A new consensus statement issued by an international multidisciplinary panel convened by the Stuttering Treatment and Research Society (STARS) highlights the neurologic aspects of childhood-onset fluency disorder (stuttering), recommending greater physician involvement in diagnosis and management.

“This is the first statement to address this commonly misunderstood condition,” Gerald A. Maguire, MD, founder of STARS and lead author of the statement, told Medscape Medical News.

Maguire, director of residency training and chair of psychiatry at College Medical Center in Long Beach, California, explained that STARS assembled 35 representatives from around the world drawn from the fields of psychiatry, neurology, and speech-language pathology, as well as individuals themselves affected by stuttering.

According to Maguire, the statement is “a call to action that we shouldn’t ignore the 80 million people who struggle with this disorder worldwide; and that we, as a greater medical community, need to engage, understand, and research better treatment options for people who stutter.”

The statement also emphasizes that physicians should take a more active role, said Maguire, staff psychiatrist at Maguire Neuropsychiatric Institute of Oroville Hospital, Oroville, California. That includes physician involvement during the diagnostic workup and treatment, referrals to relevant professionals, with interdisciplinary care becoming the standard in persistent stuttering.

Neurobiological Framework

The central statement, endorsed by 94% of participants, is that stuttering “should be recognized by the broader medical community as a heterogeneous biological brain-based disorder.” Almost no participants supported “purely psychiatric classifications.”

“Current evidence supports a neurobiological model for stuttering that points to disruptions in neural timing, sensorimotor integration, and speech-motor control,” Maguire said.

The panel concurred that there appears to be a genetic component, with research suggesting multiple associated genomic regions and genes, including some that overlap with those implicated in autism and depression. A minority of cases may be autoimmune in origin, consistent with disorders classified as pediatric autoimmune neurologic syndrome.

Neuropsychiatric conditions that often occur comorbidly with stuttering include attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, social anxiety disorder, and tic disorders.

The Central Role of Physicians

The panel agreed that a “comprehensive approach is needed to diagnose childhood-onset fluency disorder, and physicians and other medical professionals are central to the process.”

The approach incorporates developmental history, speech measures, family history, patient-reported outcomes, and neurologic and psychiatric evaluation. Panelists identified substantial gaps in standards for severity, biomarkers, subtyping, prediction of persistence vs recovery, recognition of comorbidities, and differentiation of clinical profiles.

Early intervention is crucial, they said. Over 90% of panelists endorsed interdisciplinary care for persistent stuttering involving family medicine, pediatrics, psychiatry, neurology, speech-language pathology, and psychology. Most regarded speech therapy as the “cornerstone of care.”

Barriers include shortages of trained clinicians, poor professional awareness, access limitations, and financial constraints. Treatments were considered limited.

Therapeutic Approaches to Take and to Avoid

The panelists raised concerns about medications for comorbid disorders. In particular, dopaminergic stimulants used to treat ADHD can exacerbate stuttering in some patients.

Roughly three quarters endorsed behavioral and off-label pharmacologic approaches, such as dopamine-modulating or dopamine-blocking agents, although no medication is approved for stuttering. Selective serotonin reuptake inhibitors may help comorbid social anxiety but not core stuttering symptoms. Benzodiazepines lack consistent long-term efficacy and carry dependence and withdrawal risks.

The panelists displayed less enthusiasm, according to the document, for neuromodulation and device-based treatment, agreeing further exploration is necessary.

Education and Research Needed

Clinician education is needed as is public education to reduce stigma.

The panelists encouraged training medical and office staff to support patients who stutter. Staff should show patience, maintain eye contact, and allow the patient to speak without interrupting to finishing their sentences.

The panel also stressed that outcomes should extend beyond speech fluency. All participants agreed that stuttering can affect multiple areas of life, identifying communication confidence, social participation, emotional well-being, and occupational functioning as important outcomes.

The authors concluded that future priorities “need to include development of standardized diagnostic frameworks, validated outcome measures, and accessible treatment pathways.”

Not One-Size-Fits-All

Commenting for Medscape Medical News, Martin Levinson, MD, of Medical Center Pediatrics, Bingham Farm, Michigan, said the most common presentation of stuttering that he sees is a developmental condition that starts around age 2 and dissipates within 6 months, without any intervention.

Levinson, a clinical instructor at Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, has practiced general pediatrics for 46 years, with particular focus on the neurodivergent community. His first approach is to try to wait out the 6 months before initiating a diagnostic workup or intervention, unless the problem worsens over that time.

He agreed that the population of people with persistent stuttering is extremely diverse, so no approach will be universal. In the absence of a “gold standard either defining the process or governing how to address it, the bottom line is to individually tailor [treatment] to the person.”

Richard Jackson, MD, founder and owner of Neurobehavioral Medicine Group, an outpatient psychiatric treatment center in Bloomfield Hills, Michigan, said the consensus statement is very helpful, noting that it fills a gap because there has been no previous guideline and there are currently no FDA-approved treatments for stuttering.

“It feels to me that we are, with stuttering, where we were a while ago with Tourette syndrome, when people thought [the tics] were no more than behavioral mannerisms,” said Jackson, associate clinical professor of psychiatry, Wayne State University and Oakland University William Beaumont Schools of Medicine. “With stuttering, people think it’s ‘just a phase’ and likely caused by anxiety.”

But when it doesn’t resolve, it creates difficulties in all aspects of the person’s life. “Understanding the impact of stuttering on patients is an important part of the statement.”

Maguire, Jackson, and Levinson reported having no relevant financial relationships.

Batya Swift Yasgur MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD.