What are the recommended treatments for stuttering?

Treatment of Stuttering

The recommended treatment for stuttering involves a comprehensive approach combining speech restructuring techniques, muscle tension reduction, and psychological interventions to address both the physical symptoms and psychological aspects of stuttering. 1

Speech Restructuring and Fluency Shaping Techniques

Speech restructuring and fluency shaping techniques form the core treatment for stuttering, with the strongest evidence base 2:

• Prolonged Speech Treatment Model:

  • Slowing rate of speech
  • Easy, gentle onset of sounds
  • Elongating vowels and producing prolonged speech
  • Linking words together with controlled phrasing
  • Emphasizing speech naturalness 1

• Specific Programs:

  • Camperdown Program for adults who stutter
  • La Trobe Smooth Speech Clinic Programme 1

These intensive treatment programs can be offered individually or in groups and have been shown to reduce stuttering frequency by 50-57% 2.

Muscle Tension Reduction Techniques

Excessive muscle tension often contributes to stuttering. Effective tension reduction techniques include:

• Reducing muscle tension in speech muscles using techniques from functional voice disorders
• Targeting high-frequency abnormal behaviors associated with dysfluencies
• Manipulating facial muscles or lowering the larynx
• Reducing muscular tension in head, neck, shoulders and improving postural alignment 1

Distraction and Secondary Movement Elimination

Eliminating secondary movements can improve fluency:

• Speaking while lying on the back
• Squeezing a ball while speaking
• Sorting blocks into different patterns while speaking
• Finger tapping while speaking
• Speaking while listening to music through headphones 1

These techniques serve as distractions that can be gradually faded out as speech normalizes.

Psychological Interventions

Psychological aspects of stuttering require specific attention:

• Communication counseling addressing predisposing, precipitating, and perpetuating factors
• Addressing abnormal illness beliefs and excessive attention to bodily sensations
• Teaching adaptive responses to moments of stuttering and feelings of loss of control
• Cognitive-behavioral therapy (CBT) for anxiety related to stuttering 1, 3

CBT has demonstrated strong evidence for long-term reduction in speaking anxiety, with improvements maintained at follow-up assessments 3.

Hierarchical Approach to Treatment

Treatment should follow a progressive approach:

1. Initial phase: Focus on tension reduction and education
2. Middle phase: Implement speech restructuring techniques
3. Advanced phase: Practice in progressively challenging speaking situations using a hierarchy of difficulty 1

Monitoring Treatment Response

Evaluation of treatment response during the first 1-2 sessions helps determine effectiveness 3. Many patients with functional communication disorders show dramatic and rapid improvements with appropriate speech and language therapy 3.

Emerging Approaches

While traditional fluency-shaping approaches have the most robust evidence, newer approaches are being explored:

• The CARE Model of Treatment proposes moving away from purely fluency-focused treatments toward whole-person wellness approaches 4
• Telehealth delivery of speech restructuring has been found non-inferior to face-to-face intervention 2

Important Considerations

• No single approach to stuttering treatment can claim universal success with all adults who stutter 5
• Pharmacological therapy has not been shown to improve stuttering 6
• Treatment should address both improved speech fluency and stuttering management for optimal results 5
• Avoiding avoidance behaviors is crucial for effective treatment 3

By implementing this structured approach to stuttering treatment, clinicians can help patients achieve significant improvements in fluency and quality of life.