Stuttering has existed throughout human history, and many mythical causes have been proposed, but we now know that it is a neurologic condition based in the brain.
Stuttering affects an individual’s fluency of speech characterized by repetitions of sounds or syllables, prolongations, and/or speech blocks. These stuttering events mostly occur at the initiation of speech or a phrase.
Emerging research has demonstrated that stuttering, for many, has a genetic basis. Genetics may account for 50-80% of stuttering risk, with identical twins much more likely to both stutter, than fraternal twins. Although specific genes have been identified, at this time, they only explain a minority of the cases of the stuttering. By combining the genetics with our growing understanding of the neurologic differences in stuttering, a parent can take solace in knowing that stuttering is a biological condition and is not caused by “poor parenting.”
We now know that stuttering can result from different causes. A percentage of childhood onset stuttering is considered an “autoimmune” stuttering, often beginning after an infection (e.g. strep throat.) Stuttering has many subtypes. Treatment is not a “one size fits all” condition.
Persons who stutter tend to have no difficulty when singing. We also know that stuttering symptoms are usually made worse by anxiety, and that the symptoms wax/wane (e.g. good days and bad days). This has contributed to the myth that stuttering is a psychological disorder caused by one being anxious, when in fact stuttering itself can lead to anxiety. Stuttering is related to disturbances in the brain’s coordination of speech through the cortico-basal ganglia-thalamocortical loop where anxiety can “tax” the circuit and make it not function well. Singing or speaking in rhythm, activates a different loop of speech which is preserved in persons who stutter. Emerging research suggests that the brain chemical messenger, dopamine, plays a central role in this regulation of speech.
Stuttering frequently occurs alongside neuropsychiatric conditions such as: attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), and tic disorders, such as Tourette Syndrome. These conditions share common dysregulation in brain circuits with stuttering.
Over half of individuals who stutter struggle with SAD, and at least one in six children who stutter have ADHD. Many treatments for ADHD have been shown to worsen stuttering, and in these cases, alternative medications or treatments should be considered.
Stuttering has been associated with the possibility of negatively impacting occupational and academic achievement. Persons who stutter have as much intelligence (perhaps even more) than others, but because of society’s emphasis on “verbal communication skills,” people who stutter face discrimination. It is vital for education institutions and places of employment not to stigmatize persons who stutter, but accommodate when necessary.
The parents and even the child can notice stuttering. The first professional contacted for advice is usually the primary care clinician or pediatrician. It is important for the physician to refer to a skilled speech language pathologist, as early intervention has been associated with more favorable outcomes. A physician should not simply take a “wait and see” approach, as not all children will “outgrow” stuttering. It is also key for the physician to work collaboratively with a speech language pathologist, and continue to monitor and treat for potential coexisting conditions like ADHD, SAD, or to consider the potential of the stuttering arising from a post-infection (autoimmune cause.) It is crucial for the physician to review any medication the child is taking, as some can cause or worsen stuttering. At times, the complexity of the child’s stuttering may warrant a referral to a specialist, such as a child/adolescent psychiatrist or pediatric neurologist to assist in treatment. Knowing that stuttering is a neurologic condition fosters understanding, decreases stigma, enhances acceptance and enables individuals and families to have access to appropriate services, accommodations, and comprehensive healthcare. The most effective treatment for stuttering should involve an interdisciplinary healthcare team as previously noted. Coordination of care with a knowledgeable speech language pathologist is key. Pharmacologic treatments are emerging as options.
At the moment, there are no medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of stuttering, though some are in development. Medications such as risperidone and olanzapine, which affect dopamine signaling, have shown benefit in some people who stutter, but can be associated with adverse side effects. Another medication, aripiprazole, has also garnered attention because of its unique way of balancing dopamine activity. Aripiprazole is FDA approved for treating Tourette syndrome in both children and adults, and has been explored in small studies and case reports involving individuals who stutter.
In addition, medications such as selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed. These are not to treat stuttering directly, but to help manage related conditions like social anxiety disorder or OCD Another medication under study is ecopipam, which targets a different dopamine receptor than older medications. While it is not yet FDA approved, it has shown promise in research studies for Tourette syndrome and is being explored as a potential option for stuttering as well.
Research is also exploring other approaches that include neuromodulation such as transcranial magnetic stimulation (TMS). Additionally, there are additional investigational treatments such as gemlapodect whose positive data in adult stuttering was recently presented. While these interventions remain experimental and not readily available, they represent meaningful progress in expanding treatment options and improving outcomes for people who stutter.
Speaking Up : Practical Tips for Parents
Parents and families can foster a healthy environment for their loved one by:
- Showing patience and interest when speaking slowly
- Allowing them to finish their own sentences
- Maintaining natural eye contact
- Responding to the message, not to the stutter
Although stuttering is relatively common, there remains a lack of knowledge among our healthcare community.
References
1. Polikowsky, H. G., et al. (2025). Large-scale genome-wide analyses of stuttering identify genetic risk loci and shared neurodevelopmental pathways. Nature Genetics.
https://www.nature.com/articles/s41588-025-02267-2
2. Vanderbilt University Medical Center. (2025, July 28). Large-scale study defines the genetic architecture of stuttering.
https://news.vumc.org/2025/07/28/large-scale-study-defines-genetic-architecture-of-stuttering/
3. Wayne State University – College of Liberal Arts and Sciences. (2025). Groundbreaking study confirms stuttering’s genetic roots.
https://clas.wayne.edu/news/groundbreaking-study-confirms-stutterings-genetic-roots-66922
4. NPR / North Country Public Radio. (2025, September 3). What causes stuttering? It might be in your DNA.
https://www.npr.org/2025/09/03/nx-s1-5506134/biology-genetic-testing-stutter-speech
5. Callier, V. (2025). Genome-wide study makes a quantum leap in understanding stuttering. Science.
https://www.science.org/content/article/genome-wide-study-makes-quantum-leap-understanding-stuttering
6. SheikhBahaei, S., et al. (2023). Stuttering as a spectrum disorder: A unifying hypothesis. Frontiers in Neuroscience.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10663130/
7. Maguire, G. A., Yeh, C., & Ito, B. S. (2020). The pharmacologic treatment of stuttering and its neuropharmacologic basis. Frontiers in Neuroscience.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7118465/
8. Neef, N. E., et al. (2024). Neurobiological models of developmental stuttering: Knowns and unknowns. Brain Sciences.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10883586/
9. Stuttering Treatment and Research Society (STARS). (2024). ORPHEUS Study: Gemlapodect (NOE-105) in the treatment of adults with childhood-onset fluency disorder.
https://stutteringresearch.org/research/orpheus-study-breakthrough-research/
10. Knowable Magazine. (2020). The new neuroscience of stuttering.
https://knowablemagazine.org/content/article/mind/2020/new-neuroscience-stuttering
11. National Institutes of Health – PubMed Central. (2023). Clinical and neurobiological perspectives on stuttering.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7118465/
ABOUT THE AUTHOR:
Dr. Gerald Maguire is a California based physician specializing in psychiatry, the leading medical authority on stuttering, and who is a person who stutters himself. He founded STARS (Stuttering Research and Treatment Society) with a mission to destigmatize stuttering and improve the lives of the more than 3 million people who stutter. Stuttering Treatment and Research Society (STARS) is the first non-profit organization dedicated to advancing neuroscience research and therapies for this condition. STARS is providing free educational resources to all healthcare professionals and is supporting advancements in stuttering research. We invite readers to follow our progress through our website www.stutteringresearch.org
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