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What is stuttering?

Who stutters, how is speech normally produced, what are the causes and types of stuttering, how is stuttering diagnosed, how is stuttering treated, what research is being conducted on stuttering, where can i find additional information about stuttering.

Stuttering is a speech disorder characterized by repetition of sounds, syllables, or words; prolongation of sounds; and interruptions in speech known as blocks. An individual who stutters exactly knows what he or she would like to say but has trouble producing a normal flow of speech. These speech disruptions may be accompanied by struggle behaviors, such as rapid eye blinks or tremors of the lips. Stuttering can make it difficult to communicate with other people, which often affects a person’s quality of life and interpersonal relationships. Stuttering can also negatively influence job performance and opportunities, and treatment can come at a high financial cost.

Symptoms of stuttering can vary significantly throughout a person’s day. In general, speaking before a group or talking on the telephone may make a person’s stuttering more severe, while singing, reading, or speaking in unison may temporarily reduce stuttering.

Stuttering is sometimes referred to as stammering and by a broader term, disfluent speech .

Roughly 3 million Americans stutter. Stuttering affects people of all ages. It occurs most often in children between the ages of 2 and 6 as they are developing their language skills. Approximately 5 to 10 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Boys are 2 to 3 times as likely to stutter as girls and as they get older this gender difference increases; the number of boys who continue to stutter is three to four times larger than the number of girls. Most children outgrow stuttering. Approximately 75 percent of children recover from stuttering. For the remaining 25 percent who continue to stutter, stuttering can persist as a lifelong communication disorder.

We make speech sounds through a series of precisely coordinated muscle movements involving breathing, phonation (voice production), and articulation (movement of the throat, palate, tongue, and lips). Muscle movements are controlled by the brain and monitored through our senses of hearing and touch.

The precise mechanisms that cause stuttering are not understood. Stuttering is commonly grouped into two types termed developmental and neurogenic.

Developmental stuttering

Developmental stuttering occurs in young children while they are still learning speech and language skills. It is the most common form of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when children’s speech and language abilities are unable to meet the child’s verbal demands. Most scientists and clinicians believe that developmental stuttering stems from complex interactions of multiple factors. Recent brain imaging studies have shown consistent differences in those who stutter compared to nonstuttering peers. Developmental stuttering may also run in families and research has shown that genetic factors contribute to this type of stuttering. Starting in 2010, researchers at the National Institute on Deafness and Other Communication Disorders (NIDCD) have identified four different genes in which mutations are associated with stuttering. More information on the genetics of stuttering can be found in the research section of this fact sheet.

Neurogenic stuttering

Neurogenic stuttering may occur after a stroke, head trauma, or other type of brain injury. With neurogenic stuttering, the brain has difficulty coordinating the different brain regions involved in speaking, resulting in problems in production of clear, fluent speech.

At one time, all stuttering was believed to be psychogenic, caused by emotional trauma, but today we know that psychogenic stuttering is rare.

Stuttering is usually diagnosed by a speech-language pathologist, a health professional who is trained to test and treat individuals with voice, speech, and language disorders. The speech-language pathologist will consider a variety of factors, including the child’s case history (such as when the stuttering was first noticed and under what circumstances), an analysis of the child’s stuttering behaviors, and an evaluation of the child’s speech and language abilities and the impact of stuttering on his or her life.

When evaluating a young child for stuttering, a speech-language pathologist will try to determine if the child is likely to continue his or her stuttering behavior or outgrow it. To determine this difference, the speech-language pathologist will consider such factors as the family’s history of stuttering, whether the child’s stuttering has lasted 6 months or longer, and whether the child exhibits other speech or language problems.

Although there is currently no cure for stuttering, there are a variety of treatments available. The nature of the treatment will differ, based upon a person’s age, communication goals, and other factors. If you or your child stutters, it is important to work with a speech-language pathologist to determine the best treatment options.

Therapy for children

For very young children, early treatment may prevent developmental stuttering from becoming a lifelong problem. Certain strategies can help children learn to improve their speech fluency while developing positive attitudes toward communication. Health professionals generally recommend that a child be evaluated if he or she has stuttered for 3 to 6 months, exhibits struggle behaviors associated with stuttering, or has a family history of stuttering or related communication disorders. Some researchers recommend that a child be evaluated every 3 months to determine if the stuttering is increasing or decreasing. Treatment often involves teaching parents about ways to support their child’s production of fluent speech. Parents may be encouraged to:

• Provide a relaxed home environment that allows many opportunities for the child to speak. This includes setting aside time to talk to one another, especially when the child is excited and has a lot to say.
• Listen attentively when the child speaks and focus on the content of the message, rather than responding to how it is said or interruptng the child.
• Speak in a slightly slowed and relaxed manner. This can help reduce time pressures the child may be experiencing.
• Listen attentively when the child speaks and wait for him or her to say the intended word. Don't try to complete the child’s sentences. Also, help the child learn that a person can communicate successfully even when stuttering occurs.
• Talk openly and honestly to the child about stuttering if he or she brings up the subject. Let the child know that it is okay for some disruptions to occur.

Stuttering therapy

Many of the current therapies for teens and adults who stutter focus on helping them learn ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Most of these therapies also help address the anxiety a person who stutters may feel in certain speaking situations.

Drug therapy

The U.S. Food and Drug Administration has not approved any drug for the treatment of stuttering. However, some drugs that are approved to treat other health problems—such as epilepsy, anxiety, or depression—have been used to treat stuttering. These drugs often have side effects that make them difficult to use over a long period of time.

Electronic devices

Some people who stutter use electronic devices to help control fluency. For example, one type of device fits into the ear canal, much like a hearing aid, and digitally replays a slightly altered version of the wearer’s voice into the ear so that it sounds as if he or she is speaking in unison with another person. In some people, electronic devices may help improve fluency in a relatively short period of time. Additional research is needed to determine how long such effects may last and whether people are able to easily use and benefit from these devices in real-world situations. For these reasons, researchers are continuing to study the long-term effectiveness of these devices.

Self-help groups

Many people find that they achieve their greatest success through a combination of self-study and therapy. Self-help groups provide a way for people who stutter to find resources and support as they face the challenges of stuttering.

Researchers around the world are exploring ways to improve the early identification and treatment of stuttering and to identify its causes. For example, scientists have been working to identify the possible genes responsible for stuttering that tend to run in families. NIDCD scientists have now identified variants in four such genes that account for some cases of stuttering in many populations around the world, including the United States and Europe. All of these genes encode proteins that direct traffic within cells, ensuring that various cell components get to their proper location within the cell. Such deficits in cellular trafficking are a newly recognized cause of many neurological disorders. Researchers are now studying how this defect in cellular trafficking leads to specific deficits in speech fluency.

Researchers are also working to help speech-language pathologists determine which children are most likely to outgrow their stuttering and which children are at risk for continuing to stutter into adulthood. In addition, researchers are examining ways to identify groups of individuals who exhibit similar stuttering patterns and behaviors that may be associated with a common cause.

Scientists are using brain imaging tools such as PET (positron emission tomography) and functional MRI (magnetic resonance imaging) scans to investigate brain activity in people who stutter. NIDCD-funded researchers are also using brain imaging to examine brain structure and functional changes that occur during childhood that differentiate children who continue to stutter from those who recover from stuttering. Brain imaging may be used in the future as a way to help treat people who stutter. Researchers are studying whether volunteer patients who stutter can learn to recognize, with the help of a computer program, specific speech patterns that are linked to stuttering and to avoid using those patterns when speaking.

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on stuttering:

• Speech-language pathologists
• Physician/practitioner referrals

For more information, contact us at:

NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll-free voice: (800) 241-1044 Toll-free TTY: (800) 241-1055 Email: [email protected]

NIH Pub. No. 97-4232 February 2016

* Note: PDF files require a viewer such as the free Adobe Reader .

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What Are Speech Blocks and Stuttering Blocks?

Home » Parent Press » Parenting Hacks » Speech & Language » What Are Speech Blocks and Stuttering Blocks?

Speech block refers to a temporary disruption or difficulty in producing fluent speech. It can manifest as hesitations, pauses, or an inability to vocalize words or phrases smoothly. This can impact their confidence and communication abilities. In this guide, we will explore effective strategies and techniques to help overcome speech block, enhance fluency, and promote clearer and more confident communication. Understanding the causes and implementing practical solutions can make a significant difference in fostering improved speech and communication skills.

Table of Contents

What Is a Speech Block?

A speech block is also known as stuttering or a stoppage of speech. It is when someone get suddenly “caught” on a particular part of a word that makes it difficult to continue speaking. Sometimes experts also call it a fluency disorder because the person have trouble speaking fluidly and smoothly.

Sometimes it’s hard to tell if a child is naturally stumbling or struggling with speech blocks. In order to help you differentiate between the two, we’ve got some concrete examples of what this can sound like.

Goally | The Safest Tablet for Kids

Examples of Speech Blocks

In the video example above , you can hear tangible examples of kids experiencing a speech block.

For example:

Drew gets blocked on the initial “K” sound in the word “classes.”

Child : Like were my “(c)lasses” are. 

Next, you can see Erica gets block on the “b” sound at the beginning of the word bumpy and block.

Therapist: So, tell what bumpy speeches means.

Child: (B)umpy speech is like when I have a (b)lock.

Here we see Justin block on the “p” sound in the word pushing.

Therapist: What were speech helpers doing there?

Child: They were (p)ushing too hard.

Can This Condition Be Fixed Without Therapy?

See more: What is Augmentative and Alternative Communication?

When we observe blocking, it is less likely that the child will improve without therapy. There are no rules about how often a child has to stutter before speech therapy may become the best solution. However, if the child is concerned or frequently produces the type of speech disfluencies for several weeks or months, enrolling in therapy could become extremely helpful.

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Is your child facing challenges in expressing themselves or communicating effectively? Goally has one of the best language language learning apps for kids to support their journey in building essential communication skills!

The Word Lab and AAC Talker apps provide a simple, engaging platform for your child to learn core words and become a functional communicator right from the start. Customize the experience with a voice that suits them, and watch as their confidence grows in expressing their thoughts and needs!

In conclusion, speech block can sometimes make it challenging to communicate fluently, but with the right strategies and support, you can overcome it! Remember, speech block is normal and can happen to anyone, including kids. By taking deep breaths, slowing down, practicing speaking out loud, using visual aids, and being patient with yourself, you can improve your communication skills and regain your confidence.

FAQs About Speech Block

This post was originally published on 08/04/2021. It was updated on 01/31/2024.

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Stuttering Blocks and How We Can Stop Them

by William D. Parry, CCC-SLP Copyright © 2022 by William D. Parry

What are stuttering blocks and how can we stop them? Although much has been written about various aspects of stuttering, researchers have not adequately studied or explained the underlying components of stuttering blocks. Therefore, to better understand the cause of stuttering blocks and how to deal with them, we must go beyond the published research. We must fill in the gaps with our own “working hypothesis” based on existing scientific knowledge of neurology and physiology, together with our own observations and experience. The result is the Valsalva Hypothesis , upon which the following explanations are based.

