HOW TO TREAT STUTTERING (STAMMERING) 2025

HOW TO TREAT STUTTERING (STAMMERING) 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 34

STUTTERING (STAMMERING)

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 34

STUTTERING (STAMMERING)

I. DEFINITION  

Stuttering is a speech disorder characterized by prolonged repetitions of sounds, syllables, or words, or hesitations and pauses that disrupt the rhythm and flow of speech. Its prevalence is approximately 1% in the general population, based on surveys in Europe and the United States.

II. ETIOLOGY  

Multiple factors contribute, including genetics, neurological issues, and psychological influences:  

– Organic Model: Stuttering results from incomplete hemispheric differentiation or abnormalities in the dominant brain hemisphere.  

– Learning Model: Stuttering emerges as a learned response to early childhood speech dysfluencies.  

– Cybernetic Model: Speech is a product of regulated responses; stuttering occurs when this process is disrupted.

III. DIAGNOSIS  

1. Definitive Diagnosis  

– Typically begins between 18 months and 9 years, with peak onsets at 2-3.5 years and 5-7 years.  

– Some children with stuttering also exhibit other language issues, such as articulation disorders or expressive language deficits.  

– Progresses gradually: from repeating initial consonants to entire words at sentence starts or longer words.  

– Children may read or sing normally despite stuttering.  

– Four Stages:  

1. Preschool (Stage 1):Episodic, with high recovery potential.  
2. Elementary School (Stage 2):Persistent, with rare fluent periods.  
3. Late Childhood/Early Adolescence (Stage 3):Context-specific (e.g., classroom recitations, phone use, speaking to strangers).  
4. Late Adolescence/Adulthood (Stage 4): Fear of specific words/situations, avoidance tactics, circumlocution, and anxiety-related behaviors (e.g., blinking, tics, trembling, lip twitching).  

– ICD-10 Criteria:  

  – Persistent, recurring speech disruptions (repetitions/prolongations of sounds/syllables/words, or hesitations/pauses) severe enough to impair fluency.  

  – Duration ≥3 months.

2. Ancillary Testing  

– Routine Tests: Complete blood count, biochemistry, urinalysis, ECG, abdominal ultrasound, chest X-ray.  

– Organic Cause Investigation: EEG, CT/MRI brain.  

– Psychological Assessments: Beck/Hamilton depression scales, Zung/Hamilton anxiety scales, RADS (child depression), DASS (anxiety-depression-stress), DENVER II (development), CBCL (child behavior), Vanderbilt (ADHD).

3. Differential Diagnosis  

– Early School-Age Dysfluency: Normal developmental hesitations; children remain relaxed, unlike the tension seen in stuttering.  

– Spasmodic Dysphonia: Speech disruption with abnormal breathing patterns.

IV. TREATMENT  

1. Treatment Principles  

– Comprehensive individual and family assessment before therapy.  

– Combine behavioral interventions and pharmacotherapy.  

– Address co-occurring disorders (e.g., anxiety, depression).

2. Specific Treatments  

Psychotherapy & Behavioral Interventions:  

– Target specific difficulties to reduce stuttering.  

– Mitigate secondary symptoms, encourage speech attempts.  

– Examples:  

  – Self-Therapy: Teaches individuals to manage stuttering by altering related behaviors and reframing emotional responses, reducing fear and fostering proactive control.  

  – Fluency Shaping: Rebuilds speech patterns, focusing on slowing speech rate and smooth sound transitions. Effective for adults but faces challenges with maintenance and relapse prevention.  

– Other Techniques:  

  – Breathing/relaxation exercises to slow speech and adjust volume.  

  – Distraction methods (e.g., rhythmic arm/hand/finger movements while speaking).  

  – Suggestion/hypnosis.

Pharmacotherapy:  

– Options (1-3 drugs):  

  – Benzodiazepines: Reduce anxiety.  

  – Antidepressants: Tricyclics (e.g., amitriptyline), newer agents (SSRIs: sertraline, fluoxetine; SNRIs: venlafaxine).  

  – Antipsychotics: Quetiapine, olanzapine, risperidone for severe cases or co-occurring conditions.  

– Supportive: Neuroprotectants (piracetam, ginkgo biloba, vinpocetine, choline alfoscerate, nicergoline), liver support, cognitive enhancers, nutrition (B vitamins, minerals, digestible diet, IV nutrition if needed).

V. PROGNOSIS AND COMPLICATIONS  

– 50-80% of children recover spontaneously.  

– Persistent stuttering into school age affects peer relationships and academic performance.  

– Late complications include restricted career choices and advancement.

VI. PREVENTION  

– Encourage children’s speech opportunities without interruption.  

– Early recognition and intervention are key. Distinguishing normal dysfluency from stuttering is challenging, so parents/teachers should watch for warning signs (e.g., frequent word repetitions, hesitations, tension during speech). If concerns arise, prompt evaluation and intervention are recommended.

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