Do you, or a loved one, suffer from stuttering? Or do you have voice problems that impact your ability to communicate at home and at work?

Kristl Alphonso, Robyn Foo, Gan Hui Hui, Gwyneth Lee, Valerie Lim, Deirdre Tay and Laura Chua, Speech Therapists from the Department of Speech Therapy at Singapore General Hospital, give detailed answers to your questions.

Question by michellelhg

I am a 20 year old who has just stepped into the workforce. I realize that all these while I have been experiencing difficulty in conducting error free conversation whenever I am talking to people who I am not close to. Is this a psychological problem? Please advise.

Answered by Speech therapist Speech therapy department Singapore General Hospital

From your description, it is difficult to conclude if the main cause of your speech errors is psychological. People who do not stutter do experience normal dysfluency when they speak.

These dysfluencies may increase in certain situations e.g. increased planning difficulties during spontaneous conversations, increased anxiety and/or time pressure. However if you experience blocks, repetitions and prolongations, you may be stuttering.

Blocks are tense stoppages in the air flow during speech resulting in periods of silence; repetitions are sounds which are repeated e.g. b-b-b-bat and prolongations are tense continuations of sounds e.g. ssssssssss-un. I know it can be frustrating to be dysfluent. I would definitely suggest a consultation with a speech therapist, experienced in fluency treatment, who can provide professional advise on what to do.

Question by mazel

I have heard that there might be cases of people who stutter but are able to sing very well like a normal person. Is that true, and how is that possible?

Answered by Speech therapist Speech therapy department Singapore General Hospital

Singing, as well as other activities such as chorus reading has been well documented in research to induce fluency. Research on the effect of singing on people who stutter has shown an immediate reduction in dysfluencies by over 90%. Various explanations such as increasing phonation duration and changing intonation, as well as increasing familiarity, have been offered to account for the reduction.

Question by junejia

I have a friend whom I just know has minor speech problem. I only realise that is a speech problem when another friend of mine told me so. What I noticed was, whenever I communicate with him, I only feel that he replied softly. So I never thought it was a speech problem. So I have to always makes him repeat what he had just said. I am not sure if he feel frustrated if I were to ask him repeat so many times what he just said. Is there a better way for us to communicate smoothly? Can I asked him to increased his volume when he speak? Will this hurt his feelings?

Answered by Speech therapist Speech therapy department Singapore General Hospital

There may be many reasons to why your friend is replying softly. He could naturally be a very soft-spoken person, or he may have some other underlying speech difficulty which he is aware of and does not wish to let others know. If it is the latter, the soft volume of speech may be his way of masking that speech difficulty.

If you are having difficulty understanding your friend, and by him increasing the volume of his speech will help you understand him better, then gently tell him that. Let him know that you are trying to understand him and you do not want to frustrate him by making him repeat. If he is concerned that he has a speech difficulty, direct him to seek help with a Speech Therapist.

Question by siopoh

I stammer and stutter and work closely within a team of management staff and contractors. My questions are: 1 Is stammer/stuttering contagious or infections physiologically in that sense? I do realize that that after sometime those whom dont stutter do now and then but not as obvious as me. 2 Is stuttering inheritable? Seems my young daughter sometimes do and we are trying to correct her. Thank you.

Answered by Speech Therapist Speech Therapy Department, Singapore General Hospital

1. Stuttering is developmental and is not contagious or infectious. The reason why you notice dysfluencies when people who do not stutter speak is this: normal dysfluency is inherent in speech. An example of normal dysfluency is revisions, which happens when a person revises spontaneously what he wants to say e.g. “I was thinking…err…saying that…” Although people who do not stutter can be dysfluent, the types of dysfluencies differ from that of people who stutter (PWS). For example, PWS may have obvious block e.g. have stoppages of airflow when speaking but people who do not stutter do not.
2. For a condition to be hereditary, it must be shown that genetic factors which cause the condition have passed from parent to child. So far, studies have not been able to localize the gene for stuttering. It is therefore not possible to neither refute nor confirm if stuttering is hereditary. However, studies have found that 50% to 66% of people who stutter report a relative who stutter. As such, if your child has someone in the family who stutters, she has a higher chance of stuttering over a child who does not have relatives who stutter.