What Is a Stuttering Block?

A stuttering block is an involuntary interruption in the flow of speech that prevents a speaker from voicing a word or syllable. The blockage of words begins in the brain rather than the mouth, as evidenced by the fact that persons who stutter often feel that an upcoming word contains a “brick wall,” even before they try to say it. The familiar manifestations of stuttering behavior – including forcing, repetition, or prolongation of certain consonants – are struggle responses to the underlying block. Although many people assume that stutterers have trouble saying initial consonants, persons who stutter are usually able to form the consonants reasonably well – even when forcing, repeating, and prolonging them. Their real problem is unreadiness to voice the vowel sound that follows.

What Causes Stuttering Blocks?

At the core of stuttering blocks is an interference with the brain’s motor program for phonating the principal vowel sound of a word. This is the loudest part of the word, without which the word cannot be spoken. Suppression of the vowel sound may be caused by stress hormones triggered by the brain’s amygdala as part of a fight-flight-freeze response and influenced by psychological factors. When speech does not involve phonation, such as in whispering, blocking on words rarely occurs. Conversely, stuttering blocks do not occur when singing, because the person’s intention is to voice the melody – which is carried by the vowel sounds .

There is no single factor that would explain all the variability and paradoxes of stuttering blocks. Instead, they are influenced by an interaction of three sets of contributing factors – psychological, neurological, and physiological.

Neurological Factors.

There is a growing body of evidence that persons who stutter may have various underlying neurological deficiencies compared to non-stutterers, as indicated by brain scans and other scientific studies.  However, such deficiencies alone would not necessarily cause stuttering blocks. Nor would they explain why stuttering severity can vary greatly depending on the speaking situation, or why many persons who experience stuttering blocks are relatively fluent most of the time. Such neurological weaknesses could simply make stutterers’ brains less efficient in processing speech, thereby making the person’s speech processing more susceptible to interference . Therefore, stuttering blocks may not be caused by a lack of ability to speak, but rather by an interference with the natural speaking ability the person already has.

The Role of the Amygdala.

The interference with stutterers’ speech processing can be attributed to the amygdala – a part of the brain that stores fearful memories. The amygdala’s primary role is to help us respond quickly to potential danger by triggering the release of stress hormones, thereby initiating what is known as the fight-flight-freeze response. This is a defensive reaction that we share with the animals, and which has protected our human ancestors for hundreds of thousands of years. When we are confronted by an enemy, the stress hormones prepare us to fight harder to defend ourselves, to run faster to escape danger, or, when neither of these options are feasible, to freeze in place to make ourselves less noticeable.

The amygdala’s function can be illustrated by this hypothetical example: Imagine a prehistoric man on the plains of Africa who suddenly sees a lion. If the lion were to attack, he couldn’t very well fight the lion or outrun it. Therefore, his amygdala triggers a freeze response so, by not moving, the man would be less likely to be seen. Furthermore, the stress hormones would suppress his vocalization to prevent the lion from hearing him. Meanwhile, the man instinctively holds his breath to build up air pressure in his lungs, thereby stiffening the trunk of his body in case the lion attacks.

Persons who stutter may experience similar reactions in speaking situations. Unfortunately, when the amygdala intervenes by triggering a fight-flight-freeze response, the usual result is a stuttering block .

Just as in our man vs. lion analogy, one of the effects of the freeze response is to suppress vocalization. In this case, the stress hormones interfere with the brain’s motor program for phonating the vowel sound – which is the loudest part of a word or syllable and therefore the part most likely to be heard. In multisyllable words, this is the vowel sound of the stressed syllable . We will call the loudest vowel sound in a word the key vowel sound . We are referring to the actual sound that you hear and not the written letter. Without a motor program for phonating the vowel sound, the word cannot be spoken. As a result, we may feel that saying the word is blocked as if by a “brick wall.”

In place of vowel phonation, the stress hormones may substitute a strong urge to exert physical effort on the consonant or glottal stop that precedes the vowel sound. This “effort impulse” often feels like a matter of life or death. This is understandable because, in physically dangerous situations, obeying the amygdala may save one’s life .

Physiological Factors.

As part of the fight-flight-freeze response, the man in the lion example instinctively holds his breath to defensively stiffen his body in case he is attacked. A similar build-up of air pressure may be associated with stuttering blocks. In this case, persons who stutter feel that they are trying hard to force out the word, as if it were a physical object. However, what they are actually doing is a Valsalva maneuver , which makes the block even stronger.

The Valsalva maneuver is a natural bodily function that helps us exert strenuous effort more efficiently. It may also help us force things out of the body (such as bowel movements). It is performed by a neurologically coordinated team of muscles throughout the body, called the Valsalva mechanism . After we inhale, our chest and abdominal muscles squeeze to increase air pressure in the lungs. The air pressure stiffens the trunk of the body so that our arms and legs have a stable base on which to operate more efficiently. Meanwhile, our upper airway instinctively closes to keep the pressurized air in the lungs. In the usual Valsalva maneuver, this closure is performed by “effort closure” of the larynx. However, when the Valsalva maneuver is activated in speaking, the lips or tongue may be recruited by the Valsalva mechanism to perform the same function. Because the muscles involved in a Valsalva maneuver are neurologically coordinated, the greater the air pressure becomes, the tighter the larynx or mouth automatically closes.

How Forcing Perpetuates Blocks.

The speaker’s inability to voice the vowel sound may trigger an overwhelming urge to exert physical effort in an attempt to “force out” the word or syllable. The effort usually focuses on the consonant that precedes the blocked vowel sound while squeezing the chest and abdominal muscles to build up air pressure in the lungs. In words starting with vowel sounds, the effort may focus on the preceding glottal stop, resulting in tight closure of the larynx.

The more the speaker builds up air pressure to force out the word, the more strongly the lips, tongue, or larynx automatically close to resist the air pressure. The forcing may be continuous, or it may result in forceful repetition of the preceding consonant or glottal stop followed by a schwa instead of the actual vowel sound. In addition, the speaker’s delay invoicing the vowel sound may result in prolongation of certain consonants.

Persons who stutter may subjectively feel that they are trying hard to force out a word, as if it were a physical object. However, their exertion of effort actually makes the blockage stronger by restricting the outward flow of air. Attempting to force will continue to prevent voicing of the word unless or until the “effort impulse” is discharged. Speakers then may be left with the false impression that using effort ultimately helped them get the word out. This erroneous belief may reinforce and perpetuate this behavior in the future.

Stuttering Behaviors.

Many outward stuttering behaviors are actually struggles to avoid, hide, postpone, or break through stuttering blocks. In addition to forcing, these may include repetitions, prolongations, insertion of extraneous words or sounds, and even bodily movements. As a result, listeners may erroneously define “stuttering” in terms of these superficial behaviors, whereas the underlying experience of persons who stutter is being blocked from saying words. Many current therapies encourage clients to “stutter” openly and even voluntarily – in other words, to practice what are actually struggle behaviors.

Persons who stutter often sense in advance that an upcoming word is blocked, even before they try to say it. They may then try to hide the block by struggling through it silently or, when possible, by substituting words to which the block is not attached. This strategy is often referred to as covert stuttering.

Psychological Factors.

One of the maddening characteristics of stuttering blocks is their variability. For example, a person might begin telling a joke with perfect fluency and then suddenly block on the punch line. A person may have no trouble saying a word in one situation but then block when saying the same word really matters. This phenomenon may be understood by considering the way in which various psychological factors affect the amygdala’s sensitivity.

The term “psychological factors” does not suggest that stuttering is caused by mental illness or emotional disturbance. Instead, these factors may include a person’s negative beliefs, memories, fears, anticipation of difficulty, and intentions concerning speech. For example, persons who stutter commonly enter a speaking situation feeling that it is very important to make a “good impression” by trying hard not to stutter. Such factors may put the amygdala on high alert for words and situations that it associates with stuttering. As a result, the amygdala may treat an upcoming word as if it were a physical threat and trigger the release of stress hormones, resulting in a stuttering block.

How Can We Stop Stuttering Blocks?

There have been many different approaches to stuttering therapy through the centuries, based on the then-current theories of causation. Early therapies have involved surgery to the tongue, mechanical devices in the mouth, metronomes, speaking exercises, and various forms of psychotherapy. More recent therapies have tried to change external stuttering behaviors through “fluency shaping,” “stuttering modification,” or reliance on electronic devices. Because these methods have failed to produce satisfactory long-term results, many therapists have abandoned the quest for “fluency” in favor of so-called “acceptance therapy.” Persons who stutter are told to accept their stuttering, to stutter openly and proudly, and even to stutter voluntarily.

These therapies have had limited success because they fail to address all three underlying components of stuttering blocks . Based on the understanding provided by the Valsalva Hypothesis, Valsalva Stuttering Therapy is designed to control the factors that interfere with speech on all three levels – psychological, neurological, and physiological.

Change your negative beliefs, attitudes, and intentions about speaking and stuttering. Your goal should not be “fluency” per se but rather easy and effortless speech. Instead of trying to make a “good impression” by being fluent, focus on your role and purpose in speaking . Instead of trying to please your listener, focus on your own enjoyment in expressing yourself through the music of your voice. Any thoughts about being “fluent” are likely to activate your amygdala and result in stuttering blocks.

Understand the mechanics of speech. Speech begins by inhaling air into the lungs. When the muscles of inhalation relax, air flows up the windpipe and into the larynx (or “voicebox”). There the vocal folds come together and are caused to vibrate by the outflowing air. This is called phonation . No muscular effort is involved; it is all done by the relaxed outflowing air. Therefore, trying to use effort to force out a word will only choke off the airflow. Meanwhile, a little muscle called the cricothyroid adjusts the pitch of the vocal folds, giving melody and inflection to your voice.

The result is a vibrating column of air that sounds like a melodic buzz. The buzz is turned into specific vowel sounds by the shape of your oral cavity, as determined by the position of your lips and tongue. By continuously moving, the lips and tongue add consonants. In this way, the vibrating column of air is turned into a sequence of symbolic sounds. These sounds travel from your mouth into the air, where they are picked up by the listener’s ear. If the listener knows your language, his or her brain will automatically decode the sounds into words and meaning.

Strengthen your motor program for voicing the Key Vowel Sounds of words and phrases. This will reduce the likelihood that stress hormones will interfere with your vowel phonation. Practice “Key Vowel Preparation” with exercises including “Preliminary Vowel Voicing” and “Preliminary Vowel Shaping.”

Learn to discharge the “effort impulse” without struggling. This can be done by gently tensing your puborectalis muscle at the beginning of inhalation. The puborectalis muscle is a part of the Valsalva mechanism which forms a sling around the bottom of the rectum in the pelvic region of your body. By tensing the puborectalis, you can divert the effort impulse away from your mouth or larynx and discharge it inconspicuously.

Relax your Valsalva mechanism while exhaling and speaking. This can be done by slowly relaxing your puborectalis and abdominal muscles while exhaling. Because both of these are neurologically coordinated parts of the Valsalva mechanism, relaxing them will prevent the occurrence of a Valsalva maneuver.

Practice slow, Valsalva-relaxed breathing. Almost all the muscular effort in respiration occurs while we inhale – which is when we are not speaking. Exhaling only requires relaxation of all the muscles that were used for inhaling. Speech is produced on the outflowing breath and is therefore powered by relaxation .

Treat speech as melody and movement instead of “things” to be forced out of the body. When you treat a word as if it were a physical object, it is no longer a word. It is no longer communication. It is simply a useless display of physical effort. Valsalva Stuttering Therapy includes exercises that promote the processing of speech as melody and movement. These include:

• The “Humdronian Speech Exercise,” in which phonation and articulation are practiced independently of one another but simultaneously. In the beginning, this exercise sounds unintelligible, but the two elements are gradually reintegrated into a relaxed, effortless way of speaking called “Resonant Valsalva-Relaxed Speech.”
• “Slow Motion Extremely Emotive Speech.” This begins with extremely stretched-out speech (to emphasize movement) and greatly exaggerated inflection (to emphasize melody) and then transitions into natural-sounding speech.
• Participants are encouraged to express, assert, and affirm themselves through the melody and prosody of their voice, without holding back.

A full explanation of the Valsalva Hypothesis and Valsalva Stuttering Therapy can be found in the Ultimate Expanded Fourth Edition of my book, Understanding and Controlling Stuttering (2021).

William D. Parry, CCC-SLP

A licensed speech-language pathologist, offering Valsalva Stuttering Therapy by video conferencing over the Internet (depending on location and subject to applicable law).

Valsalva Stuttering Therapy is a new approach to easier speech by controlling the physiological mechanism that may contribute to stuttering blocks, together with psychological and neurological factors. If you are interested in therapy, send an e-mail to [email protected] to inquire about a free consultation.

The Ultimate Expanded Fourth Edition of Understanding and Controlling Stuttering (2021) is now available from Amazon. You can check it out here .

You may also purchase the book from the National Stuttering Association and help support the NSA.

E-mail: [email protected]

or download a PDF version here .

[email protected]

Copyright © 2022 William D. Parry – All Rights Reserved

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• Diseases & Conditions

Stuttering is a speech condition that disrupts the normal flow of speech. Fluency means having an easy and smooth flow and rhythm when speaking. With stuttering, the interruptions in flow happen often and cause problems for the speaker. Other names for stuttering are stammering and childhood-onset fluency disorder.

People who stutter know what they want to say, but they have a hard time saying it. For example, they may repeat or stretch out a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they've reached a word or sound that's hard to get out.

Stuttering is common among young children as a usual part of learning to speak. Some young children may stutter when their speech and language abilities aren't developed enough to keep up with what they want to say. Most children outgrow this type of stuttering, called developmental stuttering.

But sometimes stuttering is a long-term condition that remains into adulthood. This type of stuttering can affect self-esteem and communicating with other people.

Children and adults who stutter may be helped by treatments such as speech therapy, electronic devices to improve speech fluency or a form of mental health therapy called cognitive behavioral therapy.

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Stuttering symptoms may include:

• Having a hard time starting a word, phrase or sentence.
• Stretching out a word or sounds within a word.
• Repeating a sound, syllable or word.
• Brief silence for certain syllables or words, or pausing before or within a word.
• Adding extra words such as "um" if expecting to have problems moving to the next word.
• A lot of tension, tightness or movement of the face or upper body when saying a word.
• Anxiety about talking.
• Not being able to communicate well with others.

These actions may happen when stuttering:

• Rapid eye blinks.
• Trembling of the lips or jaw.
• Unusual face movements, sometimes called facial tics.
• Head nodding.
• Tightening of fists.

Stuttering may be worse when the person is excited, tired or under stress, or when feeling self-conscious, hurried or pressured. Situations such as speaking in front of a group or talking on the phone can be especially hard for people who stutter.

But most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak along with someone else.

When to see a doctor or speech-language pathologist

It's common for children between the ages of 2 and 5 years to go through periods when they may stutter. For most children, this is part of learning to speak, and it gets better on its own. But stuttering that continues may need treatment to improve speech fluency.

Call your healthcare professional for a referral to a specialist in speech and language called a speech-language pathologist. Or you can contact the speech-language pathologist directly for an appointment. Ask for help if stuttering:

• Lasts more than six months.
• Happens along with other speech or language problems.
• Happens more often or continues as the child grows older.
• Includes muscle tightening or physically struggling when trying to speak.
• Affects the ability to effectively communicate at school or work or in social situations.
• Causes anxiety or emotional problems, such as fear of or not taking part in situations that require speaking.
• Begins as an adult.

Researchers continue to study the underlying causes of developmental stuttering. A combination of factors may be involved.

Developmental stuttering

Stuttering that happens in children while they're learning to speak is called developmental stuttering. Possible causes of developmental stuttering include:

• Problems with speech motor control. Some evidence shows that problems in speech motor control, such as timing, sensory and motor coordination, may be involved.
• Genetics. Stuttering tends to run in families. It appears that stuttering can happen from changes in genes passed down from parents to children.

Stuttering that happens from other causes

Speech fluency can be disrupted from causes other than developmental stuttering.

• Neurogenic stuttering. A stroke, traumatic brain injury or other brain disorders can cause speech that is slow or has pauses or repeated sounds.
• Emotional distress. Speech fluency can be disrupted during times of emotional distress. Speakers who usually do not stutter may experience problems with fluency when they are nervous or feel pressured. These situations also may cause speakers who stutter to have greater problems with fluency.
• Psychogenic stuttering. Speech difficulties that appear after an emotional trauma are uncommon and not the same as developmental stuttering.

Risk factors

Males are much more likely to stutter than females are. Things that raise the risk of stuttering include:

• Having a childhood developmental condition. Children who have developmental conditions, such as attention-deficit/hyperactivity disorder, autism or developmental delays, may be more likely to stutter. This is true for children with other speech problems too.
• Having relatives who stutter. Stuttering tends to run in families.
• Stress. Stress in the family and other types of stress or pressure can worsen existing stuttering.

Complications

Stuttering can lead to:

• Problems communicating with others.
• Not speaking or staying away from situations that require speaking.
• Not taking part in social, school or work activities and opportunities for success.
• Being bullied or teased.
• Low self-esteem.
• Stuttering. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/stuttering/. Accessed Feb. 2, 2024.
• Fluency disorders. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/fluency-disorders/. Accessed Feb. 2, 2024.
• Childhood-onset fluency disorder (stuttering). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Feb. 2, 2024.
• Stuttering. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/stuttering. Accessed Feb. 2, 2024.
• Sander RW, et al. Stuttering: Understanding and treating a common disability. American Family Physician. 2019;100:556.
• Laiho A, et al. Stuttering interventions for children, adolescents and adults: A systematic review as part of the clinical guidelines. Journal of Communication Disorders. 2022; doi:10.1016/j.jcomdis.2022.106242.
• 6 tips for speaking with someone who stutters. The Stuttering Foundation. https://www.stutteringhelp.org/6-tips-speaking-someone-who-stutters-0. Accessed Feb. 2, 2024.
• 7 tips for talking with your child. The Stuttering Foundation. https://www.stutteringhelp.org/7-tips-talking-your-child-0. Accessed Feb. 2, 2024.
• Clark HM (expert opinion). Mayo Clinic. Feb. 11, 2024.

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Understanding the Speech Block

John C. Harrison

At the heart of chronic stuttering -- specifically, the kind of dysfluency that ties you up so you momentarily cannot utter a word -- is something called a “speech block.” We have traditionally seen speech blocks as having a life of their own, mysterious and unexplainable. Speech blocks seem to “strike” us at odd moments, usually without our knowing why.

You’re standing in line at Macdonalds, about to say “hamburger,” when suddently, a speech block zooms out of the ether and (WHUMP!) hits you in the vocal cords and renders you speechless.

The blocks seem as if they are not connected to us, giving rise to such phrases as “I was hit by a speech block.” ‍ In response, we search for explanations. You hear statements such as, “Speech blocks are genetic.” -- a prime example of using one unknown to explain another. But when you understand what a block is about, it begins to make sense. There is no need to resort to such esoterica as genetics. Sometimes, simple explanations are the most compelling.

Opposing forces

I’d like to invite you to undertake a little exercise. Hook your hands together with your elbows pointed outward in opposite directions. Now try and pull your hands apart while making sure that your hands stay locked. ‍ This is an example of a block. You have two forces of equal strength pulling in opposite directions -- the force you’re exerting to pull your hands apart opposes the force you’re exerting to keep your hands locked together. As long as the two forces are equally balanced, you remain blocked.

If you want to get past the block, what are your options? Well, you can.

• decide to stop trying to pull your hands apart;
• decide to stop clamping your hands together;
• decide that this silly demonstration is not worth wasting another moment of
• your time and go do something else.

Any of these alternatives will instantly resolve the block. ‍ Let’s look at what these three options have in common. All of them involve your intentions -- in this case, your conflicting intentions. The block is caused by attempting to do two things simultaneously that pull you in diametrically opposite directions -- pull your hands apart and hold them together. ‍ How does this relate to speech? ‍ A speech block is created when you intend to do two things that are directly opposed to one another. As long as you keep trying to do them both, you will experience yourself as blocked. ‍ Shooting the horse ‍ To better understand the nature of a block, let us examine it within a totally different context. Let us say that one beautiful summer afternoon you’re riding your favorite horse in the back country. Your mount is a splendid Arabian that you’ve raised from a colt. Riding this gallant steed has become your most beloved pastime, and over 15 years the two of you have become fast friends. When you’re not riding, you’re in the stable, grooming the horse and caring for it. ‍ Today, as you canter through the tall grass, you’re lost in a magical, timeless world. Then suddenly, disaster! Your world collapses! The horse steps into a hidden hole, crashes to the ground and hurls you over its head. You roll. You pick yourself up, knees and elbows raw. But you’re oblivious to the pain, because the unthinkable has happened. Your best friend, the Arabian that you’ve loved for 15 years, is lying on the ground with its leg broken. It is in pain. It is suffering. It cannot be saved. You know that the only humane thing is to put it out of its misery. Right here. Right now. ‍ Because this is snake country, you have gotten in the habit of wearing a side arm. You have one with you now, a .38 colt. You draw the pistol, and walk slowly up to the horse. You can see its pain. This has to be done. You stretch your arm in front of you, hand gripping the .38. You aim the pistol at the horse’s forehead, and slowly squeeze the trigger.

But your finger freezes. The horse is looking straight into your eyes. You look back. This is your best friend. How can you possibly pull the trigger? You think of all the years you’ve spent together, all the happy hours in the back country. How can you just stand there and kill your best friend?

You try again, but again, you cannot get yourself to pull the trigger. Your index finger is rigid and won’t move. You’re aware of what’s holding you back. You are not willing to experience the grief you know will arise the second after you pull the trigger, the pistol lurches in your hand, and the horse’s eyes glaze over. You just cannot pull the trigger!

