Table 4

Treatment of functional dysfluency/stuttering

Domains of interventionExamples of possible strategies
Education and explanatory
  • Reassurance regarding nature of symptoms and good prognosis for resolution.

  • Explanation for rationale behind diagnosis of functional stuttering.

  • Explanation that dysfluencies can reflect effects of excessive muscle tension which may prevent normal speech but does not represent an irreversible or uncontrollable abnormality and that it can brought under their control.

  • Highlight the importance of forward airflow during speech to achieve smoothness.

Symptomatic Reduction of excessive musculoskeletal tension in both speech and non-speech muscles often associated with stuttering:
  • Reduce muscle tension, drawing on techniques used for functional voice disorders.

  • Select high frequency abnormal behaviours associated with dysfluencies.

  • Palpate or manipulate facial muscles or lower the larynx to reduce muscle tension.

  • Reduce muscular tension in head, neck, shoulders and postural alignment.


Eliminate secondary or accessory movements which may involve asking them to do something differently or adding a distraction which is faded out as speech normalises
  • Speak while lying on their back.

  • Invite person to squeeze a ball while speaking.

  • Invite person to sort blocks into different patterns while speaking.

  • Suggest finger tapping thumb and finger while speaking.

  • Speak while listening to music through headphones.


Modification of stuttering behaviours
Once excessive tension has been reduced, and the patient can produce some sounds, words or phrases with less struggle, normal speech may return in some cases. If not, it may be appropriate to introduce techniques currently used successfully for the treatment of developmental stuttering such as:
Speech restructuring and fluency shaping techniques, for example, the Prolonged Speech Treatment Model, the Camperdown Programme for adults who stutter, or the La Trobe Smooth Speech Clinic Programme.
These intensive treatment programmes offered individually or in groups may include:
  • Slowing rate of speech.

  • Easy, gentle onset.

  • Elongating vowels and producing prolonged speech.

  • Linking words together with controlled phrasing.

  • Emphasising speech naturalness.

  • Determining hierarchy of speaking situations with desensitisation tasks.

Psychological
  • Communication counselling attending to predisposing, precipitating perpetuating issues related to onset, presentation, and maintenance of stuttering behaviours.

  • Address abnormal illness beliefs, excessive attention and vigilance towards bodily sensations, and the sense of loss of control over speech fluency.

  • Teach person to respond to moments of stuttering and feelings of loss of control in more adaptive ways, using less struggle and tension which can be beneficial, both psychologically and physically.

  • Refer to mental health professionals for psychotherapy; acceptance and commitment therapy; or CBT for treatment of anxiety in relation to stuttering.

  • CBT, cognitive–behavioural therapy.