tuttering (or stammering) is a physical struggle to get the words out, often caused by a neurological condition, where the part of the brain that processes speech behaves differently. Approximately 70 million people worldwide stammer.

Stuttering most commonly begins in childhood, between two and four years of age, during the critical period of language acquisition. Stuttering is about four times more prevalent in males than in females. Someone who stammers might repeat sounds, syllables or words; prolong sounds; or get stuck on sounds or words despite the effort. There may also be visible signs of tension as they try to get the words out. Some people who stammer might talk their way around difficult words, or use filler words.

Stammering, or stuttering, can be highly variable for an individual, with moments of fluency suddenly giving way to significant struggles in speaking the next moment. No two people stammer alike; stammering varies greatly in type, frequency and severity for each individual.

Three different types of stuttering are generally known. These include developmental stuttering (the most common type occurring during speech development); neurogenic stuttering (caused by brain injury); and psychogenic stuttering (rare; often linked to psychological trauma or stress).

Stammering is often perceived solely as a speech difficulty, but its hidden emotional and psychological aspects are equally significant. Beyond speech, individuals who stammer may face intense internal struggles, including fear and anticipation of stammering moments, which can lead to feelings of sadness, embarrassment, shame or guilt. People who stammer often adapt their choices to avoid difficult words, such as ordering easier-to-say items or staying silent in challenging situations like meetings or social events. They may avoid opportunities requiring introductions, public speaking or using the phone. Early jobs can be particularly challenging. Growing up, these emotions may be compounded by negative reactions from others or even the mere perception of such responses. These experiences can deeply affect self-esteem and social confidence. Understanding these challenges is crucial for fostering empathy and providing meaningful support to individuals who stammer, thus helping them navigate these emotional complexities, gradually build confidence and learn to confront their fears.

Stuttering is typically diagnosed by a speech-language pathologist who evaluates the individual’s speech in different situations. Speech-language pathologists, more commonly known as speech therapists, are licensed communication experts who work with clients of all ages, in diverse settings like schools, hospitals, clinics and private practices. This professional inquires about the patient’s health history and how stuttering impacts their life such as personal relationships and school performances to determine whether the condition is part of usual child development or likely to be long-term. They address issues such as speech sounds, including correcting lisps; fluency, focusing on smoother speech patterns; and social communication, helping individuals understand and engage effectively with others. They train education professionals to identify and support students with communication needs, ensuring a comprehensive approach to improving communication skills, and support individuals bullied for stuttering by building their confidence, improving communication skills, and fostering understanding and acceptance of the condition in their communities.

Stuttering is influenced by genetics, neuromuscular development and environmental factors, including family dynamics. 

One prevalent myth is that stuttering is a psychological problem caused by anxiety, stress or nervousness. In reality, while anxiety or stress may exacerbate stuttering, they do not cause it. People who stutter are not inherently more nervous, fearful, anxious or shy than others. Another misconception is that stuttering can be ‘caught’ by imitating someone who stutters.

Though the exact causes remain unclear, stuttering is influenced by genetics, neuromuscular development and environmental factors, including family dynamics. Addressing these myths helps promote a more accurate understanding of the condition.

The general public can support people with stammering by fostering an environment of patience, respect and understanding. Some key behaviours include patiently allowing them to speak at their own pace, without interrupting, finishing their sentences, or asking them to take deep breaths as this can sound dismissive. In addition, people should avoid making jokes, correcting them or making insensitive remarks about speech. Also, maintain eye contact and show that you are actively listening and focusing on what they are saying showing interest in the message, not the fluency. Supportive comments can also help for example asking a person who stammers beforehand if he/ she would like to introduce themselves or if they would like to be introduced. Moreover, if a person who stutters, approaches a group talking amongst themselves, one of them can interrupt the flow and invite them to join the conversation. Such individuals may talk rapidly, so it’s important not to guess what they are saying or interrupt them, just ask them to repeat it. Furthermore, on interacting with such individuals on the phone, it’s good to be mindful that they might be having difficulty in starting a conversation, so give them plenty of time to speak. Most importantly, if at some point there is uncertainty on how to respond, politely ask how they can be supported. By creating an inclusive, non-judgmental environment, the public can help individuals with stammering feel more confident and comfortable in social interactions.

Everyone can see the physical challenge of stuttering, but the psychological battle is still widely misunderstood. The principles and methods of effective counselling by speech therapists play a crucial role in stuttering therapy. Counselling helps individuals who stutter and their families explore and address emotions, thoughts and behaviours associated with stuttering, ensuring a holistic approach to treatment.

Several associations in Pakistan are supporting people who stutter, including the Pakistan Stammering Foundation, Pakistan Stammering Hub, Rehab Cure, The National Association of Young People Who Stutter and the Stuttering Foundation. Connecting with others who share similar experiences can be comforting and validating, as it helps individuals with stuttering, feel less isolated in their journey. Sharing personal stories within the stuttering community not only raises awareness, but also empowers those who stutter by allowing them to reflect on their cultural and social identities, and the various forms of oppression they encounter. Community support is essential for individuals who stutter, offering a sense of belonging and understanding.

The writer is a family physician