At this moment you are experiencing a block. Two forces of equal strength are pulling you in opposite directions. Pull the trigger and lose your best friend. Don’t pull the trigger, and cause your best friend to suffer needlessly. You find yourself frozen.

How can you get past the block? ‍ You can choose not pull the trigger and allow the horse to suffer, or perhaps have someone come and do the job for you. Another option is to pull the trigger and accept the pain you’re sure to feel. Whichever route you take, to get past the block, something has to give.

Losing self-awareness

Were you in this position, there would be no mystery about what was going on. You’d know why you couldn’t pull the trigger. You loved the horse, and the pain of shooting it was something you could not bear. ‍ Now let’s modify this story. Let us say that you were out of touch with the fact that you cared for the horse, because you traditionally hid your feelings from yourself. You were just not the type to admit that you cared. ‍ Okay, same scenario. The horse falls and breaks its leg. You draw your pistol and point it at the horse. You start to squeeze the trigger, and again, your finger freezes. But now, the frozen finger is a mystery, because you are out of touch with your feelings. You do not allow yourself to know that you care for the horse, although you care terribly. You have pushed this caring out of your awareness. Nevertheless, the fear of having to confront those feelings is holding you captive. Some thing is stopping you from pulling that trigger. It seems beyond your control because you’re out of touch with your fears about shooting the horse. It’s a matter of will. What is stopping you is your own reluctance to act. ‍ The speech block ‍ This is analogous to what happens with a speech block. You have a divided intention -- speak/don’t speak. But because you have learned to prevent yourself from experiencing painful emotions, you close up and hold back. You push the fear (embarrassment, discomfort, etc.) out of your conscious awareness. ‍ Thus, the block seems outside of your control, because you’re only aware of half the conflict. You know you want to speak, but you are not aware of the simultaneous reluctance to speak because of the underlying fear and pain. You hold yourself back without being aware you’re doing so. That is why speech blocks seem to happen to you.

The antidote is to begin paying attention to what you’re feeling...or at least start noticing and questioning what’s going on when you block. The most compelling question I used to ask myself when I was afraid of blocking was, “Suppose I do speak right now in this situation. What might I experience? Usually, the first thing I thought of was, “I might stutter.” Perhaps. “But what else , might I experience?” Here’s where so many people go blank. They simply don’t know what else might be lurking down there.

Is it a fear of asserting yourself...of looking aggressive or coming on too strong...of being the real you? Usually, the problem lies in this area. There is something about yourself that you feel is unacceptable, so you hold back until it feels safe to talk. “Safe” means that you can now talk because the intensity of the feelings has dropped and you can now remain within your comfort zone.

A second scenario

Just to confuse things, there is another, completely different scenario that can also lead to a speech block. It, too, involves a divided intention, but it is driven by different forces. It has to do with one of the body’s natural responses -- the valsalva reflex.

William Parry in his excellent book, Understanding and Controlling Stuttering (available from the National Stuttering Association or from Amazon) postulates that a speech block can result from the misapplication of a valsalva maneuver. ‍ What is a valsalva maneuver? A valsalva maneuver is what your body does whenever you try to lift a heavy suitcase, open a stuck window, give birth, take a poop, or do anything that involves a concentrated physical effort. Your chest and shoulders become rigid. The muscles in your abdomen tighten. And your throat -- in particular, your larynx -- becomes completely locked. The locking of the larynx is the body’s way of closing the upper end of the windpipe in order to keep air in the lungs. It is called an effort closure. ‍ Why does your body do this? ‍ Blocking the upper airway at the same time as you tighten your chest and abdominal muscles puts pressure on your lungs and creates internal pressure. This, in turn, creates strength and rigidity. It allows you to push harder. It gives you strength. It’s why four inflated tires can hold the weight of a heavy automobile. ‍ Initiating a valsalva maneuver makes sense if you’re lifting your new 32-inch TV onto its stand. You need the added strength. But it is a non-productive strategy if you’re asking someone where the post office is, and you expect to have difficult saying “post,” so you start preparing yourself to push the word out. The very muscles that are tight and rigid and clamped together to give you strength are muscles that should be soft and pliant and relaxed in order to create the resonant tones associated with speech. No wonder you can’t speak. Then why do we tighten everything? ‍ Professor Woody Starkweather in an e-mail on the Stutt-L listserv on March 29, 1995, offered an excellent description of how some children end up misapplying the valsalva maneuver as they first struggle to learn to speak. Here’s what Woody said: Personally, I think that most "garden variety" people who stutter (PWS) when they are very young find themselves repeating whole words. At this point, they aren't usually struggling (there are exceptions), but they are still being impeded in their ability to say what they want to by these sometimes long, whole word repetitions. Their first reaction to this is usually frustration. They want to talk and they can't go forward as quickly as they want to. Typically, this happens between two and four years of age. ‍ At this age, the most common strategy for a child to use who is hindered by something in a task he or she wants to perform is to push hard. If something is in your way, you push it out of the way. The idea that some things work better if you don't try harder is an alien concept to the preschool child, by and large. So they start to push the words out, and it works a little and some of the time because eventually the word does come out, in spite of the pushing, and it feels as though the child has pushed it out.

So he or she learns to push (with subglottal air pressure) when they feel stuck, and a nonproductive, maladaptive strategy for coping with stuttering has been born. The effect on the stuttering behavior is that the repetitions get shorter, i.e., part-word instead of whole word, blockages may increase because at a certain threshold of pushing the vocal folds clamp tighter together (the valsalva reflex), and the tempo of the repetitions increases because pushing harder usually also involves trying to talk faster through the stuttering behavior, that is, trying to stutter faster to get it over with.

There are a variety of strategies -- some kids focus on speeding up during stuttering, others just push hard, others learn very early to avoid by turning away, stopping talking, saying "never mind," etc. And I believe quite strongly that the only way to recover from this problem is first to become very aware of what you are doing during the stuttering. For an adult, this will usually involve learning about even more strategies that have been layered ontop of those early ones, but eventually the PWS comes to know and understand those very early pushing, speeding up, and avoidance behaviors.

Building awareness

So there you have it. Not just one but two credible explanations for what causes a speech block, and not once did we have to mention genetics or faulty brain functions. ‍ Losing awareness of your intentions is not specific to stuttering. People develop blocks around all sorts of things. I once knew a guy who was not able to urinate in a men’s room whenever someone else was in the room with him. Same problem. For whatever reason (usually such fears are deep-seated) he held himself back by tightening his sphincter, but he didn’t know he was doing this. He just knew he couldn’t urinate. When the person left the room, then his sphincter relaxed, and he could complete his business.

As with most problems like this, the recovery process begins by developing your awareness of what’s going on and bringing these unconscious behaviors back into consciousness. This calls for observing each blocking situation carefully, perhaps keeping a diary so you can keep track of what threads are showing up consistently from one blocking experience to another.

Do you block around authority figures. Do you block when you’re afraid you’ll be wrong. Or when you’re afraid of looking foolish? Or aggressive? Or embarrassed? Do anxious feelings come up when you have to assert yourself? ‍ Do you notice that each time you block, you also seem to be holding your breath? What else do you notice you’re doing? What else can you begin to bring back to conscious awareness.

Either of the scenarios I described above can cause a speech block. And sometimes, both are operating at the same time. So you really need to pay attention. Nobody said that recovering from blocking is easy. It’s not. But making the effort -- and keeping at it -- will eventually pay off by helping you take conscious control of an unconscious reflex.

John C. Harrison can be reached at [email protected]

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Stuttering Blocks – What Are They?

Fluency Shaping Techniques Stuttering blocks occur in the connected speech of people who stutter. Stuttering “blocks”  are usually categorized as: 

Repetitions –

• Repeating the same sound or syllable several times. Repetitions usually occur at the beginning of words although sometimes at the end or even the middle syllable.
• The schwa sound “uh” is commonly used to sustain the repetition. For example tuh-tuh-time rather than ti-ti-time.

Prolongations –

Holding the sound, either of the consonant  “wwwwwwwhy” or the vowel “oooooonly”.  Basically the speaker is unable to get to the next sound and is forced to prolong the sound before.

Although all three forms, repetitions, prolongations, and blocks are commonly referred to as stuttering blocks (and counted in measurements of syllables and words stuttered), the term block refers to not being able to get any sound out at all. The person is stuck in silence, but many times this block is accompanied by struggle and tension. the speaker is trying to force the sound out but tension at the articulators or larynx prevents the air from flowing to produce the sound.

What To Do About Stuttering Blocks

Two approaches are used in stuttering treatment to prevent blocks:

• Stuttering Modification – addresses the stuttering block directly reducing the tension.
• Fluency Shaping – restructures the speech to replace stuttering with a new way of speaking.

Some treatments use both to some extent and may combine the approach with work on attitudes and feelings about stuttering using cognitive therapies.

Replacing Stuttering Blocks With A New Way of Speaking

The stutter-free speech program.

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The Stuttering Block

The mysterious Stuttering block explained

“I have trouble speaking sometimes. The words don’t come out fluent, or they don’t come out at all. This happens especially when I’m excited, nervous, or during stressful situations.”

”No no, not stuttering. Just….stuck.”

"Stuttering is when people repeat or prolong sounds, right?"

So what is stuttering?

Stuttering, in its simplest form, is any disruption to fluency. This could be repetitions, prolongations, or blocks and may occur anywhere in the word or phrase. As a way to get through these stuttering moments, one may use fillers, revise their thought, or simply change the word.

How come I've never heard of the stuttering block?

I had my own personal experience with this a few years ago when I was determined to find out why I talked like this. I always had silent blocks (since the time I started speaking) that remained an enigma for years. My mom used to tell me “Your thoughts just move faster than your mouth.”

I wasn’t buying it.

I googled, “not being able to get your words out” because that's all I knew. What came up was an article on the stuttering block. I was intrigued to learn that this existed! I thought stuttering was simply when people repeat sounds.

What happens in a stuttering block?

Whether you’re repeating a single sound and unable to get to the next sound, or stuck and unable to get to the first sound, the theme here is STUCK. Stuttering is also characterized by a loss of control (an involuntary disruption to the speech mechanism).

You may stutter if you exhibit most or all of the following:

I feel a lot of tension during the disfluency. In my lungs In my throat and/or In my jaw

How do I know if I am blocking?

I think if I just relaxed I could speak fine.

Well, yes, maybe if your vocal mechanism were completely relaxed everything would be fluent (in fact, there are therapy techniques that focus specifically on this). However, sometimes these “relaxation techniques” just don’t work. There’s something underneath that’s causing the stutter; that even when you’re completely relaxed, you still stutter. Nerves or anxiety does not cause stuttering. Stuttering is a neurophysiological disorder. Oftentimes, it is the stuttering that causes the anxiety.

I don’t always have trouble speaking. Sometimes I can say things perfectly fine.

Yep, that’s the nature of the beast. Sometimes you’re fluent, sometimes you’re not. There are endless variables.

I get along by changing words and revising my thoughts.

