Communication disorders on this page include

• Stuttering
• Social communication disorder
• Speech sound disorder
• Language disorder

People with stuttering, called childhood onset fluency disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), have problems with the flow and timing of speech. It can involve repeated sounds and syllables (“I would like m-m-m-more please”), lengthened consonant and vowel sounds (“that sssounds like fun”), physical tension when producing words, or pauses in speech. The disorder involves a disturbance in normal speech pattern that is inappropriate for the individual’s age.

Symptoms include at least one of the following:

• Sound and syllable repetitions
• Prolonging consonant or vowel sounds
• Broken words (e.g., pauses within a word)
• Pauses in speech, silent or filled (audible or silent blocking)
• Substituting words to avoid problematic words (circumlocutions)
• Having excess of physical tension when producing words
• Single syllable whole-word repetitions (e.g., “I-I-I-I see him”)

The disorder is diagnosed when the speech disturbance interferes with school, work or social communication. The severity of the symptoms can vary from situation to situation, and they are often more severe when there is special pressure to communicate (such as when giving a report at school or interviewing for a job). The stuttering often does not occur when the person is reading out loud, singing, or talking to pets or inanimate objects.

Stuttering can contribute to a person’s stress and anxiety, and stress and anxiety can worsen the problem of stuttering. A person who stutters may become anxious or fearful in anticipation of the problem and may try to avoid certain words or sounds or avoid certain speech situations, such as using the phone or speaking in public. For some, the stuttering is accompanied by physical movements (such as eye blinks, tics, tremors of the lips or face, jerking of the head or fist clenching) seen in Tourette’s Syndrome.

The disorder usually begins in childhood between age 2 and 7 years. Typically, stuttering starts gradually, with repetition of initial consonants, first words of a phrase, or long words. For most children the problem ends on its own by adolescence. But for an estimated 3 million people in the U.S., stuttering persists into adulthood. An estimated 5% of people will experience stuttering in their lives. Stuttering runs in families, and research has shown it is associated with specific problems in how the brain works in relation to speech.

The stuttering should not be attributed to a speech motor or sensory deficit associated with a neurologic insult such as a stroke.

Treatment

Treatment for children and adults generally involves speech therapy with a specially qualified speech-language pathologist. Early intervention is essential to achieving the best outcomes. If a child shows symptoms of stuttering, parents/caregivers should seek an evaluation from a qualified speech language pathologist.

When stuttering continues into late adolescence and adulthood, treatment may include talk therapy, medication, and/or speech therapy. Although no medication is approved by the FDA for stuttering, several studies have shown that medications may be helpful for some.

Misperceptions

Unfortunately, there are still stigma and misperceptions relating to stuttering. For example, contrary to common misperceptions: people who stutter are not just nervous or shy by nature; stuttering is not generally caused by emotional trauma; and stuttering is not just a habit people can break.

Respectful Approaches

What can you do to be respectful and helpful when in conversation with a person who stutters? Here are some suggestions from the Stuttering Foundation:

• Don’t make remarks like: “Slow down,” or “Take a breath.” These are not helpful and can be felt as demeaning.
• Let the person know by your manner that you are listening to what he or she says — not how they say it.
• Maintain natural eye contact and wait patiently and naturally until the person is finished.
• Try to avoid finishing sentences or filling in words.
• Speak in an unhurried way, though not unnaturally slow.

More Information

• National Stuttering Association 
• Stuttering Foundation of America
• StutterTalk: Stuttering Association for the Young in Australia (weekly podcasts)
• Friends: The National Association of Young People Who Stutter

   

Physician Review

Evelyn M. Rodriguez Thomas M.D., M.P.H., MBA, FAAP

September 2024

  References

When we engage in conversation, we follow many unspoken rules, such as turn-taking, personal space and appropriate tone and volume. Most children learn these rules fairly naturally or with a bit of prompting. But for some, understanding and following the rules of social communication is extremely challenging.

Children with social communication disorder may say inappropriate or unrelated things during conversation and their challenges may lead to problems making and keeping friends. However, they generally don’t have trouble with the mechanics of speaking—they can pronounce and understand words and create sentences.

Communication problems may be noticeable in some children by age 4 or 5, but for others, problems may not become obvious until later when communication becomes more complex. Many of the characteristics of social communication disorder are also seen in people with autism, however, autism also involves repetitive behaviors and fixed interests. To be diagnosed with social communication disorder, autism spectrum disorder must be ruled out as diagnosis, and patients cannot have any history of restricted and repetitive behaviors.

A variety of treatment approaches are used to help individuals with social communication disorder. Interventions generally focus on increasing the individual engagement and independence in their daily activities. They can involve individual clinician-directed interventions and group interventions to practice communication skills and social interactions, such as social skills groups. Treatment typically involves collaboration with a variety of professionals (e.g., classroom teachers, special educators, psychologists, and vocational counselors).

Interventions may also include the use of social scripts or Social Stories™. Social scripts use as visual aids or written conversations to help students learn and practice skills such as greeting someone or asking for help. Social stories explain a specific situation, such as a visit to the doctor, from the child’s perspective. They are designed to help the child understand what to expect and how to respond appropriately. (Read more from the American Speech-Language-Hearing Association and Head Start. )

Physician Review

Darja Djordjevic, M.D., Ph.D.

August 2025

People with speech sound disorder have difficulties producing speech and they are often hard to understand. It can lead to problems in school or social situations.

Producing speech sounds requires both the phonological knowledge* of speech sounds and the ability to coordinate the movements of the jaw, tongue, and lips with breathing and vocalizing. Children with speech production difficulties may have difficulty with either understanding speech sounds or with articulation.

Learning to produce speech sounds clearly and accurately and learning to produce connected speech fluently are developmental skills. Among typically developing children, overall speech should be intelligible by age 4. By age 7, most speech sounds should be produced clearly, and most words should be pronounced accurately. Normal variations in speech, including regional, social, or cultural/ethnic variations of speech, should be considered in determining a diagnosis.

A speech sound disorder is diagnosed when speech sound production is not what would be expected based on the child’s age and developmental stage. A speech-language pathologist can test a child’s speech and language and provide treatment if needed. They can help children learn the correct way to make sounds and when sounds are right or wrong, and practicing sounds in different words. Most children with speech sound disorder respond well to treatment and speech difficulties improve over time. Some children require continuing special services throughout their elementary school years.

*Phonological awareness is a group of skills relating to working with sounds in spoken language. Learn more.

Physician Review

Darja Djordjevic, M.D., Ph.D.

August 2025

A child with language disorder has difficulties with learning and using language, including spoken, written, or sign language. Problems are usually with vocabulary and sentence structure. The child’s language abilities are substantially below that expected for age and significantly interfere with effective communication, school or socialization. The child’s first words and phrases are likely to be delayed and vocabulary less varied than expected.

Language disorder develops in early childhood, up to age 24 months. However, it needs to be distinguished from normal variations in development and cultural/ethnic variations, and the distinction may be difficult to make before 4 years of age. In addition, the difficulties must not be the result of hearing or other sensory or motor issues, intellectual disability, or another medical or neurological condition.

Language disorder can be diagnosed and treated by a speech-language pathologist. Language disorder is associated with other neurodevelopmental disorders, including specific learning disorder, attention-deficit/hyperactivity disorder and autism spectrum disorder. Academic problems tend to involve reading and writing. In spite of persistent problems, most children with language disorder do finish high school, while some go on to college, and most live independent lives.

Physician Review

Darja Djordjevic, M.D., Ph.D.

August 2025