Stuttering in adults: causes, treatment and help

What is stuttering?

Stuttering is a disruption in the rhythm and flow of speech. You know exactly what you want to say, but your speech stalls on the way out. It has nothing to do with vocabulary or how you think. It's the act of putting sound to the words that causes the trouble.

Stuttering typically shows up in three ways:

• Repetitions: a sound or syllable is repeated, as in "c-c-c-coffee".
• Prolongations: a sound is stretched out, as in "mmmmum".
• Blocks: the sound gets completely stuck. Your mouth is ready but nothing comes, and several seconds can pass before the word lets go.

Many people who stutter also develop accompanying movements. It might be blinking, tension in the jaw or a jerk of the head, which the body uses to force the word out.

The part nobody hears

Stuttering is often compared to an iceberg. What other people hear is the tip. Below the surface is everything you do to avoid stuttering: the words you swap, the conversations you skip, and the constant planning of what you can say without getting stuck. Then there are the feelings: the dread before a phone call, the shame afterwards, and the exhaustion after a day spent keeping watch over every sentence.

Some adults have become so good at avoiding that the people around them have no idea they stutter. This is called covert stuttering. From the outside the speech sounds fluent. From the inside it's hard work, and the price is that you say less than you'd like to.

Why do people stutter? What we know about the causes

Stuttering almost always begins in childhood, typically between the ages of two and five. About five per cent of all children stutter for a period, and for roughly four in five of them it passes. Just under one in a hundred adults stutters, and about four in five of them are men.

The exact cause of stuttering isn't known. Researchers have found differences in the brains of both children and adults who stutter, and heredity plays a large part: stuttering often runs in families, so if you stutter, there's a good chance that a parent, an uncle or a grandparent did too.

Three myths about why people stutter

• "It's nerves." No. Nervousness can make stuttering worse, but it isn't the cause. Many people who stutter are calm people, and many nervous people don't stutter.
• "It's about intelligence." No. Stuttering says nothing about how clever you are. There is no link between stuttering and intelligence.
• "It's the parents' fault." No. Stuttering isn't caused by upbringing, and it doesn't come from anyone having done something wrong.

What is true is that the situation matters. Most people stutter more under time pressure, on the phone, when they have to say their own name, or when they're talking to someone they want to impress. And most people stutter less, or not at all, when they sing, speak in unison with others or talk to themselves. That shows your speech works. It's the interplay between speech, body and expectation that locks up. If you'd like to know more, read why people stutter.

Stuttering in adults looks different from stuttering in children

A child who stutters rarely thinks about it at first. An adult has had many years to learn which words and situations are dangerous. That's why stuttering in adults is often as much about what you avoid as about what can be heard.

You may recognise some of this:

• You send a message rather than phone, even when a call would be quicker.
• You have a fixed set of words you know you can say, and you steer round the rest.
• You let other people order, do the introductions or speak up in the meeting.
• You chose your education or your job according to how little you'd have to talk.
• You're worn out after social occasions, even though nobody heard you stutter.

Avoidance works in the moment. You're spared from getting stuck right now. But every time you go round a word or a situation, you teach yourself that it was dangerous, and next time the fear is a little bigger. That's how stuttering can come to run more and more of your life without your actual speech having got any worse.

It's also why many adults say "I don't stutter that much" when in reality they spend an enormous amount of energy on it. How much you stutter can't be measured only by what others hear. It also has to be measured by how much you hold yourself back.

I stutter. Can it go away?

The honest answer is that stuttering in adults rarely disappears on its own, and that there is no cure. If anyone promises you'll be "cured" in a weekend, be sceptical.

That doesn't mean you have to live with things as they are. There's a big difference between stuttering and letting stuttering decide. A great many adults gain control of their speech: they can make phone calls, introduce themselves, give a speech and say what they mean, when they want to. Some still stutter now and then. The difference is that they have tools to get through it, and they no longer plan their lives around avoiding it.

In The McGuire Programme we call the goal eloquence. That isn't the same as fluency. Eloquence is saying what you want to say, when you want to say it.

Help for stuttering: your options as an adult

There are several routes, and they don't rule each other out. Which one suits you best depends on how much room stuttering takes up in your life and how much you're ready to put in. We've put together an overview of stuttering treatment for adults.

