check out the Fluency Pack!

7. Continuous Voicing and Airflow

Ask the patient to ‘keep the motor going’ by saying the entire production or sentence without any breaks (until they need to take a breath).

8. Cancellations

When a patient starts to stutter, teach the patient to:

• First pause
• Take a breath
• Start again with less tension

“F-f-f- [Pause. Breath] Friday.”

9. Pull Outs

When a patient stutters, ask them to pull or slide out of it as they continue voicing to avoid a stoppage or block.

“H-h-h- [slide out] hhhhe leaves on Friday.”

10. Preparatory Sets

When a patient anticipates that they will stutter on a sound, ask them to ‘ease’ into the word by slightly prolonging the initial sound.

“He [ease into it] llleaves on Friday.”

11. Metronome

Help your patient to self-pace and speak at a slower rate by using a metronome.

Prompt the patient to say one syllable or word per beat. Gradually increase the speed to a normal speaking rate.

There are plenty of free metronome apps for you and your patients.

12. Choral Speech

Read aloud in unison with your patient. Fade out until the patient is reading aloud alone.

13. Shadowing

Have the patient read from a script in unison with a recording of the same script.

14. Pacing

• Write out target words or phrases for your patient. Place a dot under each syllable
• Ask your patient to touch each dot and say one syllable per dot
• Continue the pace of one dot per syllable
• Gradually move on to phase completions then sentences

At the word and phrase level, use our free pacing board.

15. Voluntary Stuttering

Voluntary stuttering is stuttering on purpose.

By stuttering on purpose, the PWS can feel more in control of their speech. This can decrease the anxiety of unintentional stuttering.

To voluntarily stutter, the PWS chooses to stutter at specific intervals (e.g., every 3rd word, the beginning of every sentence) or on specific sounds (e.g. all the hard consonants).

Resources

1. Admitting That You Stutter
2. Stamuri Stuttering Treatment App

16. Avoidance Reduction Therapy for Stuttering (ARTS®)

This therapy addresses the emotional struggles that a PWS goes through to avoid stuttering.

These include avoidance behaviors (closing eyes, substituting words) and feelings and attitudes that perpetuate the fear of stuttering.

ARTS systematically reduces this fear and avoidance.

Speech-language pathology professionals and others can learn how to do ARTS via in-person and online training.

17. Support Groups & Community

Support groups and communities can offer PWS much-needed emotional and practical support.

The National Stuttering Association (NSA) has local chapters and events (online and live).

18. Interview Practice

The National Stuttering Association offers free online job interview practice.

They also have free webinars to help PWS overcome workplace barriers in specific career paths, including:

• Entrepreneur
• Teacher
• Customer service
• Speech-language pathologist!

To improve public speaking skills and increase confidence, many PWS have benefited from joining Toastmasters International.

Read a r/stutter Reddit thread about Toastmasters.

19. Board Certification

To become a fluency boss, consider becoming a board-certified specialist in fluency.

To apply, you need to have:

• Completed your C’s
• 3 years of experience treating fluency disorders
• At least 450 clinical treatment hours
• 6 CEUs of intermediate to advanced training in fluency disorders

20. Acceptance & Commitment Therapy (ACT)

ACT is an evidence-based psychological treatment for stuttering. It uses mindfulness to increase self-acceptance and emotional regulation.

It’s been shown to improve speech fluency and mental health (Beilby, 2012).

21. Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy has been shown to enhance traditional stuttering treatment, especially when coupled with mindfulness (Menzies, 2019).

It helps PWS to replace negative thoughts, emotions, and behaviors with positive ones.

22. Mindfulness

Mindfulness can be very helpful for PWS.

By becoming aware of the present moment without judgment, PWS can readily feel what’s happening in their bodies and minds when they stutter.

This can lead to self-acceptance, greater calm, and noticing patterns they can change to improve fluency.

Resources

1. Mindfulness for People Who Stutter: 4 Guided Meditations

23. Self-Disclosure

Self-disclosure is when a PWS discloses that they have a stutter.

This can help both the PWS and their conversation partner to feel more at ease when talking. Self-disclosure of stuttering is also associated with a better quality of life (Boyle, 2018).

Examples of self-disclosure:

• Identify as a PWS. “Hi, I’m Fabien, and I’m a person who stutters.”
• Explain what’s going on. “I’ll be your nurse t-t-today. You may notice that I stutter. It has no impact on the care you’ll receive.”
• Subtle hints. “I can meet for coffee next week, although I have speech therapy on Fridays.”

(Margulis, 2022; Herder, 2018)

More Stuttering Resources

References

• American Speech-Language-Hearing Association (n.d.). Fluency Disorders (Practice Portal). Retrieved Dec, 28, 2023, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/.
• Boyle, M. P., Milewski, K. M., & Beita-Ell, C. (2018). Disclosure of stuttering and quality of life in people who stutter. Journal of Fluency Disorders, 58, 1-10. https://doi.org/10.1016/j.jfludis.2018.10.003
• Gupta, S., Yashodharakumar, G. Y., & Vasudha, H. H. (2016). Cognitive behavior therapy and mindfulness training in the treatment of adults who stutter. The International Journal of Indian Psychology, 3(3), 78–87.
• Herder, C (2018). 3 Basic Rules of Self-Advertising Your Stuttering. American Institute for Stuttering. Retrieved Dec 29, 2023, from https://www.stutteringtreatment.org/blog/3-basic-rules-of-self-advertising-your-stuttering
• Junuzovic-Zunic, L., Sinanovic, O., & Majic, B. (2021). Neurogenic Stuttering: Etiology, Symptomatology, and Treatment. Medical Archives, 75(6), 456-461. https://doi.org/10.5455/medarh.2021.75.456-461
• Margulis, C. (2022). Stuttering Self-Disclosure: An Empowering Opportunity. Medbridge. Retrieved Dec, 29, 2023, from https://www.medbridge.com/blog/2022/04/stuttering-self-disclosure-an-empowering-opportunity/
• Menzies, R., O’Brian, S., Packman, A., Jones, M., Helgadóttir, F. D., & Onslow, M. (2019). Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial. Journal of communication disorders, 80, 81–91. https://doi.org/10.1016/j.jcomdis.2019.04.003