Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 2000 Jun 27;162(13):1849–1855.

Stuttering: an update for physicians

D Costa 1, R Kroll 1
PMCID: PMC1231378  PMID: 10906923

Abstract

Stuttering is a disturbance in the normal fluency and time patterning of speech. Developmental stuttering (DS), with or without associated psychiatric illness, is the most common form and includes all cases with gradual onset in childhood that are not the result of acquired brain damage. Persistent developmental stuttering (PDS) is DS that has not undergone spontaneous or speech-therapy-induced remission. Organic models of DS focus on incomplete lateralization or abnormal cerebral dominance. There is also evidence that DS has a significant genetic component to its cause. Neuroimaging research data and the effectiveness of dopamine receptor antagonists in DS seem to support the theory of a hyperdopaminergic origin. Speech therapy remains the main treatment for DS; however, antidepressants can be useful in selected cases. Risperidone, a serotonin-dopamine antagonist, has been shown to be more effective than placebo in decreasing the severity of stuttering. The long-term efficacy and safety of serotonin-dopamine antagonists in DS deserve further study.

Full Text

The Full Text of this article is available as a PDF (403.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abwender D. A., Trinidad K. S., Jones K. R., Como P. G., Hymes E., Kurlan R. Features resembling Tourette's syndrome in developmental stutterers. Brain Lang. 1998 May;62(3):455–464. doi: 10.1006/brln.1998.1948. [DOI] [PubMed] [Google Scholar]
  2. Ambrose N. G., Yairi E. Normative disfluency data for early childhood stuttering. J Speech Lang Hear Res. 1999 Aug;42(4):895–909. doi: 10.1044/jslhr.4204.895. [DOI] [PubMed] [Google Scholar]
  3. Ardila A., Bateman J. R., Niño C. R., Pulido E., Rivera D. B., Vanegas C. J. An epidemiologic study of stuttering. J Commun Disord. 1994 Mar;27(1):37–48. doi: 10.1016/0021-9924(94)90009-4. [DOI] [PubMed] [Google Scholar]
  4. Bloch M., Stager S., Braun A., Calis K. A., Turcasso N. M., Grothe D. R., Rubinow D. R. Pimozide-induced depression in men who stutter. J Clin Psychiatry. 1997 Oct;58(10):433–436. doi: 10.4088/jcp.v58n1004. [DOI] [PubMed] [Google Scholar]
  5. Brady J. P. Drug-induced stuttering: a review of the literature. J Clin Psychopharmacol. 1998 Feb;18(1):50–54. doi: 10.1097/00004714-199802000-00008. [DOI] [PubMed] [Google Scholar]
  6. Brady J. P. The pharmacology of stuttering: a critical review. Am J Psychiatry. 1991 Oct;148(10):1309–1316. doi: 10.1176/ajp.148.10.1309. [DOI] [PubMed] [Google Scholar]
  7. Braun A. R., Varga M., Stager S., Schulz G., Selbie S., Maisog J. M., Carson R. E., Ludlow C. L. Altered patterns of cerebral activity during speech and language production in developmental stuttering. An H2(15)O positron emission tomography study. Brain. 1997 May;120(Pt 5):761–784. doi: 10.1093/brain/120.5.761. [DOI] [PubMed] [Google Scholar]
  8. Bruun R. D., Budman C. L. Risperidone as a treatment for Tourette's syndrome. J Clin Psychiatry. 1996 Jan;57(1):29–31. [PubMed] [Google Scholar]
  9. Casey D. E. Will the new antipsychotics bring hope of reducing the risk of developing extrapyramidal syndromes and tardive dyskinesia? Int Clin Psychopharmacol. 1997 Feb;12 (Suppl 1):S19–S27. doi: 10.1097/00004850-199702001-00004. [DOI] [PubMed] [Google Scholar]
  10. Comings D. E., Wu S., Chiu C., Ring R. H., Gade R., Ahn C., MacMurray J. P., Dietz G., Muhleman D. Polygenic inheritance of Tourette syndrome, stuttering, attention deficit hyperactivity, conduct, and oppositional defiant disorder: the additive and subtractive effect of the three dopaminergic genes--DRD2, D beta H, and DAT1. Am J Med Genet. 1996 May 31;67(3):264–288. doi: 10.1002/(SICI)1096-8628(19960531)67:3<264::AID-AJMG4>3.0.CO;2-N. [DOI] [PubMed] [Google Scholar]
  11. Conture E. G. Treatment efficacy: stuttering. J Speech Hear Res. 1996 Oct;39(5):S18–S26. doi: 10.1044/jshr.3905.s18. [DOI] [PubMed] [Google Scholar]
  12. Costa A. D., Kroll R. M. Sertraline in stuttering. J Clin Psychopharmacol. 1995 Dec;15(6):443–444. doi: 10.1097/00004714-199512000-00011. [DOI] [PubMed] [Google Scholar]
  13. Costa D. Antidepressants and the treatment of stuttering. Am J Psychiatry. 1992 Sep;149(9):1281–1281. doi: 10.1176/ajp.149.9.1281a. [DOI] [PubMed] [Google Scholar]