A speech and language therapist

A speech and language therapist is trained to work with speech and communication. What is publicly available depends on the country you live in, so ask your GP or your local speech and language therapy service what help there is for adults who stutter and what it costs. In Denmark, for example, adults can get free stuttering therapy through their municipality. There are also therapists in private practice. Therapy typically consists of conversations and exercises over a longer period. If you're not sure which to choose, read about a speech and language therapist for adults or a stuttering course.

Intensive stuttering courses

On an intensive course you work on your speech for many hours at a stretch over a few days, often alongside other people who stutter. The advantage is that you practise the techniques enough for them to stick, and that you try them out in real situations and not only in a room. The McGuire Programme is an intensive course of that kind. You can read more about it further down.

Community and self-help

Many adults have never spoken to another person who stutters. Simply meeting someone who knows it from the inside can shift a great deal. A national stuttering association in your country, such as STAMMA in the UK, is a good place to find knowledge and meet others.

What you can do today

• Say it out loud. Tell one person that you stutter. It takes much of the pressure out of a conversation when you no longer have to hide it.
• Notice what you avoid. For one week, write down the words and situations you go round. Then you'll know what is actually taking up the room.
• Pick one small thing you usually avoid, and do it anyway. Order your own coffee. Make one phone call.
• Slow down. Time pressure is one of the things that most often makes speech lock. You're allowed to take your time.

These small steps don't remove the stutter, but they change your direction. You start walking into situations, and that's where change begins.

How The McGuire Programme works with stuttering

The McGuire Programme is an intensive course for anyone aged 14 or over who stutters. All the instructors stutter themselves and have been through the course. They know what it feels like to be stuck in a block, and they know what it takes to move on.

The course lasts four days, from Thursday 08:00 to Sunday 14:00, and the days can be up to 16 hours long. It's hard work, and that's part of the point. In four days you will:

• learn a new way of breathing, costal breathing, which is the foundation for everything else
• practise techniques such as Hit and Hold and Block release, which help you into and out of the words that get stuck
• work with deliberate dysfluency, where you go into the thing you usually avoid, on purpose
• use all of it out in the real world: on the phone, in the street and in front of an audience, with the group behind you

The course works on both the physical side of speech and on the fear and avoidance. That's why you don't only practise in a room, but also talk to strangers in the street and give a public speech.

The course ends on Sunday, but the support doesn't. You get lifelong support and become part of a network of people who stutter and who keep practising together. The daily practice afterwards is what keeps the new habits alive. The price is DKK 18,000 as a one-off payment.

McGuire suits you if you're ready to work for it, after the course as well. It's less of a fit if you're looking for a quick fix without practice. You can read about what a McGuire stuttering course is like, or see the upcoming courses in Aarhus, Malmö and Oslo. The McGuire Programme also runs courses in other countries.

When should you seek help for stuttering?

There's no threshold for how much you have to stutter before you're "allowed" to seek help. A good guide is whether stuttering makes you turn down something you'd really like: a job, a degree, a conversation, a speech at your sister's wedding. If the answer is yes, that's reason enough.

It's never too late. Many people only start working on their speech in their thirties, forties or later, often because something in life makes it impossible to keep avoiding: a new job, children, or a promotion with more meetings.

If you suddenly start stuttering as an adult

If you've never stuttered before and suddenly start as an adult, talk to your doctor first. Stuttering that comes on suddenly can be linked to illness or an injury to the brain, and it needs to be examined before you go any further with therapy or a course. Read more about sudden stuttering in adults.

Know someone who stutters? Here's how to help

Perhaps you're reading this because your partner, your child, a friend or a colleague stutters. You can make a big difference without being an expert.

• Let the person finish. Don't guess the word and don't finish the sentence, even when you want to help.
• Keep eye contact, during a block too. When you look away, the pause gets longer and more awkward for both of you.
• Drop the well-meant advice like "take it easy" and "just breathe". It's kindly meant, but it adds to the pressure.
• Listen to what is being said, not to how it's being said.
• Feel free to ask how you can best help. Most people would rather have the question than the silence.

And if the person you know is thinking about getting help, back them up. It takes courage to start working on something you've hidden for many years.

The first step

If you've read this far, there's a good chance stuttering takes up more room in your life than you'd like. The first step doesn't have to be a big one. It could be telling one person that you stutter. It could be asking your GP or local health service about a speech and language therapist. Or it could be a chat with one of us, who have stood where you're standing.

The most important thing is that you don't keep waiting for it to pass on its own. It rarely does. But it can get a great deal better.

Frequently asked questions