When a child presents with a query of stuttering, the general rule of thumb is that an assessment should be sought regardless. Stuttering is chronic and intractable if left untreated and has serious disabling effects. I would advise that your child seeks the professional opinion of a speech therapist who specializes in fluency as soon as possible, to decide if she requires treatment. Stuttering in children before the age of 5 is extremely treatable if treatment is done by a trained speech therapist using evidence-based practice.

Question by nai9pc

What has been published are passive help for people who stutter by mainly being patient and respectful to them. How can we (in our ordinary encounters) help these people more actively to overcome their hinderance (excluding the "expected answer" of seeking speech therapists ~ whose help I would expect to be more intense, deeper and faster)?

Answered by Speech therapist Speech therapy department Singapore General Hospital

As a rule of thumb, we suggest that you treat people who stutter with the same respect you would like to be treated with. This often involves allowing them to finish what they have to say and listening to them attentively, respectfully and patiently without cutting them off, finishing their sentences for them or putting unnecessary pressure on them.

People who stutter are individuals in their own right and have their own personal preferences with regards to what kind of help they would like from others. Some people who stutter may prefer to not speak about their stutter whilst others may be very open about it.

If you know a of a person who stutters and are close to them it is best to ask them what you, as a friend, can do to help them. Some people who are undergoing treatment may ask for your help to practice techniques that they have learnt in speech therapy or they may just be happy knowing that they have your support as a friend.

Question by arra1997

What treatments are available for school children who stutter

Answered by Speech therapist Speech therapy department Singapore General Hospital

Depending on the age of the school-aged children and the severity of their stutter, treatment can vary from simple behavior management approaches that are traditionally used with younger children to more complicated approaches that require a complete change in the speech pattern.

Some examples are self imposed time-out and self-modeling. As school-aged children are beginning to develop their own autonomy but may still lack maturity, they may not always be compliant with treatment approaches that require a lot of parental involvement and may also have difficulty taking responsibility for the practice and use of treatment strategies taught.

Therefore, treatment at this age often focuses on reducing the severity of the stuttering instead of achieving minimal stuttered speech.

Question by gohbeekuan

Can speech therapy cure the problem of stuttering, or does it just minimize its occurrence?

Answered by Speech therapist Speech therapy department Singapore General Hospital

Stuttering is a motor-speech disorder and there is no known cure. If identified and treated early (before the age of 6 years old), there is a very good chance that the child will be stutter-free for many years after treatment.

For older children, adolescents and adults, the stutter will always be present but specific speech strategies can help to control the stutters, resulting in stutter-free speech. This, however, requires a constant awareness and monitoring of one’s speech and the internal motivation and conscientiousness to continually use the speech strategies to control the stutters.

Question by mosmos

I am already in the workforce for about 10 years. However, whenever I speak to a client or higher authority, my voice will stutter. I did not realise that my speech was shuttering until when my colleagues had noticed it and asked me why am I afraid of the client. I felt very embarassed and stress after that incident. Whenever I was asked to handle a client, I tend to use excuses and pass it to my other colleagues. I am unsure where can I find affordable specialist for treatment.

Answered by Speech therapist Speech therapy department Singapore General Hospital

It is hard to determine if you are stuttering or are encountering some normal dysfluencies. People who do not stutter can also exhibit dysfluencies in their speech and, stress, tiredness and anxiety can be some factors that make people more dysfluent. These factors can also increase the severity of stutters in people who stutter.

Therefore, it is advisable for you to see a Speech Therapist to determine first and foremost if you are stuttering or not and what treatment is available for you. Public Hospitals generally provide services that are affordable to the general public. You should consult a doctor to obtain a referral to see a speech therapist.

