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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.

Monica Marzinske, CCC-SLP

Speech-language therapy.

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Speaking clearly: Help for people with speech and language disorders

• Speech-Language

Speaking and language abilities vary from person to person. Some people can quickly articulate exactly what they are thinking or feeling, while others struggle being understood or finding the right words.

These struggles could be due to a speech or language disorder if communication struggles cause ongoing communication challenges and frustrations. Speech and language disorders are common.

It's estimated that 5% to 10% of people in the U.S. have a communication disorder. By the first grade, about 5% of U.S. children have a noticeable speech disorder. About 3 million U.S. adults struggle with stuttering and about 1 million U.S. adults have aphasia. These conditions make reading, speaking, writing and comprehending difficult.

People with speech and language disorders can find hope in rehabilitation. Speech-language pathologists can evaluate and treat these disorders. This can lead to a happier, healthier and more expressive life.

Types of speech and language disorders

Speech and language disorders come in many forms, each with its own characteristics:.

• Aphasia People with aphasia have difficulty with reading, writing, speaking or understanding information they've heard. The intelligence of a person with aphasia is not affected.
• Dysarthria People with dysarthria demonstrate slurred or imprecise speech patterns that can affect the understanding of speech.
• Apraxia A person with this disorder has difficulty coordinating lip and tongue movements to produce understandable speech.
• Dysphagia This condition refers to swallowing difficulties, including food sticking in the throat, coughing or choking while eating or drinking, and other difficulties.
• Stuttering This speech disorder involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say but have difficulty saying it.
• Articulation disorder People with this disorder have trouble learning how to make specific sounds. They may substitute sounds, such as saying "fum" instead of "thumb".
• Phonological disorder Phonological processes are patterns of errors children use to simplify language as they learn to speak. A phonological disorder may be present if these errors persist beyond the age when most other children stop using them. An example is saying "duh" instead of "duck."
• Voice Voice disorders include vocal cord paralysis, vocal abuse and vocal nodules, which could result in vocal hoarseness, changes in vocal volume and vocal fatigue.
• Cognitive communication impairment People with cognitive communication impairment have difficulty with concentration, memory, problem-solving, and completion of tasks for daily and medical needs.

Speech and language disorders are more common in children. It can take time to develop the ability to speak and communicate clearly. Some children struggle with finding the right word or getting their jaws, lips or tongues in the correct positions to make the right sounds.

In adults, speech and language disorders often are the result of a medical condition or injury. The most common of these conditions or injuries are a stroke, brain tumor, brain injury, cancer, Parkinson's disease, multiple sclerosis, Lou Gehrig's disease or other underlying health complications.

Treatment options

Speech and language disorders can be concerning, but speech-language pathologists can work with patients to evaluate and treat these conditions. Each treatment plan is specifically tailored to the patient.

Treatment plans can address difficulties with:

• Speech sounds, fluency or voice
• Understanding language
• Sharing thoughts, ideas and feelings
• Organizing thoughts, paying attention, remembering, planning or problem-solving
• Feeding and swallowing
• Vocabulary or improper grammar use

Treatment typically includes training to compensate for deficiencies; patient and family education; at-home exercises; or neurological rehabilitation to address impairments due to medical conditions, illnesses or injury.

Treatment options are extensive and not limited by age. Children and adults can experience the benefits of treatment.

If you or a loved one are struggling with speech and language issues, you are not alone. Millions of people experience similar daily challenges. Better yet, help is available.

Monica Marzinske is a speech-language pathologist  in New Prague , Minnesota.

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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.

Phynart Studio / Getty Images

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.

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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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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

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• Speaking Skills

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 330,097 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

About This Article

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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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• Childhood apraxia of speech

Childhood apraxia of speech (CAS) is a rare speech disorder. Children with this disorder have trouble controlling their lips, jaws and tongues when speaking.

In CAS , the brain has trouble planning for speech movement. The brain isn't able to properly direct the movements needed for speech. The speech muscles aren't weak, but the muscles don't form words the right way.

To speak correctly, the brain has to make plans that tell the speech muscles how to move the lips, jaw and tongue. The movements usually result in accurate sounds and words spoken at the proper speed and rhythm. CAS affects this process.

CAS is often treated with speech therapy. During speech therapy, a speech-language pathologist teaches the child to practice the correct way to say words, syllables and phrases.

