In this post, we’ll review strategies for treating stuttering in the adult population. We refer to a person who stutters as PWS.
Remember that adults with development stuttering may have experienced a lot of stigma and embarrassment over the years. They also likely had therapy for their stuttering in the past—with varying results.
First, complete a thorough case history and interview.
Throughout treatment, provide plenty of information to your patient. Discuss the reasons for your treatment decisions. Be flexible: Adjust your plan of care to meet your patient where they’re at (ASHA, Fluency Disorders).
- Goal Bank for Adult Speech Therapy
- Aphasia Treatment Approaches
- How to Make a Memory Book (free template)
Types of Stuttering Treatment
1. Speech Modification
Speech modification techniques are used on all of a person’s speech, not just disfluencies. They aim to change the timing and tension of all speech. The ultimate goal is more fluent speech overall.
2. Stuttering Modification
Stuttering modification techniques target disfluent speech. To do this efficiently, the PWS must first understand what’s happening in their bodies during both fluent and disfluent speech.
Stuttering modification helps PWS to:
- Identify core stuttering behaviors
- Recognize physical concomitant behaviors
- Locate the point of physical tension and struggle during moments of disfluency
- Ultimately reduce that physical tension
(ASHA, Fluency Disorders)
3. Address Negative Reactions
These treatment approaches address the negative reactions that accompany stuttering. They are often included in other stuttering treatments, although there are several approaches that focus entirely on replacing negative thoughts and/or finding acceptance for the stuttering.
We include referrals to mental health professionals in this category.
4. Increase Participation
This approach helps the PWS become a more active participant in life, including speaking up more often and overcoming barriers to participation.
Treatment examples are outings, phone calls, or strategies to overcome workplace challenges.
21 Stuttering Therapy Ideas for Adults
PWS may end up adopting many stuttering techniques—but introduce one at a time.
In general, if a speech or stuttering modification technique doesn’t reduce disfluencies after three sessions (or the patient doesn’t like it) then drop it and try a different one.
Many patients will learn the speech and stuttering modification techniques by reading aloud or copying a direct model. As they get more comfortable with the technique, have them progress to more complex reading material (sentences loaded with trigger sounds/words, etc.) and simple conversations with a familiar partner.
More ways to increase complexity:
- More complex conversations with a familiar partner
- Introduce background noise
- Speak in different settings
- Speak with different conversation partner
1. Review Anatomy & Physiology
Review the anatomy and physiology of speaking with your patient before beginning treatment. Improved body awareness can make treatment more effective:
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 folds open, and your lungs expand and fill with air.
- When you breathe out, air rushes out from your lung and between your vocal folds.
Phonation (Creating Sounds)
- Just before you speak, you exhale and your vocal folds 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.
- Video reviewing how we speak (by Eugene Speech Therapy)
2. Reduced Speech Rate
The patient starts by producing about 1 syllable per second, stretching out each sound, and inserting pauses between syllables and words.
Reduced Speech Rate While Reading:
- 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
Also known as “smooth speech”. It reduces speech rate and stuttering behaviors by prolonging syllables. Gradually train the patient to speak at a normal rate.
- “Heee leaves ooon Friiidaaay.”
4. Breath Curve
The breath curve is a simple image that helps PWS visualize how to coordinate respiration with phonation.
To print: right click, copy image, paste onto a word document, format as you desire, then print! Or see the Fluency Pack for a print-and-go version.
How to Use the Breath Curve:
- Trace the curve with your finger
- Inhale on the up-curve
- Exhale on the down-curve
- Say “haaa” shortly after exhalation begins
- 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.
Ask the patient to begin by producing /h/ plus a vowel sound. Follow with /h/ initial words, /h/ initial sentences, then phrases that begin with vowel sounds.
6. Light Articulatory Contacts
The articulators move and touch gently. To reduce articulatory tension, teach your patient the difference between a hard versus a light contact.
For instance, teach the difference between producing /h/ and /p/. Ask the patient to use light contacts while completing the following contact drills:
Light vs. Hard Sounds
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).
Teach the patient to first pause for a few seconds after stuttering and then say the word again, with less tension.
“F-f-f- [pause]. Ffffriday.”
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.”
Help your patient to self-pace and speak at a slower rate by using a metronome.
Prompt the patient to produce one syllable or word per beat. Gradually increase the speed to a normal speaking rate.
There are plenty of free metronome apps that you and your patients can download on your phones or tablets.
12. Choral Speech
Read aloud in unison with your patient. Fade out until the patient is reading aloud alone.
The patient reads from a script in unison with a recording of the same script.
- Write out target words or phrases for your patient. Place a dot under each syllable.
- Ask your patient to touch each dot and produce one syllable per dot.
- Continue the pace of one dot per syllable.
- Gradually move on to phase completions then sentences.
Pseudostuttutering is stuttering on purpose. The PWS may choose to stutter at specific intervals (every 3rd word, the beginning of every sentence, etc.) or on specific sounds (all the hard consonants, etc.)
By stuttering on purpose, the person can feel more in control of their speech, which can reduce the anxiety of unintentional stuttering.
16. Avoidance Reduction Therapy (ARTS®)
This therapy addresses the struggles that a PWS goes through to avoid stuttering. These are avoidance behaviors (closing eyes, substituting words, etc.) and feelings and attitudes that maintain a fear of stuttering.
The goal and process of ARTS therapy are to systematically reduce this fear and avoidance.
17. Support Groups & Community
18. Board Certification
To become a fluency boss, consider becoming a board-certified specialist in fluency.
To apply, you’ll need to complete your C’s plus three years of experience with at least 450 hours treating fluency disorders.
19. Cognitive Restructuring
The goal of cognitive restructuring is to help a PWS replace negative thoughts they have about themselves and their speech with new thoughts that serve them better.
You’ll need extra training to implement this treatment—or refer out to a qualified mental health professional.
Acceptance & Commitment Therapy (ACT)
ACT is a holistic, person-centered approach that allows individuals to alter the relationships they have with their emotions and thoughts. One of the core principles of ACT is mindfulness. Mindfulness is an intentional awareness of the present moment (e.g., through meditation) to help disengage from automatic thoughts and redirect attention, de-escalate emotions, and increase self-acceptance.
Cognitive Behavioral Therapy (CBT)
The purpose of CBT is to modify current negative thoughts, emotions, and/or behaviors and replace them with positive ones through identification of thought patterns and challenging cognitive distortions in real time. More recently, CBT and mindfulness have been applied to stuttering therapy and may support that CBT+mindfulness is more beneficial to clients who stutter than CBT alone.
As mentioned above, mindfulness can be very helpful for PWS. By becoming aware of the present moment, without judgment, PWS can more readily feel what’s happening in their bodies and mind when they stutter.
This can lead to self-acceptance, staying calm, and noticing patterns they can work on to improve their fluency.
21. Self-Disclosure or Self-Advertising
Self-disclosure is when a PWS ‘discloses’ that they have a stutter. This can help both the person who stutters and their conversation partner to feel more at ease when talking.
The American Institute of Stuttering gives several examples of self-disclosure:
John, a doctor in a hospital, visiting a new patient on his daily rounds: “Hi Mrs. Doe, I’m Dr. S-S-Ssssssmith. You might notice I stutter. It has nothing to do with your case. It’s just how I talk. Now, let’s talk about your blood pressure.”
Anna, at the grocery store. She doesn’t have her rewards card and is prompted by the cashier to provide a phone number: “Sure, but first I should say I actually stutter, and saying numbers are particularly hard for me. Thanks in advance for your patience.”