Question by octane

I am a 60 year old homemaker. I am okay with my speech to my children, family, friends and strangers. However my children told me that, whenever I need to ask a formal question, whether over the phone to a customer service officer or over at the bank counter teller, I will tend to repeat a single word or last longer than normal. Do I need treatment in such cases?

Answered by Speech therapist Speech therapy department Singapore General Hospital

Usually, people who stutter, stutter across all situations, but may report that their stuttering worsens in some stressful or anxious situations, for example when they are speaking to people of authority, on the phone or strangers. I am not sure if you are noticing milder stuttering when you speak with your children, family, friend or strangers.

We need to determine if you stutter or are just having normal dysfluencies. Whether you wish to seek treatment or not also depends on how bothered you are about your speech. The question you need to ask yourself is: “Is your speech bothering you or disrupting your day to day functioning/communicating.”

Seeking treatment can be more important and deemed necessary by some individuals while others may not be bothered by their speech and prefer not to seek treatment.

Question by charmingtail

My mom is a teacher. Why do teachers get voice disorder more frequently? How are voice disorder evaluated and treated? what can we do to prevent it? Thanks

Answered by Speech therapist Speech therapy department Singapore General Hospital

Teaching is an occupation with high vocal demand as teachers use their voices continuously for long hours and often at raised volume. Throat muscles involved in voice production, and vocal cords, which come together and vibrate to produce voice, can become strained under these conditions. Background noise from students, poor classroom acoustics, and inadequate voice rest also add to vocal demand.

It is important to note that vocal pathologies such as nodules and polyps can develop because of strain and effort over extended periods. These factors can affect how the voice sounds, which can affect the teacher’s ability to teach and communicate with students effectively.

Some warning signs of a voice disorder are throat discomfort or soreness, running out of breath while speaking, vocal fatigue, difficulty in projecting the voice, and change in voice quality (e.g. rough, hoarse, husky). If these symptoms persist for over two months, an ear, nose and throat (ENT) doctor should be consulted.

To evaluate vocal pathologies, an ENT doctor usually takes a medical history, and performs a laryngoscopy to visually examine the voice box Treatment options differ among the various voice disorders, but commonly involve referral to a speech therapist. The speech therapist will evaluate factors contributing to the person’s voice disorder, and recommend individualised approaches for managing the voice. These include voice care strategies, lifestyle changes,voice exercises and training to improve the vocal mechanism.

Some preventive tips to help minimise injury to the vocal cords include:

• Keeping hydrated with water across the day (approximately 2litres/day)
• Conserving the voice
  • Rest the voice when it is tired or not needed
  • Use a microphone/ loud speaker
• Adjusting classroom or student layout for teachers
• Avoiding oily, spicy, fried foods, and citrus, carbonated and caffeinated drinks. They promote acid reflux, which refers to stomach acid coming up the throat. Acid reflux can cause tissue swelling in the voice box
• Avoiding ‘pushing’ the voice if it changes, or if experiencing cold or flu symptoms.

Question by Cindy Sim

Hi I have a colleague who stutters since young age.

During presentation and even at discussion, we sort of find it irritating for him to stutter so often that we already knew what he was going to say or conclude.

Could you be able to provide advice how to minimize his stuttering or even improve his condition.

Thank you,
Cindy Sim

Answered by Speech therapist Speech therapy department Singapore General Hospital

The severity of people who stutter can vary from very mild stuttering to very severe stuttering. Stuttering can interfere with the time taken to get the message across. If it is difficult to continue to pay attention to your friend and wait for him to complete his sentence, it is best to ask him what he would like you to do when he gets stuck.