Do you feel like you’re not saying what you want to say? Always on the lookout for words you might get stuck on? Carefully craft that work presentation and filter out the hard words?

I have a lot of trouble on my name.

Saying your name or things you “have" to say, especially under time pressure, is often challenging for people who stutter.

Yes, but I can avoid this.

Let me introduce you to COVERT stuttering.

There are many ways that someone may fall into the category of a covert stutterer. Here are two of the most common:

1. No one really knows you stutter. People may hear a little disfluency, but you pass it off as “normal slip-ups.” When an unavoidable block occurs, you may change the word or pretend you forgot the word.

2. People know you stutter or have some sort of speech impediment, but it’s the elephant in the room. Family, friends, and/or coworkers have heard you stutter, but no one talks about it. You may feel intense shame about your speech.

If this sounds like you, schedule a free consultation with speech IRL today.

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

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Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

Centers for Disease Control and Prevention. Language and speech disorders .

Cincinnati Children's Hospital. Stuttering .

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, and language .

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Fluency Disorder

What is a fluency disorder.

Having a fluency disorder means you have trouble speaking in a fluid or flowing way. You may say the whole word or parts of the word more than once. Or you may pause awkwardly between words. This is called stuttering. You may speak fast and jam words together, or say "uh" often. This is called cluttering.

These changes in speech sounds are called disfluencies. Many people have a few disfluencies in their speech. But if you have a fluency disorder, you will have many disfluencies when you talk. Speaking and being understood may be a daily struggle.

What causes a fluency disorder?

Experts don’t know the exact causes of fluency disorders. They may be genetic and run in families. They can happen at the same time as another speech disorder. The symptoms of a fluency disorder can be made worse by emotions such as stress or anxiety.

Who is at risk for a fluency disorder?

Theories have included organic, behavioral, and psychological causes of fluency disorders. If members of your family have a fluency disorder, you may be at higher risk to develop one.

What are the symptoms of a fluency disorder?

A fluency disorder causes problems with the flow, rhythm, and speed of speech. If you stutter, your speech may sound interrupted or blocked. It may sound as if you're trying to say a sound, but it doesn't come out. You may repeat part or all of a word as you to say it. You may drag out syllables. Or you may talk breathlessly, or seem tense while trying to speak.

A different type of fluency disorder is called clutter. If you clutter, you often speak fast and blend some words together or cut off parts of them. You may sound like you're slurring or mumbling. And you may stop and start speech and say "um" or "uh" often when talking.

Some people use accessory or secondary behaviors to prevent or hide disfluencies. These can include:

Covering your mouth or pretending to cough or yawn to cover up stuttering

Not speaking, even when you want to or need to

Not using certain words that seem to cause stuttering

Pretending to forget what you wanted to say

Changing the order of words in sentences

Using "filler" sounds between words to make the rate of speech sound more normal

Children with fluency disorders also may develop beliefs that can hurt them later on. For instance, a child who stutters may decide that speaking is too hard. Feeling fear, anxiety, anger, and shame about speaking are also common.

How is a fluency disorder diagnosed?

Experts feel it's important to assess and address speech disorders early. Children who struggle with speech can find school and community activities challenging or painful. They can't communicate their thoughts. They may also have problems making friends.

A fluency disorder can be diagnosed by a speech-language pathologist (SLP). An SLP will ask about your health history and listen to you speak. You may have an oral-mechanism exam and have your speech-language skills tested.

How is a fluency disorder treated?

Once you're diagnosed, an SLP can use exercises and strategies to help you speak more fluently. A fluency disorder can't be cured. But an SLP uses different methods to help you manage speech day-to-day. These methods can reduce the number of disfluencies in your daily speaking.

An SLP can help you lower your own stress around moments of fluency problems. The SLP will work on changing your negative feelings, thoughts, and beliefs about your speech. They will help you reduce the use of accessory behaviors. You will learn strategies such as speaking in shorter sentences, and controlling your breathing and how fast you speak. An SLP will often talk with family, caregivers, and teachers about the disorder and how to help.

Living with a fluency disorder

If someone you know has a fluency disorder:

Use available resources.  Public schools are required to assess children with communication disorders. If the child meets certain criteria, the school must provide treatment services. If you have a child as young as age 3 with communication problems, contact your local public school’s office. Talk with the principal about assessment options.

Be patient and supportive.  It's frustrating to try to understand someone with a fluency disorder. But it can be much more frustrating for the person who has it. Be as patient as you can while the person works on their speech.

Be kind.  Making fun of a person with a fluency disorder is a form of bullying. It's destructive and may take away the person’s desire to communicate.

Join a support group.  Many fluency disorders, such as stuttering, have support groups. Spending time with other families coping with fluency disorders can be helpful.

When should I call my healthcare provider?

Call your healthcare provider if you have:

Symptoms that get worse

New symptoms

Key points about fluency disorders

A fluency disorder causes problems with the flow, rhythm, and speed of speech.

Stuttering is 1 example. Another type is cluttering. That's when you speak fast and jam words together or say “uh” often.

It's important to assess and address speech disorders early.

A fluency disorder can be diagnosed by a speech-language pathologist (SLP).

A fluency disorder can’t be cured. But an SLP can use exercises and strategies to help you speak more fluently.

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Home / Blog

Speech Impediment Guide: Definition, Causes, and Resources

December 8, 2020 

Tables of Contents

What Is a Speech Impediment?

Types of speech disorders, speech impediment causes, how to fix a speech impediment, making a difference in speech disorders.

Communication is a cornerstone of human relationships. When an individual struggles to verbalize information, thoughts, and feelings, it can cause major barriers in personal, learning, and business interactions.

Speech impediments, or speech disorders, can lead to feelings of insecurity and frustration. They can also cause worry for family members and friends who don’t know how to help their loved ones express themselves.

Fortunately, there are a number of ways that speech disorders can be treated, and in many cases, cured. Health professionals in fields including speech-language pathology and audiology can work with patients to overcome communication disorders, and individuals and families can learn techniques to help.

Commonly referred to as a speech disorder, a speech impediment is a condition that impacts an individual’s ability to speak fluently, correctly, or with clear resonance or tone. Individuals with speech disorders have problems creating understandable sounds or forming words, leading to communication difficulties.

Some 7.7% of U.S. children — or 1 in 12 youths between the ages of 3 and 17 — have speech, voice, language, or swallowing disorders, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). About 70 million people worldwide, including some 3 million Americans, experience stuttering difficulties, according to the Stuttering Foundation.

Common signs of a speech disorder

There are several symptoms and indicators that can point to a speech disorder.

• Unintelligible speech — A speech disorder may be present when others have difficulty understanding a person’s verbalizations.
• Omitted sounds — This symptom can include the omission of part of a word, such as saying “bo” instead of “boat,” and may include omission of consonants or syllables.
• Added sounds — This can involve adding extra sounds in a word, such as “buhlack” instead of “black,” or repeating sounds like “b-b-b-ball.”
• Substituted sounds — When sounds are substituted or distorted, such as saying “wabbit” instead of “rabbit,” it may indicate a speech disorder.
• Use of gestures — When individuals use gestures to communicate instead of words, a speech impediment may be the cause.
• Inappropriate pitch — This symptom is characterized by speaking with a strange pitch or volume.

In children, signs might also include a lack of babbling or making limited sounds. Symptoms may also include the incorrect use of specific sounds in words, according to the American Speech-Language-Hearing Association (ASHA). This may include the sounds p, m, b, w, and h among children aged 1-2, and k, f, g, d, n, and t for children aged 2-3.

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Categories of Speech Impediments

Speech impediments can range from speech sound disorders (articulation and phonological disorders) to voice disorders. Speech sound disorders may be organic — resulting from a motor or sensory cause — or may be functional with no known cause. Voice disorders deal with physical problems that limit speech. The main categories of speech impediments include the following:

Fluency disorders occur when a patient has trouble with speech timing or rhythms. This can lead to hesitations, repetitions, or prolonged sounds. Fluency disorders include stuttering (repetition of sounds) or   (rapid or irregular rate of speech).

Resonance disorders are related to voice quality that is impacted by the shape of the nose, throat, and/or mouth. Examples of resonance disorders include hyponasality and cul-de-sac resonance.

Articulation disorders occur when a patient has difficulty producing speech sounds. These disorders may stem from physical or anatomical limitations such as muscular, neuromuscular, or skeletal support. Examples of articulation speech impairments include sound omissions, substitutions, and distortions.

Phonological disorders result in the misuse of certain speech sounds to form words. Conditions include fronting, stopping, and the omission of final consonants.

Voice disorders are the result of problems in the larynx that harm the quality or use of an individual’s voice. This can impact pitch, resonance, and loudness.

Impact of Speech Disorders

Some speech disorders have little impact on socialization and daily activities, but other conditions can make some tasks difficult for individuals. Following are a few of the impacts of speech impediments.

• Poor communication — Children may be unable to participate in certain learning activities, such as answering questions or reading out loud, due to communication difficulties. Adults may avoid work or social activities such as giving speeches or attending parties.
• Mental health and confidence — Speech disorders may cause children or adults to feel different from peers, leading to a lack of self-confidence and, potentially, self-isolation.

Resources on Speech Disorders

The following resources may help those who are seeking more information about speech impediments.

Health Information : Information and statistics on common voice and speech disorders from the NIDCD

Speech Disorders : Information on childhood speech disorders from Cincinnati Children’s Hospital Medical Center

Speech, Language, and Swallowing : Resources about speech and language development from the ASHA

Children and adults can suffer from a variety of speech impairments that may have mild to severe impacts on their ability to communicate. The following 10 conditions are examples of specific types of speech disorders and voice disorders.

1. Stuttering

This condition is one of the most common speech disorders. Stuttering is the repetition of syllables or words, interruptions in speech, or prolonged use of a sound.

This organic speech disorder is a result of damage to the neural pathways that connect the brain to speech-producing muscles. This results in a person knowing what they want to say, but being unable to speak the words.

This consists of the lost ability to speak, understand, or write languages. It is common in stroke, brain tumor, or traumatic brain injury patients.

4. Dysarthria

This condition is an organic speech sound disorder that involves difficulty expressing certain noises. This may involve slurring, or poor pronunciation, and rhythm differences related to nerve or brain disorders.

The condition of lisping is the replacing of sounds in words, including “th” for “s.” Lisping is a functional speech impediment.

6. Hyponasality

This condition is a resonance disorder related to limited sound coming through the nose, causing a “stopped up” quality to speech.

7. Cul-de-sac resonance

This speech disorder is the result of blockage in the mouth, throat, or nose that results in quiet or muffled speech.

8. Orofacial myofunctional disorders

These conditions involve abnormal patterns of mouth and face movement. Conditions include tongue thrusting (fronting), where individuals push out their tongue while eating or talking.

9. Spasmodic Dysphonia

This condition is a voice disorder in which spasms in the vocal cords produce speech that is hoarse, strained, or jittery.