Children with childhood apraxia of speech (CAS) may have a variety of speech symptoms. Symptoms vary depending on a child's age and the severity of the speech problems.

CAS can result in:

• Babbling less or making fewer vocal sounds than is typical between the ages of 7 to 12 months.
• Speaking first words late, typically after ages 12 to 18 months old.
• Using a limited number of consonants and vowels.
• Often leaving out sounds when speaking.
• Using speech that is hard to understand.

These symptoms are usually noticed between ages 18 months and 2 years. Symptoms at this age may indicate suspected CAS . Suspected CAS means a child may potentially have this speech disorder. The child's speech development should be watched to determine if therapy should begin.

Children usually produce more speech between ages 2 and 4. Signs that may indicate CAS include:

• Vowel and consonant distortions.
• Pauses between syllables or words.
• Voicing errors, such as "pie" sounding like "bye."

Many children with CAS have trouble getting their jaws, lips and tongues to the correct positions to make a sound. They also may have a hard time moving smoothly to the next sound.

Many children with CAS also have language problems, such as reduced vocabulary or trouble with word order.

Some symptoms may be unique to children with CAS , which helps to make a diagnosis. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's hard to diagnose CAS if a child has only symptoms that are found both in CAS and in other disorders.

Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those associated with CAS include:

• Trouble moving smoothly from one sound, syllable or word to another.
• Groping movements with the jaw, lips or tongue to try to make the correct movement for speech sounds.
• Vowel distortions, such as trying to use the correct vowel but saying it incorrectly.
• Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh."
• Using equal emphasis on all syllables, such as saying "BUH-NAN-UH."
• Separation of syllables, such as putting a pause or gap between syllables.
• Inconsistency, such as making different errors when trying to say the same word a second time.
• Having a hard time imitating simple words.
• Voicing errors, such as saying "down" instead of "town."

Other speech disorders sometimes confused with CAS

Some speech sound disorders often get confused with CAS because some of the symptoms may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.

A child with an articulation or phonological disorder has trouble learning how to make and use specific sounds. Unlike in CAS , the child doesn't have trouble planning or coordinating the movements to speak. Articulation and phonological disorders are more common than CAS .

Articulation or phonological speech errors may include:

• Substituting sounds. The child might say "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup."
• Leaving out final consonants. A child with CAS might say "duh" instead of "duck" or "uh" instead of "up."
• Stopping the airstream. The child might say "tun" instead of "sun" or "doo" instead of "zoo."
• Simplifying sound combinations. The child might say "ting" instead of "string" or "fog" instead of "frog."

Dysarthria is a speech disorder that occurs because the speech muscles are weak. Making speech sounds is hard because the speech muscles can't move as far, as quickly or as strongly as they do during typical speech. People with dysarthria may also have a hoarse, soft or even strained voice. Or they may have slurred or slow speech.

Dysarthria is often easier to identify than CAS . However, when dysarthria is caused by damage to areas of the brain that affect coordination, it can be hard to determine the differences between CAS and dysarthria.

Childhood apraxia of speech (CAS) has a number of possible causes. But often a cause can't be determined. There usually isn't an observable problem in the brain of a child with CAS .

However, CAS can be the result of brain conditions or injury. These may include a stroke, infections or traumatic brain injury.

CAS also may occur as a symptom of a genetic disorder, syndrome or metabolic condition.

CAS is sometimes referred to as developmental apraxia. But children with CAS don't make typical developmental sound errors and they don't grow out of CAS . This is unlike children with delayed speech or developmental disorders who typically follow patterns in speech and sounds development but at a slower pace than usual.

Risk factors

Changes in the FOXP2 gene appear to increase the risk of childhood apraxia of speech (CAS) and other speech and language disorders. The FOXP2 gene may be involved in how certain nerves and pathways in the brain develop. Researchers continue to study how changes in the FOXP2 gene may affect motor coordination and speech and language processing in the brain. Other genes also may impact motor speech development.

Complications

Many children with childhood apraxia of speech (CAS) have other problems that affect their ability to communicate. These problems aren't due to CAS , but they may be seen along with CAS .

Symptoms or problems that are often present along with CAS include:

• Delayed language. This may include trouble understanding speech, reduced vocabulary, or not using correct grammar when putting words together in a phrase or sentence.
• Delays in intellectual and motor development and problems with reading, spelling and writing.
• Trouble with gross and fine motor movement skills or coordination.
• Trouble using communication in social interactions.