  14. Costa D., Antoniac M., Berghianu S., Marinescu R., Boeru L., Bruja N., Gheorghiu D., Verzaru I., Uleu C., Pop A. Clinical and paraclinical aspects of tetany in stuttering. Act Nerv Super (Praha) 1986 Jun;28(2):156–158. [PubMed] [Google Scholar]
  15. Craig A., Hancock K., Chang E., McCready C., Shepley A., McCaul A., Costello D., Harding S., Kehren R., Masel C. A controlled clinical trial for stuttering in persons aged 9 to 14 years. J Speech Hear Res. 1996 Aug;39(4):808–826. doi: 10.1044/jshr.3904.808. [DOI] [PubMed] [Google Scholar]
  16. Di Rocco A., Brannan T., Prikhojan A., Yahr M. D. Sertraline induced parkinsonism. A case report and an in-vivo study of the effect of sertraline on dopamine metabolism. J Neural Transm (Vienna) 1998;105(2-3):247–251. doi: 10.1007/s007020050053. [DOI] [PubMed] [Google Scholar]
  17. Finn P. Establishing the validity of recovery from stuttering without formal treatment. J Speech Hear Res. 1996 Dec;39(6):1171–1181. doi: 10.1044/jshr.3906.1171. [DOI] [PubMed] [Google Scholar]
  18. Goldstein J. C., Waterhouse N. J., Juin P., Evan G. I., Green D. R. The coordinate release of cytochrome c during apoptosis is rapid, complete and kinetically invariant. Nat Cell Biol. 2000 Mar;2(3):156–162. doi: 10.1038/35004029. [DOI] [PubMed] [Google Scholar]
  19. Gordon C. T., Cotelingam G. M., Stager S., Ludlow C. L., Hamburger S. D., Rapoport J. L. A double-blind comparison of clomipramine and desipramine in the treatment of developmental stuttering. J Clin Psychiatry. 1995 Jun;56(6):238–242. [PubMed] [Google Scholar]
  20. Hancock K., Craig A., McCready C., McCaul A., Costello D., Campbell K., Gilmore G. Two- to six-year controlled-trial stuttering outcomes for children and adolescents. J Speech Lang Hear Res. 1998 Dec;41(6):1242–1252. doi: 10.1044/jslhr.4106.1242. [DOI] [PubMed] [Google Scholar]
  21. Heimberg R. G., Liebowitz M. R., Hope D. A., Schneier F. R., Holt C. S., Welkowitz L. A., Juster H. R., Campeas R., Bruch M. A., Cloitre M. Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Arch Gen Psychiatry. 1998 Dec;55(12):1133–1141. doi: 10.1001/archpsyc.55.12.1133. [DOI] [PubMed] [Google Scholar]
  22. Heuer R. J., Sataloff R. T., Mandel S., Travers N. Neurogenic stuttering: further corroboration of site of lesion. Ear Nose Throat J. 1996 Mar;75(3):161–168. [PubMed] [Google Scholar]
  23. Kapur S. A new framework for investigating antipsychotic action in humans: lessons from PET imaging. Mol Psychiatry. 1998 Mar;3(2):135–140. doi: 10.1038/sj.mp.4000327. [DOI] [PubMed] [Google Scholar]
  24. Lombroso P. J., Scahill L., King R. A., Lynch K. A., Chappell P. B., Peterson B. S., McDougle C. J., Leckman J. F. Risperidone treatment of children and adolescents with chronic tic disorders: a preliminary report. J Am Acad Child Adolesc Psychiatry. 1995 Sep;34(9):1147–1152. doi: 10.1097/00004583-199509000-00011. [DOI] [PubMed] [Google Scholar]
  25. Lydiard R. B. The role of drug therapy in social phobia. J Affect Disord. 1998 Sep;50 (Suppl 1):S35–S39. doi: 10.1016/s0165-0327(98)00090-1. [DOI] [PubMed] [Google Scholar]
  26. Scahill L., Riddle M. A., King R. A., Hardin M. T., Rasmusson A., Makuch R. W., Leckman J. F. Fluoxetine has no marked effect on tic symptoms in patients with Tourette's syndrome: a double-blind placebo-controlled study. J Child Adolesc Psychopharmacol. 1997 Summer;7(2):75–85. doi: 10.1089/cap.1997.7.75. [DOI] [PubMed] [Google Scholar]
  27. Stahl S. M. Basic psychopharmacology of antidepressants, part 1: Antidepressants have seven distinct mechanisms of action. J Clin Psychiatry. 1998;59 (Suppl 4):5–14. [PubMed] [Google Scholar]
  28. Steidl L., Pesák J., Chytilová H. Stuttering and tetanic syndrome. Folia Phoniatr (Basel) 1991;43(1):7–12. doi: 10.1159/000266095. [DOI] [PubMed] [Google Scholar]
  29. Stein M. B., Baird A., Walker J. R. Social phobia in adults with stuttering. Am J Psychiatry. 1996 Feb;153(2):278–280. doi: 10.1176/ajp.153.2.278. [DOI] [PubMed] [Google Scholar]
  30. Wu J. C., Maguire G., Riley G., Lee A., Keator D., Tang C., Fallon J., Najafi A. Increased dopamine activity associated with stuttering. Neuroreport. 1997 Feb 10;8(3):767–770. doi: 10.1097/00001756-199702100-00037. [DOI] [PubMed] [Google Scholar]
  31. Yairi E., Ambrose N., Cox N. Genetics of stuttering: a critical review. J Speech Hear Res. 1996 Aug;39(4):771–784. doi: 10.1044/jshr.3904.771. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES