One of the more common questions I receive from clinicians and parents is simply this: “Is stuttering neurological?”
Answering this question directly and clearly is important, not only because it is valuable for people to have an accurate understanding of what stuttering is (and what it is not) but also because we want to address the underlying anxiety that the question may convey. When parents and others ask if stuttering is neurological, the subtext is often something like, “does that mean that there’s nothing we can do about it?” Or, even, "does my child have brain damage?"
Here’s how I approach the question. First, I affirm that it is good that the parent/clinician is asking that question, because this means that they are open to learning more about stuttering. Too often, people operate on old ideas or misperceptions about stuttering—and in our field, we have many old ideas and misperceptions that people have to wade through in order to get to current understandings of the condition. Thus, I take it as a great first step that they are curious.
Second, I let them know that yes, indeed, we now know that stuttering is associated with differences in both neural function and neural structure. (Indeed, we have known this for many years. The first research paper documenting differences in blood flow in the brains of those who stutter dates to 1990, and since then, there have been dozens of papers highlighting many aspects of the differing neurology in people who stutter.) Thus, we can say with some certainty that stuttering arises due to differences in the brain. It is not a psychological disorder, though it can certainly have significant psychological consequences for those who live with the condition. And, it is not a learned behavior, though learning plays a significant role in how and when people stutter.
Third, I point out that knowing about the neurological underpinnings of is important, but it still does not explain everything. For example, we still do not fully understand why these neurological differences lead to disruptions in speech production. It's a long way from the brain to the mouth, I'm afraid, but research is ongoing.
Finally, I emphasize that simply knowing that stuttering is neurological in origin does not negate any of the good work that speech-language pathologists can do to help those who stutter. In fact, it underscores the importance of helping people who stutter come to terms with the fact that they are different—and that it is okay to be different.
This knowledge also helps to explain the difficulties that we are likely to have with fluency-only treatments: being fluent all the time is simply not the way the brains of people who stutter work. It takes effort for them to speak in a different way in order to enhance their fluency—a lot of effort —and that is why we so often see high relapse rates in fluency-focused therapies. For this reason (and many others), therapy can and should incorporate multiple components. Some people will indeed work on their fluency, but many will also learn to handle moments of stuttering more effectively so that stuttering is less disruptive to their communication (i.e., they will stutter more easily). And, most will likely need to work on acceptance and desensitization so they can cope successfully with the fact that they stutter.
Understanding the neurological origin of the disorder also helps us recognize that stuttering is not the result of them doing something wrong. It’s just the way their brains work, and it's not their fault.
So, next time someone asks you whether stuttering is neurological, take it as an opportunity to educate them about stuttering and to provide these with all important messages: there is hope for people who stutter, and stuttering is not their fault! This knowledge can make a real difference in how they view the condition and in how they view themselves.