Diagnosing and treating childhood apraxia of speech at an early stage may reduce the risk of long-term persistence of the problem. If your child experiences speech problems, have a speech-language pathologist evaluate your child as soon as you notice any speech problems.

Childhood apraxia of speech care at Mayo Clinic

• Jankovic J, et al., eds. Dysarthria and apraxia of speech. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed April 6, 2023.
• Carter J, et al. Etiology of speech and language disorders in children. https://www.uptodate.com/contents/search. Accessed April 6, 2023.
• Childhood apraxia of speech. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/. Accessed April 6, 2023.
• Apraxia of speech. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx. Accessed April 6, 2023.
• Ng WL, et al. Predicting treatment of outcomes in rapid syllable transition treatment: An individual participant data meta-analysis. Journal of Speech, Language and Hearing Research. 2022; doi:10.1044/2022_JSLHR-21-00617.
• Speech sound disorders. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/. Accessed April 6, 2023.
• Iuzzini-Seigel J. Prologue to the forum: Care of the whole child — Key considerations when working with children with childhood apraxia of speech. Language, Speech and Hearing Services in Schools. 2022; doi:10.1044/2022_LSHSS-22-00119.
• Namasivayam AK, et al. Speech sound disorders in children: An articulatory phonology perspective. 2020; doi:10.3389/fpsyg.2019.02998.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
• Ami TR. Allscripts EPSi. Mayo Clinic. March 13, 2023.
• Kliegman RM, et al. Language development and communication disorders. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 6, 2023.
• Adam MP, et al., eds. FOXP2-related speech and language disorder. In: GeneReviews. University of Washington, Seattle; 1993-2023. https://www.ncbi.nlm.nih.gov/books/NBK1116. Accessed April 6, 2023.
• How is CAS diagnosed? Childhood Apraxia of Speech Association of North America. https://www.apraxia-kids.org/apraxia_kids_library/how-is-cas-diagnosed/. Accessed April 13, 2023.
• Chenausky KV, et al. The importance of deep speech phenotyping for neurodevelopmental and genetic disorders: A conceptual review. Journal of Neurodevelopmental Disorders. 2022; doi:10.1186/s11689-022-09443-z.
• Strand EA. Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech Language Pathology. 2020; doi:10.1044/2019_AJSLP-19-0005.
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Health Library Speech Disorders

What is a speech disorder.

Many children will experience a temporary delay in speech and language development. Most will eventually catch up. Others will continue to have difficulty with communication development. Communication disorders include speech disorders and language disorders. Speech disorders are discussed in this article and some general guidelines are also given.  This will help you decide if your child needs to be tested by a speech-language pathologist.

A child with a speech disorder may have difficulty with speech sound production, voice, resonance or fluency (the flow of speech).

Speech Sound Disorders

A child with a speech sound disorder is unable to say all of the speech sounds in words. This can make the child’s speech hard to understand. People may not understand the child in everyday situations.  For most children, the cause of the speech sound disorder is unknown.  Other speech sound disorders can be linked to things such as a cleft palate, problems with the teeth, hearing loss, or difficulty controlling the movements of the mouth.

Reasons for Concern

• The child doesn't babble using consonant sounds (particularly b, d, m, and n) by age 8 or 9 months.
• The child uses mostly vowel sounds or gestures to communicate after 18 months.
• The child’s speech cannot be understood by many people at age 3.
• The child’s speech is difficult to understand at age 4 or older.

Voice Disorders

The voice is produced as air from the lungs moves up through and vibrates the vocal folds. This is called phonation. With voice disorders, the voice may be harsh, hoarse, raspy, cut in and out, or show sudden changes in pitch. Voice disorders can be due to vocal nodules, cysts, papillomas, paralysis or weakness of the vocal folds.

• The voice is hoarse, harsh or breathy.
• The voice is always too loud or too soft.
• The pitch is inappropriate for the child's age or gender.
• The voice often "breaks" or suddenly changes pitch.
• Frequent loss of voice

Resonance Disorders

Resonance is the overall quality of the voice. A resonance disorder is when the quality of the voice changes as it travels through the different-shaped spaces of the throat, nose and mouth. Resonance disorders include the following:

Hyponasality (Denasality): This is when not enough sound comes through the nose, making the child sound “stopped up.” This might be caused by a blockage in the nose or by allergies.

