All sorts of treatments and remedies are marketed to adults who stutter. Some of them are sensible and evidence-based; while others are total nonsense.
The hard thing is sorting wheat from chaff. Luckily, a systematic review of peer-reviewed evidence has just been published.
Here are 19 things we took from it:
- Stuttering and stammering are the same thing. We will call it stuttering in this article, because that’s the term usually used in Australia.
- At any point in time, about 1% of the population stutters. Stuttering is much more common that many people think.
- Males are more affected by stuttering than females, with a ratio of around 5:1 (Yairi & Ambrose, 1992).
- Four single genes have been identified for stuttering (Raza et al., 2015).
- Stuttering is caused by genetic and environmental factors, but we don’t know exactly why it happens (e.g. Fagnani et al., 2011).
- Twin studies show genetic factors have a big impact on stuttering: about 82% of the variance is due to additive genetic factors; about 18% to non-shared environmental factors (Rautakoski et al., 2012)
- Stuttering can restrict social participation and life opportunities. (But not always.)
- Adults who stutter are at an increased risk of anxiety-related mood and personality disorders, compared to controls (e.g. Iverach & Rapee, 2014).
- There is as yet no cure for stuttering.
- Speech restructuring treatments – also known as prolonged speech or fluency shaping treatments – currently enjoy the highest level of evidence, including the support of multiple randomised controlled trials. Speech restructuring treatments are the standard of care for adults who stutter.
- Speech restructuring is the replacement of stuttered speech with a different speech pattern that enables the adult to control their stuttering symptoms while sounding as natural as possible.
- Speech restructuring strategies include:
- slowing down your speech rate;
- extending (prolonging) vowels;
- using gentle onsets;
- continuous voicing;
- continuous airflow;
- controlled exhalation; and
- diaphragmatic breathing.
- In one evidence-based speech restructuring program we use, called the Camperdown Program, adults learn these techniques by following a video model.
- Speech restructuring treatments, like the Camperdown Program, reduce stuttering frequency by an average of 50-57%. But no current treatment eliminates stuttering altogether.
- Speech restructuring treatment by telehealth is as effective as face-to-face therapy. Many adults we work with find it more convenient – especially for adults juggling job and family commitments.
- One of the bigger challenges with speech restructuring is shaping the speech pattern so it sounds natural enough for the adult to use out in their real world (e.g. Tasko et al., 2007):
- Adults who use speech restructuring sometimes feel different to other people, which can be a reason for adults not to use the technique in real life interactions.
- Restructured speech has been criticised as resulting in speech patterns that are generally not acceptable to some speakers (e.g. Baxter et al., 2016).
- Video self-modelling – watching videos of yourself speaking fluently using speech restructuring – may be a useful adjunct therapy to help some people get comfortable with seeing and hearing themselves using the pattern and sounding ‘natural enough’ (Cream et al., 2003).
- Speech naturalness is an important thing to focus on. In other words, you need to be comfortable using the technique in the real world for it to be worthwhile.
- Transcranial direct current stimulation shows promise as an adjunct therapy for adults who stutter in combination with behavioural modification therapies like metronome-timed speech or choral speech (Chesters et al., 2018), reducing stuttering by 22-27%. But we need to see more studies on it before getting too excited.
- Online Cognitive behaviour therapy (CBT) – iGlebe (free from the Australian Stuttering Research Centre) is now available, combined with speech restructuring therapy, has a number of benefits, including a reduction in unhelpful thoughts and beliefs, less avoidance, less social phobia, and less fear of negative evaluation (Menzies et al., 2008). But we need more studies on this to make sure CBT works, and to work out when adults who stutter should do it (before, during, or after speech restructuring therapy).
- The Australian Stuttering Research Centre at the University of Technology Sydney has recently published lots of free resources to support speech pathologists and adults who are doing the Camperdown Program. These resources can be accessed here.
Clinical bottom line
Speech restructuring treatments, like the Camperdown Program, are effective for adults who stutter, reduce stuttering by 50-57% on average, and can be done face-to-face or by telehealth. Evidence for other treatments continues to grow and we need to keep a close eye on it. We need more research urgently on how best to combine speech therapy and psychological treatments to ensure adults who stutter get the best treatment at the right time.
Principal source: Brignell, A., Krahe, M., Downes, M., Kefalianos, E. Reilly, S. & Morgan. A.T. (2020). A systematic review of interventions for adults who stutter. Journal of Fluency Disorders, 64, 105766.
Related articles and resources:
- The Camperdown Program
- Stuttering: what do we mean by ‘recovery’?
- Does anxiety cause stuttering?
- How to speak with people who stutter: do we need rules?
- Banter Research Review 1: Stuttering Relapse – Video Self-Modelling versus Cognitive Behaviour Therapy
- Stuttering treatments: what works for whom? An evidence update
- Controlling stuttering: what it feels like in the real world
- Doing two things at once: empowering adults who stutter to make informed choices about their fluency
- The Camperdown Program: Practice Goal Setter
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.