10. Other voice disorders

These conditions can include having a voice that sounds breathy, hoarse, or scratchy. Some disorders deal with vocal folds closing when they should open (paradoxical vocal fold movement) or the presence of polyps or nodules in the vocal folds.

Speech Disorders vs. Language Disorders

Speech disorders deal with difficulty in creating sounds due to articulation, fluency, phonology, and voice problems. These problems are typically related to physical, motor, sensory, neurological, or mental health issues.

Language disorders, on the other hand, occur when individuals have difficulty communicating the meaning of what they want to express. Common in children, these disorders may result in low vocabulary and difficulty saying complex sentences. Such a disorder may reflect difficulty in comprehending school lessons or adopting new words, or it may be related to a learning disability such as dyslexia. Language disorders can also involve receptive language difficulties, where individuals have trouble understanding the messages that others are trying to convey.  

Resources on Types of Speech Disorders

The following resources may provide additional information on the types of speech impediments.

Common Speech Disorders: A guide to the most common speech impediments from GreatSpeech

Speech impairment in adults: Descriptions of common adult speech issues from MedlinePlus

Stuttering Facts: Information on stuttering indications and causes from the Stuttering Foundation

Speech disorders may be caused by a variety of factors related to physical features, neurological ailments, or mental health conditions. In children, they may be related to developmental issues or unknown causes and may go away naturally over time.

Physical and neurological issues. Speech impediment causes related to physical characteristics may include:

• Brain damage
• Nervous system damage
• Respiratory system damage
• Hearing difficulties
• Cancerous or noncancerous growths
• Muscle and bone problems such as dental issues or cleft palate

Mental health issues. Some speech disorders are related to clinical conditions such as:

• Autism spectrum disorder
• Down syndrome or other genetic syndromes
• Cerebral palsy or other neurological disorders
• Multiple sclerosis

Some speech impairments may also have to do with family history, such as when parents or siblings have experienced language or speech difficulties. Other causes may include premature birth, pregnancy complications, or delivery difficulties. Voice overuse and chronic coughs can also cause speech issues.

The most common way that speech disorders are treated involves seeking professional help. If patients and families feel that symptoms warrant therapy, health professionals can help determine how to fix a speech impediment. Early treatment is best to curb speech disorders, but impairments can also be treated later in life.

Professionals in the speech therapy field include speech-language pathologists (SLPs) . These practitioners assess, diagnose, and treat communication disorders including speech, language, social, cognitive, and swallowing disorders in both adults and children. They may have an SLP assistant to help with diagnostic and therapy activities.

Speech-language pathologists may also share a practice with audiologists and audiology assistants. Audiologists help identify and treat hearing, balance, and other auditory disorders.

How Are Speech Disorders Diagnosed?

Typically, a pediatrician, social worker, teacher, or other concerned party will recognize the symptoms of a speech disorder in children. These individuals, who frequently deal with speech and language conditions and are more familiar with symptoms, will recommend that parents have their child evaluated. Adults who struggle with speech problems may seek direct guidance from a physician or speech evaluation specialist.

When evaluating a patient for a potential speech impediment, a physician will:

• Conduct hearing and vision tests
• Evaluate patient records
• Observe patient symptoms

A speech-language pathologist will conduct an initial screening that might include:

• An evaluation of speech sounds in words and sentences
• An evaluation of oral motor function
• An orofacial examination
• An assessment of language comprehension

The initial screening might result in no action if speech symptoms are determined to be developmentally appropriate. If a disorder is suspected, the initial screening might result in a referral for a comprehensive speech sound assessment, comprehensive language assessment, audiology evaluation, or other medical services.

Initial assessments and more in-depth screenings might occur in a private speech therapy practice, rehabilitation center, school, childcare program, or early intervention center. For older adults, skilled nursing centers and nursing homes may assess patients for speech, hearing, and language disorders.

How Are Speech Impediments Treated?

Once an evaluation determines precisely what type of speech sound disorder is present, patients can begin treatment. Speech-language pathologists use a combination of therapy, exercise, and assistive devices to treat speech disorders.

Speech therapy might focus on motor production (articulation) or linguistic (phonological or language-based) elements of speech, according to ASHA. There are various types of speech therapy available to patients.

Contextual Utilization  — This therapeutic approach teaches methods for producing sounds consistently in different syllable-based contexts, such as phonemic or phonetic contexts. These methods are helpful for patients who produce sounds inconsistently.

Phonological Contrast — This approach focuses on improving speech through emphasis of phonemic contrasts that serve to differentiate words. Examples might include minimal opposition words (pot vs. spot) or maximal oppositions (mall vs. call). These therapy methods can help patients who use phonological error patterns.

Distinctive Feature — In this category of therapy, SLPs focus on elements that are missing in speech, such as articulation or nasality. This helps patients who substitute sounds by teaching them to distinguish target sounds from substituted sounds.

Core Vocabulary — This therapeutic approach involves practicing whole words that are commonly used in a specific patient’s communications. It is effective for patients with inconsistent sound production.

Metaphon — In this type of therapy, patients are taught to identify phonological language structures. The technique focuses on contrasting sound elements, such as loud vs. quiet, and helps patients with unintelligible speech issues.

Oral-Motor — This approach uses non-speech exercises to supplement sound therapies. This helps patients gain oral-motor strength and control to improve articulation.

Other methods professionals may use to help fix speech impediments include relaxation, breathing, muscle strengthening, and voice exercises. They may also recommend assistive devices, which may include:

• Radio transmission systems
• Personal amplifiers
• Picture boards
• Touch screens
• Text displays
• Speech-generating devices
• Hearing aids
• Cochlear implants

Resources for Professionals on How to Fix a Speech Impediment

The following resources provide information for speech therapists and other health professionals.

Assistive Devices: Information on hearing and speech aids from the NIDCD

Information for Audiologists: Publications, news, and practice aids for audiologists from ASHA

Information for Speech-Language Pathologists: Publications, news, and practice aids for SLPs from ASHA

Speech Disorder Tips for Families

For parents who are concerned that their child might have a speech disorder — or who want to prevent the development of a disorder — there are a number of activities that can help. The following are tasks that parents can engage in on a regular basis to develop literacy and speech skills.

• Introducing new vocabulary words
• Reading picture and story books with various sounds and patterns
• Talking to children about objects and events
• Answering children’s questions during routine activities
• Encouraging drawing and scribbling
• Pointing to words while reading books
• Pointing out words and sentences in objects and signs

Parents can take the following steps to make sure that potential speech impediments are identified early on.

• Discussing concerns with physicians
• Asking for hearing, vision, and speech screenings from doctors
• Requesting special education assessments from school officials
• Requesting a referral to a speech-language pathologist, audiologist, or other specialist

When a child is engaged in speech therapy, speech-language pathologists will typically establish collaborative relationships with families, sharing information and encouraging parents to participate in therapy decisions and practices.

SLPs will work with patients and their families to set goals for therapy outcomes. In addition to therapy sessions, they may develop activities and exercises for families to work on at home. It is important that caregivers are encouraging and patient with children during therapy.  

Resources for Parents on How to Fix a Speech Impediment

The following resources provide additional information on treatment options for speech disorders.

Speech, Language, and Swallowing Disorders Groups: Listing of self-help groups from ASHA

ProFind: Search tool for finding certified SLPs and audiologists from ASHA

Baby’s Hearing and Communication Development Checklist: Listing of milestones that children should meet by certain ages from the NIDCD

If identified during childhood, speech disorders can be corrected efficiently, giving children greater communication opportunities. If left untreated, speech impediments can cause a variety of problems in adulthood, and may be more difficult to diagnose and treat.

Parents, teachers, doctors, speech and language professionals, and other concerned parties all have unique responsibilities in recognizing and treating speech disorders. Through professional therapy, family engagement, positive encouragement and a strong support network, individuals with speech impediments can overcome their challenges and develop essential communication skills.

Additional Sources

American Speech-Language-Hearing Association, Speech Sound Disorders

Identify the Signs, Signs of Speech and Language Disorders

Intermountain Healthcare, Phonological Disorders

MedlinePlus, Speech disorders – children

National Institutes of Health, National Institutes on Deafness and Other Communication Disorders, “Quick Statistics About Voice, Speech, Language”

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Health Library Stuttering (Disfluency)

What is stuttering (disfluency).

Stuttering is a disorder that appears as an interruption in the smooth flow or “fluency” of speech. Breaks or disruptions that occur in the flow of speech are labelled “disfluencies.”  All speakers may experience disfluent events, especially under certain conditions, such as nervousness, stress, fatigue or complexity of language. Stuttering, on the other hand, is a different type of disfluency. People who stutter generally tend to have more disfluencies than other speakers overall.  They may develop negative perceptions and thoughts about their speech and themselves as a result of their speaking difficulties.

Stuttering usually begins in early childhood when speech and language skills are expanding and other developmental learning is taking place. This typically occurs between the ages of 2 and 5, and in most cases, stuttering will vary widely across days and months. In most cases, the stuttering resolves on its own. Current data suggests that between 75-80% of children who stutter at some time in their development will recover. For those who continue to stutter with consistency, early, effective treatment may leave them with little or no stuttering.  Currently, over three million Americans or 1% of the population stutter. Males are three to four times more likely to continue to stutter into adulthood than females.

Many famous, successful people have dealt with stuttering in their lives. These include: James Earl Jones, Ed Sheeran, Joe Biden, Emily Blunt, Kenyon Martin, Shaquille O’Neal, John Stossel, Darren Sproles, Bill Walton, Nicholas Brendon, Alan Rabinowitz, Carly Simon, Bob Love, and Marilyn Monroe.

Causes of Stuttering

The exact cause of stuttering is unknown. However, most experts agree that stuttering has a neurological basis, affecting areas of the brain that control how speech and language are processed. Stuttering can run in families due to a genetic cause. The likelihood of recovery within a family that has a history of recovered stuttering is as significant as the likelihood of persistence in those families where recovery has not occurred.

Certain environmental stressors may increase the frequency and extent of stuttering, such as anxiety or stress, urge to speak quickly, changes in routine (such as the birth of a baby), and demands to speak in front of others.

Children who stutter are just as intelligent and well-adjusted as other children of the same age who do not experience stuttering.

Characteristics of Stuttering

Stuttering takes many forms and can be differentiated from the typical kinds of speech breaks that all speakers exhibit. In general most children tend to have more disfluencies as they are developing longer and more complex language structure. Below are some examples of typical disfluencies and those considered more stutter-like in nature.

Typical Disfluencies

• Whole phrase repetitions (“Where is … where is the ball?”)
• Single whole word repetitions (“Where … where is the ball?”)
• Interjections (“Where…um is the ball?”)
• Revisions (“What ... where is the ball?”)
• Hesitations (A long pause when thinking)

Less Typical (Stutter-Like) Disfluencies

• Repetition of sounds (“sh-sh-shoe”)
• Repetitions of syllables (“ba-ba-ball”)
• Prolongation: stretching of sounds (“Wh-------re is the ball?”)
• Blocks: a tense stop in the flow of speech; child may open his or her mouth to speak but no sound comes out and/or there is a noticeable stoppage of airflow at some point in the upper airway (mouth area).