Hypernasality : This happens when the movable, soft part of the palate (the velum) does not completely close off the nose from the back of the throat during speech. Because of this, too much sound escapes through the nose. This can be due to a history of cleft palate, a submucous cleft, a short palate, a wide nasopharynx, the removal of too much tissue during an adenoidectomy, or poor movement of the soft palate.

Cul-de-Sac Resonance: This is when there is a blockage of sound in the nose, mouth or throat. The voice sounds muffled or quiet as a result.

Reasons for Concern:

• Speech sounds hyponasal or hypernasal
• Air is heard coming out of the nose during speech

Fluency Disorders (Stuttering)

Fluency is the natural “flow” or forward movement of speech. Stuttering is the most common type of fluency disorder. Stuttering happens when there are an abnormal number of repetitions , hesitations, prolongations, or blocks in this rhythm or flow of speech. Tension may also be seen in the face, neck, shoulders or fists. There are many theories about why children stutter. At present, the cause is most likely linked to underlying neurological differences in speech and language processing. Internal reactions from the person talking, and external reactions from other listeners, may impact stuttering, but they do not cause stuttering.

• The parents are concerned about stuttering.
• The child has an abnormal number of repetitions, hesitations, prolongations or blocks in the natural flow of speech.
• The child exhibits tension during speech.
• The child avoids speaking due to a fear of stuttering.
• The child considers themselves to be someone who stutters.

Treatment for Speech Disorders

Early intervention is very important for children with communication disorders. Treatment is best started during the toddler or preschool years. These years are a critical period of normal language learning. The early skills needed for normal speech and language development can be tested even in infants. At that age, the speech-language pathologist works with the parents on stimulating speech and language development in the home. Active treatment in the form of individual therapy usually starts between the ages of 2 and 4 years.

If you have concerns about your child’s communication skills, discuss them with your child’s doctor. The doctor will likely refer the child to a speech-language pathologist for evaluation and treatment.

All children with speech and language disorders should also have their hearing tested.

Helping Your Child

Children learn speech and language skills by listening to the speech of others, and practicing as they talk to others. Parents are the most important teachers for their child in their early years.

They can help the child by giving lots of opportunities to listen to speech and to talk. This can be done by frequently pointing out and naming important people, places, and things. They can also read and talk to the child throughout the day, especially during daily routines, interactive plays, and favorite activities. Parents can give the child models of words and sentences to repeat.

Parents can also set up opportunities for the child to answer questions and talk. Listening to music, singing songs and sharing nursery rhymes are also great ways to build speech and language skills while having fun with your child.

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Dysarthria (difficulty speaking)

Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines. Speech and language therapy can help.

Immediate action required: Call 999 if:

• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a stroke, which is a medical emergency. The symptoms of a stroke usually come on suddenly.

Check if it's dysarthria

The main symptom of dysarthria is unclear speech. This can make it difficult for you to make yourself understood.

Your speech may only be slightly unclear, or you may not be able to speak clearly at all.

Other symptoms include:

• difficulty moving your mouth, tongue or lips
• slurred or slow speech
• difficulty controlling the volume of your voice, making you talk too loudly or quietly
• a change in your voice, making it nasal, strained or monotone
• hesitating a lot when talking, or speaking in short bursts instead of full sentences

Being stressed or tired may make your symptoms worse.

Dysarthria is not the same as dysphasia, although you can have both conditions at the same time. Dysphasia, also known as aphasia , is where you have difficulty understanding words or putting them together in a sentence.

Non-urgent advice: See a GP if:

• you've noticed gradual changes to your or your child's speech and you're worried

They'll examine you and may refer you to a specialist for further tests.

Causes of dysarthria

Dysarthria is usually caused by damage to the brain or conditions that affect the nervous system. It can happen at any age.

Common causes include:

• stroke , severe head injury and brain tumours
• Parkinson's disease , multiple sclerosis and motor neurone disease
• cerebral palsy and Down's syndrome

It can also be a side effect of certain medicines, such as some medicines to treat epilepsy.

Treatment for dysarthria

If you have dysarthria, you'll usually be referred to a speech and language therapist. They'll offer therapy to help your speech and communication.

The therapy you're offered will be different depending on the cause of your dysarthria and how severe it is.

Some people may find therapy does not help their symptoms, or their speech may get worse as their condition progresses. Their therapy may focus on helping communication in other ways.

