Stuttering is when fluent speech is disrupted by repetition, prolongations, or blocks (ASHA, n.d.)
Whatever the cause of their stutter, it can be very frustrating for your adult patients. But there’s plenty that speech therapy can do to help!
In this article, you’ll learn:
- The causes of stuttering in adults
- How to identify developmental, neurogenic, and psychogenic stuttering
- Treatment tips for each
Causes of Stuttering in Adults
Stuttering in adults is either developmental or acquired.
Developmental stuttering is the most common type of stuttering. It begins in early childhood, usually between 2 to 6 years old, and is caused by genetic and neurophysiological factors (ASHA, n.d.)
Around 1% of adults have developmental stuttering (from 5–8 % of preschool-age children; Chow et al., 2023).
The core stuttering behaviors are repetitions, prolongations, and blocks of initial sounds and syllables.
Read 23 Ways To Treat Stuttering for an evidence-based guide to stuttering treatments.
Acquired stuttering is a stutter that is acquired, most often due to a neurological event. Acquired stuttering may be caused by:
- A neurogenic change like a stroke, traumatic brain injury, Parkinson’s disease, seizure disorder
- A psychogenic change or exacerbation of a mental health disorder
- Medications
Keep scrolling for more on how to identify and treat neurogenic vs psychogenic stuttering.
What Is Neurogenic Stuttering?
Neurogenic stuttering is a type of acquired stuttering.
It’s caused by brain damage that leads to disfluencies, most often after a stroke or TBI (Junuzovic-Zunic et al., 2021). For that reason, it usually has a sudden onset.
Neurogenic stuttering often co-occurs with other speech and/or language disorders, like aphasia, apraxia, and/or dysarthria.
Neurogenic stuttering behaviors may include:
- Repetitions, prolongations, and blocks that are not restricted to initial sounds or syllables
- Stuttering during automatic speech tasks, like counting
- Patients don’t respond to fluency-inducing conditions (choral speaking, rhythmic speech, prolonged speech, singing, etc.)
(Manning & DiLollo, 2017)
They’re also less likely to have secondary behaviors like blinking or facial grimaces that are common in developmental stuttering. But these may develop over time.
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How To Treat Neurogenic Stuttering
Neurogenic stuttering symptoms will improve as the neurological problem improves.
Many of the treatments that work for developmental stuttering can also treat neurogenic stuttering.
Speech therapy can treat neurogenic stuttering with strategies to:
- Modify speech
- Modify stuttering
- Address negative reactions
- Increase participation
Speech modification strategies change the timing and tension of speech. Patients use these strategies with all speech, not just when they stutter. Strategies include reduced speech rate, easy onset, light articulatory contact, and continuous voicing.
Stuttering modification strategies target the stutter itself. Examples are cancellations, pull-outs, and preparatory sets.
Speech therapy can also recommend ways to relax, such as mindfulness. And can help patients overcome barriers to participation with tasks like outings, phone calls, and strategies to overcome workplace challenges.
Read 23 Ways To Treat Stuttering for details on how to treat stuttering.
What Is Psychogenic Stuttering?
Psychogenic stuttering is another form of acquired stuttering.
This type of stuttering also has a sudden onset but is caused by excessive stress, not a neurological disorder. That said, it can co-occur with a neurological disorder.
Causes of psychogenic stuttering include:
- Trauma/PTSD
- Conversion disorder (real physical or sensory problems without a neurological cause)
- Adverse life events
- Psychological distress/exacerbation of a mental illness
- Drug dependence
Psychogenic stuttering behaviors can include:
- Repetitions, prolongations, and blocks in any position
- Atypical fluency disruptions, like excessive repetitions of each phoneme
- Worse symptoms on easier speaking tasks
- Atypical secondary behaviors, like an anxious body movement that’s not related to the stutter
- Unusual grammar
- Rapid improvement of stuttering after disclosing emotionally sensitive information
Neurogenic vs Psychogenic Stuttering?
The best way to differentiate between neurogenic and psychogenic stuttering is to look for a CNS impairment. If there is a neurological impairment, you’re likely seeing a neurogenic stutter.
Also keep in mind that neurogenic stuttering is far more common (Manning & DiLollo, 2017).
How To Treat Psychogenic Stuttering
Psychogenic stuttering symptoms may resolve as the patient’s stress resolves.
Speech therapy can offer symptomatic therapy. For best results, it’s important that you’re optimistic and encouraging.
Researchers recommend being careful not to imply that a psychogenic stutter isn’t valid. Instead, frame it as good news: it means that full recovery is possible.
Treatment of psychogenic stutter may include:
- Helping identify and reduce muscle tension during speech
- Practicing speech without tension
- Normalizing prosody after fluency improves
- Speech modification and stuttering modification techniques
- Referring out for mental health counseling and stress reduction as needed
(Manning & DiLollo, 2017; Weightman, 2014)
More Resources
See the Fluency Pack for print-and-go stuttering treatments. For more guidance on working with adult speech therapy patients, join The Adult Speech Therapy Roadmap course!
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
Adult Speech Therapy Roadmap Course
The Adult Speech Therapy Roadmap is an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy, from Day 1 to Discharge.
References
- American Speech-Language-Hearing Association (n.d.). Fluency Disorders (Practice Portal). Retrieved September 2024, from www.asha.org/practice-portal/clinical-topics/fluency-disorders/.
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Chow, H. M., Garnett, E. O., Koenraads, S. P. C., & Chang, S.-E. (2023). Brain developmental trajectories associated with childhood stuttering persistence and recovery. Developmental Cognitive Neuroscience, 60, 1–15. https://doi.org/10.1016/j.dcn.2023.101224
- Junuzovic-Zunic, L., Sinanovic, O., & Majic, B. (2021). Neurogenic Stuttering: Etiology, Symptomatology, and Treatment. Medical archives (Sarajevo, Bosnia and Herzegovina), 75(6), 456–461. https://doi.org/10.5455/medarh.2021.75.456-461
- Laiho A, Elovaara H, Kaisamatti K, Luhtalampi K, Talaskivi L, Pohja S, Routamo-Jaatela K, Vuorio E. (2022). Stuttering interventions for children, adolescents, and adults: a systematic review as a part of clinical guidelines. J Commun Disord. 99:106242. doi: 10.1016/j.jcomdis.2022.106242.
- Manning, W., & DiLollo, A. (2017). Clinical Decision Making in Fluency Disorders (4th ed.). Plural Publishing.
- Weightman, M., Vining Radomski, M., Mashima, P., & Roth, C. (2014). Mild Traumatic Brain Injury Rehabilitation Toolkit. Borden Institute.