Stuttering can become more difficult to deal with as children grow older. They may become more self-conscious and lack confidence in speaking situations. If left untreated, stuttering has the potential to affect future decisions, including job choices and social relationships.

Treatment for Stuttering

The child should see a speech-language pathologist if:

• The stuttering persists longer than six months and occurs frequently during the day
• The child shows tension, a facial grimace, or struggle behavior during speech
• The child avoids talking situations or expresses concerns about speech
• The child avoids saying certain words or sounds
• The family has a concern about their child’s speech
• The child has shown signs of frustration or embarrassment during or after a stutter event

Stuttering is treated through speech therapy. There are different kinds of therapy depending on the individual child and their family. Therapy also focuses on building confidence and enhancing communication skills. Families and patients are counseled and given support throughout the therapy process.

Helping Your Child

The treatment of stuttering depends on the unique needs of the child. However, the following are some general suggestions for helping a child who stutters:

Reduce Things That Tend To Exacerbate Stuttering

• Temporarily avoid creating situations that are likely to increase the child’s disfluencies. These situations may include talking on demand to an adult (e.g., “Tell grandma about your day at school”) or talking in front of the class.
• Refrain from telling your child to slow down, relax, take a deep breath, or think before trying to say something. Such suggestions may only bring more of a negative awareness about talking.

Listen Attentively

• Actively listen to your child when they are talking. Direct your attention to what your child is saying.
• Maintain eye contact when the child is talking. Don’t look away or show a negative reaction when the child is stuttering.
• Reinforce the child’s attempts at talking by responding positively.
• Make sure family members take turns when talking and don’t talk all at once.

Model Slower Talking with More Pauses

• Use a relaxed rate of speech when talking to the child. An unhurried, Mr. Rogers-like approach to talking is suggested.
• Talk about your own activities through the day. This will encourage the child to talk about their activities in a relaxed environment.

If the Child Is in Therapy

• Work closely with the speech-language pathologist and follow specific instructions given to do at home.

Website Resources for Stuttering

• American Speech-Language-Hearing Association
• Stuttering Foundation of America
• National Stuttering Association

Last Updated 12/2023

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How to Get Rid of a Speech Disorder

Last Updated: December 4, 2023 Fact Checked

This article was co-authored by Devin Fisher, CCC-SLP . Devin Fisher is a Speech-Language Pathologist based in Las Vegas, Nevada. Devin specializes in speech and language therapy for individuals with aphasia, swallowing, voice, articulation, phonological social-pragmatic, motor speech, and fluency disorders. Furthermore, Devin treats cognitive-communication impairment, language delay, and Parkinson's Disease. He holds a BS and MS in Speech-Language Pathology from Fontbonne University. Devin also runs a related website and blog that offers speech-language therapy resources and information for clinicians and clients. There are 13 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 330,417 times.

Many people feel insecure about their speech impediments, whether they're dealing with a lisp or an inability to articulate words. Although it may not seem like it—particularly if you have been dealing with this problem for years—you may be able to get rid of or improve your speech impediment with a few speech-training practices and some major confidence-boosters. And don't forget to seek out the professional opinion of a speech and language therapist/pathologist for more information.

Helping Yourself with a Speech Disorder

• One modern approach is to use technology. There are apps that can run on smartphones and tablets that listen to what you say and then give you feedback. For example, on Android there is the free app "Talking English." You can also find similar apps in the Apple App Store.

Stephanie Jeret

Cues and picture boards can help those with aphasia find words and express thoughts. For aphasia or trouble finding words, cues like the first sound can help jog your memory. Picture boards are great too, especially if speaking is very difficult. These tools allow people to communicate their needs and thoughts through other means.

Using Your Body to Improve Speech

• Shoulders relaxed
• Back straight
• Feet steady

• Sit comfortably and with an erect posture. Breathe in deeply through your nose. You should use your hand to feel your stomach expanding like a balloon being inflated. Hold the breath and then release it slowly, feeling your stomach deflating beneath your hand. Repeat this exercise before you have to speak publicly to relieve stress.

Getting Professional Help

• Speech therapy is helpful for correcting your impediment. The therapist will point out the part of speech where you're having problems, and will work with you to correct it. Private speech therapy sessions do not come cheap, although most insurance policies will fund services needed to treat speech disorders.
• There's no substitute for learning and practice when it comes to the proper and effective use of language. Take every opportunity to speak, to practice and brush up on the correct pronunciation and enunciation provided to you by a professional.

• Every time the dentist adjusts your braces (or even dentures), you need to train yourself to talk and to eat properly. It may be quite painful at first, but remember not to go too far, lest you end up with a mouth injury.
• Most braces are used for orthodontic purposes, although some braces can be used as decorations. Braces are rather expensive, and you may need to take out a dental plan or cash in on dental insurance to pay for them.
• Kids and teenagers don't like to wear braces because they're often teased as “metal mouths” or “railroad faces.” The fact is that braces are still the best way to correct a lisp caused by misaligned teeth.

Assessing Your Speech Disorder

• Cleft lips and palates were a major cause of speech impediments until surgery became affordable. Now, children born with clefts can have reconstructive surgery and a multidisciplinary team of providers that help with feeding and speech and language development. [14] X Research source
• Malocclusion is when the teeth do not have the proper normal bite. Malocclusions are usually corrected through braces, although orthodontic surgery is necessary in some cases. Individuals with this condition may talk with a lisp, make a whistle sound when certain words are spoken, or mumble.
• Neurological disorders caused by accidents or brain and nerve tumors can cause a speech disorder called dysprosody. Dysprosody involves difficulty in expressing the tonal and emotional qualities of speech such as inflection and emphasis.

Expert Q&A

• Welcome good speech. Look forward to it, and accept and celebrate even little improvements. Thanks Helpful 0 Not Helpful 0
• Try to slow down and pronounce each word properly, as this can also help when trying to overcome a speech problem. Thanks Helpful 0 Not Helpful 0

• See a Speech Pathologist who maintains their Certification of Clinical Competence from the American Speech and Hearing Association. These professionals are able to evaluate, diagnose and treat speech impairments. Nothing replaces sound medical advice from a specialist. Thanks Helpful 11 Not Helpful 14

You Might Also Like

• ↑ https://www.uts.edu.au/sites/default/files/2018-10/Camperdown%20Program%20Treatment%20Guide%20June%202018.pdf
• ↑ Devin Fisher, CCC-SLP. Speech Language Pathologist. Expert Interview. 15 January 2021.
• ↑ https://www.stutteringhelp.org/sites/default/files/Migrate/Book_0012_tenth_ed.pdf
• ↑ http://www.coli.uni-saarland.de/~steiner/publications/ISSP2014.pdf
• ↑ https://sps.columbia.edu/news/five-ways-improve-your-body-language-during-speech
• ↑ https://www.nhs.uk/mental-health/self-help/guides-tools-and-activities/breathing-exercises-for-stress/
• ↑ http://kidshealth.org/teen/diseases_conditions/sight/speech_disorders.html#
• ↑ https://www.nidcd.nih.gov/health/stuttering
• ↑ https://medlineplus.gov/ency/article/001058.htm
• ↑ http://www.asha.org/public/speech/disorders/CleftLip/
• ↑ https://www.cdc.gov/ncbddd/developmentaldisabilities/language-disorders.html
• ↑ https://www.stanfordchildrens.org/en/topic/default?id=stuttering-90-P02290
• ↑ https://raisingchildren.net.au/preschoolers/development/language-development/stuttering

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The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

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UK politics: government to appeal against ruling that blocks Rwanda deportations in Northern Ireland – as it happened

Rishi Sunak says Belfast judgment will not affect his plans and the Good Friday agreement should not be used to obstruct Westminster policy

• 3d ago Afternoon summary
• 3d ago No 10 declines to deny report saying Cameron discussed Ukraine war ending in peace deal with Trump
• 3d ago Starmer says there will be 'no watering down' of Labour's new deal for working people
• 3d ago Sunak says ministers will appeal against Belfast court ruling on Rwanda policy, which he says won't stop flights leaving in July
• 3d ago DWP says it is planning to increase fines for people who falsely claim benefits
• 3d ago 'Common sense' minister Esther McVey announces ban on civil servants wearing rainbow lanyards
• 3d ago Labour MP Chris Bryant being treated after skin cancer detected in his lung
• 3d ago DUP says Northern Ireland will be 'magnet for asylum seekers' unless government amends migration law
• 3d ago Sunak's speech and Q&A - summary and analysis
• 3d ago Court rules Rwanda deportation law should not apply in Northern Ireland because it breaches Good Friday agreement
• 3d ago Scottish Labour leader Anas Sarwar accuses SNP of 'squandering opportunities' of Scottish parliament
• 3d ago Starmer says Sunak wrong to say Britain less safe under Labour
• 3d ago Sunak says UK will keep backing Ukraine, playing down report hinting Trump win could lead to west backing peace deal
• 3d ago Sunak claims Labour would not be able to maintain military support for Ukraine for as long as necessary
• 3d ago Sunak says Britain will be less safe under Labour
• 3d ago Sunak says Elphicke defection shows Starmer is 'completely and utterly unprincipled' and doesn't stand for anything
• 3d ago Sunak rejects claim Tories have not spent enough on defence
• 3d ago Sunak says he would ignore ECHR injunctions 'every single time' in order to get deportation flights off to Rwanda
• 3d ago Sunak says 'it's just not true' to say 14 years of Tory government to blame for all problems facing Britain
• 3d ago Sunak says Starmer's shift from embracing Jeremy Corbyn to Natalie Elphicke show he has 'no principles'
• 3d ago Sunak says next election will be choice 'between future and past'
• 3d ago Starmer urges Labour's mayors to set 'gold standard' for local growth plans
• 3d ago Nadhim Zahawi named chair of Very Group after saying he's quitting as MP at election
• 3d ago Minister apologises to women affected by birth trauma after UK inquiry
• 3d ago Labour Chris Bryant suggests Buckland should face standards inquiry for covering up Elphicke's alleged lobbying bid
• 3d ago Sunak suggests next five years will be ‘some of most dangerous’ in UK history and he’s best leader to keep people safe

Sunak starts with global security threats.

The dangers that threaten our country are real. There’s an increasing number of authoritarian states like Russia, Iran, North Korea and China working together to undermine us and our values. War has returned to Europe, with our Nato allies warning that if Putin succeeds in Ukraine, they might be next.

But he quickly slides into culture war issues too.

People are abusing our liberal democratic values of freedom of speech, the right to protest, to intimidate, threaten and assault others, to sing antisemitic chants on our streets and our university campuses, and to weaponize the evils of antisemitism or anti-Muslim hatred, in a divisive ideological attempt to set Britain against Britain. And from gender activists hijacking children’s sex education, to cancel culture, vocal and aggressive fringe groups are trying to impose their views on the rest of us. They’re trying to make it morally unacceptable to believe something different and undermine people’s confidence and pride in our own history and identity.