Speech and language therapy may include:

• exercises to strengthen the muscles used for speech
• strategies to make your speech easier to understand, such as slowing down when you're talking
• using communication aids, such as an alphabet board or a voice amplifier

Find out more

• Headway: communication problems after brain injury
• Stroke Association: communication tools

Page last reviewed: 17 February 2023 Next review due: 17 February 2026

Am Fam Physician. 2024;109(4):361-362

As published by the USPSTF.

The full recommendation statement is available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/speech-and-language-delay-and-disorders-in-children-age-5-and-younger-screening .

The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.

This series is coordinated by Joanna Drowos, DO, contributing editor.

A collection of USPSTF recommendation statements published in AFP is available at https://www.aafp.org/afp/uspstf .

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This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

RFK Jr. speaks candidly about his gravelly voice: ‘If I could sound better, I would’

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There was a time before the turn of the millennium when Robert F. Kennedy Jr. gave a full-throated accounting of himself and the things he cared about. He recalls his voice then as “unusually strong,” so much so that he could fill large auditoriums with his words. No amplification needed.

The independent presidential candidate recounts those times somewhat wistfully, telling interviewers that he “can’t stand” the sound of his voice today — sometimes choked, halting and slightly tremulous.

The cause of RFK Jr.’s vocal distress? Spasmodic dysphonia, a rare neurological condition, in which an abnormality in the brain’s neural network results in involuntary spasms of the muscles that open or close the vocal cords.

My voice doesn’t really get tired. It just sounds terrible.

— Robert F. Kennedy Jr.

“I feel sorry for the people who have to listen to me,” Kennedy said in a phone interview with The Times, his voice as strained as it sounds in his public appearances. “My voice doesn’t really get tired. It just sounds terrible. But the injury is neurological, so actually the more I use the voice the stronger it tends to get.”

Since declaring his bid for the presidency a year ago, the 70-year-old environmental lawyer has discussed his frayed voice only on occasion, usually when asked by a reporter. He told The Times: “If I could sound better, I would.”

SD, as it’s known, affects about 50,000 people in North America, although that estimate may be off because of undiagnosed and misdiagnosed cases, according to Dysphonia International , a nonprofit that organizes support groups and funds research.

As with Kennedy, cases typically arise in midlife, though increased recognition of SD has led to more people being diagnosed at younger ages. The disorder, also known as laryngeal dystonia, hits women more often than men.

Internet searches for the condition have spiked, as Kennedy and his gravelly voice have become staples on the news. When Dysphonia International posted an article answering the query, “What is wrong with RFK Jr.’s voice?,” it got at least 10 times the traffic of other items.

Those with SD usually have healthy vocal cords. Because of this, and the fact that it makes some people sound like they are on the verge of tears, some doctors once believed that the croaking or breathy vocalizations were tied to psychological trauma. They often prescribed treatment by a psychotherapist.

But in the early 1980s, researchers, including Dr. Herbert Dedo of UC San Francisco, recognized that SD was a condition rooted in the brain.

Researchers have not been able to find the cause or causes of the disorder. There is speculation that a genetic predisposition might be set off by some event — physical or emotional — that triggers a change in neural networks.

Some who live with SD say the spasms came out of the blue, seemingly unconnected to other events, while others report that it followed an emotionally devastating personal setback, an injury accident or a severe infection.

Kennedy said he was teaching at Pace University School of Law in White Plains, N.Y., in 1996 when he noticed a problem with his voice. He was 42.

His campaigns for clean water and other causes in those days meant that he traveled the country, sometimes appearing in court or giving speeches. He lectured, of course, in his law school classes and co-hosted a radio show. Asked whether it was hard to hear his voice gradually devolve, Kennedy said: “I would say it was ironic, because I made my living on my voice.”

“For years people asked me if I had any trauma at that time,” he said. “My life was a series of traumas … so there was nothing in particular that stood out.”

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Kennedy was just approaching his 10th birthday when his uncle, President John F. Kennedy, was assassinated. At 14, his father was fatally shot in Los Angeles, on the night he won California’s 1968 Democratic primary for president.

RFK Jr. also lost two younger brothers: David died at age 28 of a heroin overdose in 1984 and Michael died in 1997 in a skiing accident in Aspen, Colo., while on the slopes with family members, including then-43-year-old RFK Jr.