Some people who stutter do not mind you completing his/her sentence, while others may feel offended and prefer that you wait till their message is completed. Some tips on how to interact with people who stutter:

• Let them finish what they are saying. Focus on what they are saying instead of how they are saying it. Be patient.
• Maintain eye contact and body language which show you are listening.
• Give them their turn in a conversation.
• Don’t imitate or tease them about their speech.
• In cases of severe stuttering where there are long periods of dysfluencies, you may ask if they are alright with writing their message down.
• If you are close to this person, you may ask them if there is anything they would like you to do when they stutter. Each individual has their own preference for how they cope and would like to be treated

The above tips are ways to reduce factors that potentially make the stutters worse. You may also suggest that your colleague seeks a consultation with a speech therapist to explore treatment options.

To improve his stuttering, he can approach the speech therapy department for an initial assessment with a speech therapist. A speech therapist who is specialized in the treatment of stuttering will be able to provide information counseling about available treatment which may help him be more fluent.

Question by restemp85

Is stuttering heriterary all the time? My hubby stutters but his immediate and extended family members dont. I wonder if my newborn baby will have speech problem too?

Answered by Speech therapist Speech therapy department Singapore General Hospital

The cause of stuttering is still unknown. What is known is that it is a physical disorder that may have a genetic component. In twin studies, if one identical twin stutters, there is a 90% chance that the other twin will stutter. Researchers have recently identified the chromosome associated with stuttering. This supports the theory of genetics as a possible cause of stuttering. However results are preliminary and cannot be used to account for all individuals who stutter.

About 60% of people who stutter have a family history of stuttering and it affects boys more than girls at a ratio of 4:1. People who stutter are predisposed, meaning that it is determined in the make up of a child whether a child will stutter or not. If you have a family member who stutters, there will be a higher change that their children may stutter. However, we cannot predict who will stutter or how severe it will be. But rest assured, treatment for stuttering in the preschool years is very effective.

The onset for stuttering is usually around the age of 2 to 4 years old. If your child is suspected to be stuttering, please bring them to see a Speech Therapist who is trained in carrying out the Lidcombe Program. The Lidcombe program has been extensively researched and is currently the Gold Standard of treating Preschoolers who stutter.

Question by fate-destiny

My Younger Sister Whenever She Is Feeling Nervous Or Anxiety,She Tends To Stutter.Until Now,She Finds It Hard To Find A Job As She Is Afraid To Go For Job Interviews.When A Person Is Feeling Fear In The Heart,Is It A Normal Reaction For A Person To Stutter?

Answered by Speech therapist Speech therapy department Singapore General Hospital

People who stutter may stutter more in situations which can cause raised anxiety. For people who do not stutter, this may also be the case. Anxiety causing situations may give rise to the “stage fright” phenomena, where people who do not stutter find it very difficult to speak in front of an audience. This may also give rise to more dysfluencies.

It is common for people who do not stutter to have dysfluencies, although the rate of dysfluencies as well as the type of dysfluencies differ. It seems your sister may have raised anxiety about interviews. Seeing a speech therapist may help your sister identify if speech or anxiety is the bigger issue resulting in her fear.

Question by Mirzi Ramos

Hi can I ask what is the main cause why most of the I stutter? Is it because I always sleep very late and I do smoke? Thanks

Answered by Speech therapist Speech therapy department Singapore General Hospital

It is unlikely that "sleeping late" and "smoking" cause stuttering. The exact cause of stuttering is currently unknown. However, the disorder is known to be hereditary and genetically linked. That means that an individual has a higher chance of stuttering if they have a family member who also stutters. This notion is supported by studies of twins where twin concordance (the probability that a pair of individuals will both have a certain characteristic) was found to account for 70% of cases of stuttering (Felsenfeld et al., 2000). Brain imaging studies suggest that people who stutter may have a problem with neural processing of spoken language.

However, if you are a person who has been diagnosed with stuttering, then your stuttering can become more severe when you are tired, stressed or anxious. These conditions do not cause stuttering in the first place; they merely exacerbate the stuttering.

Ref: U11 ​