Clinical Review

Clinical management of stuttering in children and adults

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d3742 (Published 24 June 2011) Cite this as: BMJ 2011;342:d3742
  1. Susan O’Brian, senior research fellow1,
  2. Mark Onslow, director1
  1. 1Australian Stuttering Research Centre, University of Sydney, Lidcombe, NSW 2060, Australia
  1. Correspondence to: M Onslow mark.onslow{at}sydney.edu.au

Summary points

  • Stuttering is a common speech disorder of neural speech processing that usually begins during the first three or four years of life and may affect as many as 10% of children

  • Educational, occupational, and social problems are common if chronic stuttering is not treated early

  • Mental health problems, in particular social anxiety, are likely to develop with chronic stuttering

  • Early intervention is recommended, preferably within one year of onset of stuttering

  • Randomised controlled trials have shown an early parent implemented behavioural intervention to be efficacious for stuttering control in preschool children

  • Speech restructuring can rehabilitate speech in people with chronic stuttering

Stuttering, also known as stammering, is a common speech disorder of neural speech processing that typically begins during the first years of life. An Australian cohort study (n=1619) of children recruited at 8 months of age found that 8.5% had begun to stutter a 36 months of age, and 12.2% by 48 months.1 A review of 44 studies shows a prevalence of around 1% for schoolchildren worldwide (range 0.03-5.2%).w1 Stuttering is essentially a movement disorder of speech, with observable effects on the jaw and mouth, but also facial muscles and sometimes upper limbs. Those who stutter are at risk of developing social anxiety or mental health problems.

Evidence from randomised trials has shown that treatment before 6 years of age reduces the chance of stuttering becoming intractable. Children can recover without formal intervention, but it is not possible to predict who will recover spontaneously. It is therefore best to take advantage of the window of opportunity within which children may be treated with best effect, which is within one year of onset. For adults with long term stuttering, early randomised trials of behavioural and cognitive interventions show promise.

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