It was much more recently, and two decades after the speech disorder cropped up, that Kennedy came up with a theory about a possible cause. Like many of his highly controversial and oft-debunked pronouncements in recent years, it involved a familiar culprit — a vaccine.

Kennedy said that while he was preparing litigation against the makers of flu vaccines in 2016, his research led him to the written inserts that manufacturers package along with the medications. He said he saw spasmodic dysphonia on a long list of possible side effects. “That was the first I ever realized that,” he said.

Although he acknowledged there is no proof of a connection between the flu vaccines he once received annually and SD, he told The Times he continues to view the flu vaccine as “at least a potential culprit.”

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Kennedy said he no longer has the flu vaccine paperwork that triggered his suspicion, but his campaign forwarded a written disclosure for a later flu vaccine. The 24-page document lists commonly recognized adverse reactions, including pain, swelling, muscle aches and fever.

It also lists dozens of less common reactions that users said they experienced. “Dysphonia” is on the list, though the paperwork adds that “it is not always possible to reliably estimate their frequency or establish a causal relationship to the vaccine.”

Public health experts have slammed Kennedy and his anti-vaccine group, Children’s Health Defense, for advancing unsubstantiated claims, including that vaccines cause autism and that COVID-19 vaccines caused a spike of sudden deaths among healthy young people.

Dr. Timothy Brewer, a professor of medicine and epidemiology at UCLA, said an additional study cited by the Kennedy campaign to The Times referred to reported adverse reactions that were unverified and extremely rare.

“We shouldn’t minimize risks or overstate them,” Brewer said. “With these influenza vaccines there are real benefits that so far outweigh the potential harm cited here that it’s not worth considering those types of reactions further.”

Anyone with concerns about influenza vaccine side effects should consult their physician, he said.

So what does research suggest about SD?

“We just don’t know what brings it on,” said Dr. Michael Johns, director of the USC Voice Center and an authority on spasmodic dysphonia. “Intubation, emotional trauma, physical trauma, infections and vaccinations are all things that are incredibly common. And it’s very hard to pin causation on something that is so common when this is a condition that is so rare.”

No two SD sufferers sound the same. For some, spasms push the vocal cords too far apart, causing breathy and nearly inaudible speech. For others, such as Kennedy, the larynx muscles push the vocal cords closer together, creating a strained or strangled delivery.

“I would say it was a very, very slow progression,” Kennedy said last week. “I think my voice was getting worse and worse.”

There were times when mornings were especially difficult.

“When I opened my mouth, I would have no idea what would come out, if anything,” he said.

One of the most common treatments for the disorder is injecting Botox into the muscles that bring the vocal cords together.

Kennedy said he received Botox injections every three or four months for about 10 years. But he called the treatment “not a good fit for me,” because he was “super sensitive to the Botox.” He recalled losing his voice entirely after the injections, before it would return days later, somewhat smoother.

Looking for a surgical solution, Kennedy traveled to Japan in May, 2022. Surgeons in Kyoto implanted a titanium bridge between his vocal cords (also known as vocal folds) to keep them from pressing together.

He told a YouTube interviewer last year that his voice was getting “better and better,” an improvement he credited to the surgery and to alternative therapies, including chiropractic care.

The procedure has not been approved by regulators in the U.S.

Johns cautioned that titanium bridge surgeries haven’t been consistently effective or durable and said there have been reports of the devices fracturing, despite being implanted by reputable doctors. He suggested that the more promising avenue for breakthroughs will be in treating the “primary condition, which is in the brain.”

Researchers are now trying to find the locations in the brain that send faulty signals to the larynx. Once those neural centers are located, doctors might use deep stimulation — like a pacemaker for the brain — to block the abnormal signals that cause vocal spasms. (Deep brain stimulation is used to treat patients with Parkinson’s disease and other afflictions.)

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Long and grueling presidential campaigns have stolen the voice of many candidates. But Kennedy said he is not concerned, since his condition is based on a neural disturbance, not one in his voice box.

“Actually, the more I use the voice, the stronger it tends to get,” he said. “It warms up when I speak.”

Kennedy was asked whether the loss of his full voice felt particularly frustrating, given his family’s legacy of ringing oratory. He replied, his voice still raspy, “Like I said, it’s ironic.”

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James Rainey has covered multiple presidential elections, the media and the environment, mostly at the Los Angeles Times, which he first joined in 1984. He was part of Times teams that won three Pulitzer Prizes.

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