Sunak says next election will be choice 'between future and past'

Rishi Sunak is giving his speech.

He starts by saying the next election will be a choice “between the future and the past”.

And he uses the line, briefed in advance, about how the next five years could be some of the most dangerous faced by Britain in its history. (See 9.13am .)

Starmer urges Labour's mayors to set 'gold standard' for local growth plans

While Rishi Sunak is focusing on security this morning (see 9.13am ), Keir Starmer is focusing on the economy. He is chairing a meeting with Labour’s mayors where he will urge them to help develop a “gold standard” for local growth plans.

According to an overnight press release, Starmer will say:

These local elections showed that the British public is ready to put their trust in this changed Labour oarty. We will repay that trust by delivering economic growth for everyone, everywhere in partnership with our Labour mayors. Our growing team of Labour mayors is already setting the agenda and delivering for local people despite a failing Tory government that is choking off our economy and hoarding power in Westminster. My Labour government would rebuild our economy hand in hand with local leaders. That’s why boosting growth across every region will be top of the agenda for our devolution plans. Drawing on the expertise and ideas of Labour mayors who know their communities best, we can set the ‘gold standard’ for delivering local growth.

Starmer, Angela Rayner, the deputy Labour leader and shadow levelling up secretary, and Rachel Reeves, the shadow chancellor, will be representing the shadow cabinet at the meeting.

And the 11 mayors there will be: Tracy Brabin (West Yorkshire), Andy Burnham (Greater Manchester), Oliver Coppard (South Yorkshire), Sadiq Khan (London), Nik Johnson (Cambridgeshire and Peterborough), Kim McGuiness (North East), Dan Norris (West of England), Richard Parker (West Midlands), Steve Rotheram (Liverpool city region), David Skaith (York and North Yorkshire) and Claire Ward (East Midlands).

Nadhim Zahawi named chair of Very Group after saying he's quitting as MP at election

The former UK chancellor Nadhim Zahawi is to become chair of Very Group, the online retailer owned by the billionaire Barclay family, days after announcing that he would step down as a Conservative MP at the next general election. Jasper Jolly has the story.

Minister apologises to women affected by birth trauma after UK inquiry

Maria Caulfield , the health minister, was speaking to broadcasters this morning to respond to a report from the all-party parliamentary group (APPG) on birth trauma. It says that while for many women giving birth is a positive experience, for around a third of them it is traumatic. And it cites evidence saying to that 4 to 5% of women develop post-traumatic stress disorder every year after giving birth, which amounts to around 30,000 women.

As Kevin Rawlinson reports, in her interviews Caulfield apologised to women affected by birth trauma and claimed that the government was already addressing many of the points raised by the APPG.

Maria Caulfield , the health minister, was doing a morning interview round this earlier. Asked about the allegations about Natalie Elphicke published in the Sunday Times (see 1.17am ), she said there “probably” should be an investigation but that it was for Labour to carry this out.

Asked why Robert Buckland had not told anyone earlier about his meeting with Elphicke, she told Times Radio:

I don’t know the details of that meeting, you would have to ask Robert Buckland about that, but this is now something that the Labour party would have to investigate. They’ve been busy playing political games about who sits on which benches. We’ve been busy getting on with running the country.

Labour Chris Bryant suggests Buckland should face standards inquiry for covering up Elphicke's alleged lobbying bid

Yesterday the Sunday Times splashed on a story that implied the Conservative party was out to extract maximum revenge on Natalie Elphicke following her defection to Labour.

In a story that quoted Robert Buckland , the former justice secretary, the paper claimed that, just before her then husband was about to go on trial for sexual assault in July 2020, Natalie Elphicke lobbied Buckland to try to get the case heard by an alternative judge. Elphicke has not denied the story, although she has said she does not accept the “characterisation” of the meeting given by the Sunday Times (ie, that she was trying to get Buckland to ensure her husband was treated more leniently).

The Sunday Times: Elphicke ‘asked lord chancellor for favour over husband’s trial’ #TomorrowsPapersToday pic.twitter.com/VDn8ECxrrc — George Mann (@sgfmann) May 11, 2024

At first sight, this looked like a problem for Labour . Trying to interfer with a judicial process is a serious matter, and can be a criminal offence, and Labour’s newest recruit has questions to anwer.

But, if this was an intentional hit job by CCHQ, then it may have backfired, for reasons explained last night in a post on X by the Secret Barrister , the pseudonym used by a barrister who has written a series of highly-praised exposés of how the law operates.

The biggest story today is that the then-Lord Chancellor and Secretary of State for Justice was a direct witness to a criminal attempt to pervert the course of justice, and covered it up for four years because it involved one of his political allies. pic.twitter.com/ExtieF2XA5 — The Secret Barrister (@BarristerSecret) May 12, 2024

The biggest story today is that the then-Lord Chancellor and Secretary of State for Justice was a direct witness to a criminal attempt to pervert the course of justice, and covered it up for four years because it involved one of his political allies.

And today the Labour party is running with this line. Chris Bryant , the shadow minister for creative industries, was on Sky News this morning. He was chair of the Commons standards committee when it published a report criticising Elphicke and four other Tory MPs for interfering with a judicial decision after Charlie Elphicke’s conviction (relating to the publication of character references) and Bryant told Sky News this morning that Buckland should have disclosed at that point what he knew about Elphicke’s history of lobbying the judiciary on behalf of her husband.

Bryant suggested that it was Buckland who should be investigated, not Elphicke. He explained:

When we were doing that investigation, I would have thought that if what Robert Buckland has said today, namely that he says that she lobbied him, if that is true, he should have told our committee. So if anybody should be being investigated by the parliamentary commissioner for standards - and he’s perfectly independent, it’s up to him to decide - frankly, it should be Robert Buckland.

Here is my colleague Gaby Hinsliff ’s snap reaction to Rishi Sunak’s argument this morning.

I think Sunak’s right these are unusually dangerous times but it begs the question ‘so why did you make Grant Shapps defence sec then’ & that’s been the problem for years now: internal politics trumping operational effectiveness pic.twitter.com/jLWkwrIgfM — gabyhinsliff (@gabyhinsliff) May 13, 2024

I think Sunak’s right these are unusually dangerous times but it begs the question ‘so why did you make Grant Shapps defence sec then’ & that’s been the problem for years now: internal politics trumping operational effectiveness

The No 10 advance briefing on the PM’s speech “landed well” (in spin jargon) in the pro-Tory papers.

Monday's DAILY TELEGRAPH: PM: Britain safer under Tories for dangerous years ahead #TomorrowsPapersToday pic.twitter.com/glxRl8wT7t — Jack Surfleet (@jacksurfleet) May 12, 2024

Monday's DAILY MAIL: RIshi warns UK is entering a 'dangerous era' #TomorrowsPapersToday pic.twitter.com/Eym5QadMIJ — Jack Surfleet (@jacksurfleet) May 12, 2024

Monday's DAILY EXPRESS: PM's bold vision for 'stark choices' facing Britain #TomorrowsPapersToday pic.twitter.com/WzDl0Aumwk — Jack Surfleet (@jacksurfleet) May 12, 2024

Sunak suggests next five years will be ‘some of most dangerous’ in UK history and he’s best leader to keep people safe

Good morning. Rishi Sunak has made various attempts to define what he stands for, in a way that would frame the choice at the next election to his advantage, and this morning we’ll get another version. When he became Tory leader; he was the antidote to Liz Truss; competence and fiscal responsibility. For a while last year he was the motorists’ champion and net zero realist. He has dabbled a bit with being anti-woke. Last autumn, for several weeks, he made a sustained and serious attempt to claim he would be the change candidate at the election (a move that failed because it was wholly implausible ). More recently he has been the person “sticking to the plan”. And today he is going to present himself as the leader best able to keep people “safe and secure” in a dangerous world.

Downing Street released some extracts from the speech overnight and Kiran Stacey has written up the briefing here.

And here is the key passage from the advance briefing. Sunak will say:

I have bold ideas that can change our society for the better, and restore people’s confidence and pride in our country. I feel a profound sense of urgency. Because more will change in the next five years than in the last thirty. I’m convinced that the next few years will be some of the most dangerous yet most transformational our country has ever known.

According to the briefing, Sunak will say that war, a global rise in immigration, threats to “shared values and identities” and new technologies like artificial intelligence are what makes the future so threatening.

One problem is that is his “next five years” theory sounds questionable. Thirty years ago the internet barely had an impact on everyday life and a mobile phone was the size of a brick (and about as intelligent). Another difficulty is that Sunak is leading his party into an election, people like positivity, and his analysis all sounds rather gloomy. According to the advance briefing, Sunak will address this by saying that “we’re a nation of optimists” and that he can offer people a more secure future.

Sunak is not the first Tory to frame the election in these terms. Only last week David Cameron, the foreign secretary and former PM, said keeping people safe would be “on the ballot paper” and that “security to me is the most conservative value of all” .

But if security is the essay question, is the Conservative party the answer? Not according to opinion polls. Last month Lord Ashcroft, the former Tory deputy chair who now runs a respected polling operation, published figures saying that the voters trust Labour more than the Conservatives on all key issues , including defence.

Labour responded overnight with a statement from Pat McFadden , the party’s national campaign coordinator saying, in effect, that it does not really matter what Sunak claims because his party’s record is so poor. McFadden said:

Nothing the prime minister says will change the fact that over the past fourteen years the Conservatives have brought costly chaos to the country, with this being the only parliament in living memory where people’s standard of living will be lower at the end of it than the beginning. The Tories crashed the economy by using the country for a giant and reckless economic experiment, for which the British people are still paying the price. Even as the prime minister speaks, others in his party are positioning themselves to replace him. The only way to stop the chaos, turn the page and start to renew is with a change of government. The Conservatives can’t fix the country’s problems because they are the problem. Another five years of them would not change anything for the better.

Here is the agenda for the day.

10am: Anas Sarwar, the Scotish Labour leader, gives a speech on Labour’s plans to reset devolution.

10am : Esther McVey , the Cabinet Office minister, gives a speech to the Centre for Policy Studies thinktank on “putting common sense at the heart of govenment”.

11am: Rishi Sunak delivers his speech in London at the Policy Exchange thinktank.

2.30pm: Mel Stride, the work and pensions secretary, takes questions in the Commons.

3.45pm: Downing Street holds a lobby briefing.

Also, Keir Starmer is holding a meeting today with Labour’s elected mayors. He will be asking them to work with him on proposals for local growth plans.

For technical reasons we are not using the ‘send us a message’ feature any more, and if you want to contact me, please post a message below the line (BTL) or message me on X (Twitter). I can’t read all the messages BTL, but if you put “Andrew” in a message aimed at me, I am more likely to see it because I search for posts containing that word. If you want to flag something up urgently, it is best to use X; I’ll see something addressed to @AndrewSparrow very quickly. I find it very helpful when readers point out mistakes, even minor typos (no error is too small to correct). And I find your questions very interesting too. I can’t promise to reply to them all, but I will try to reply to as many as I can, either BTL or sometimes in the blog.

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