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November/December 2024
November/December 2024 Issue Acquired Stuttering in Older Adults The onset of stuttering in older adults can have a wide-ranging impact. Imagine living a lifetime—65 if not 80 or 90 years—communicating the entire time exactly how and when you want, with little thought to the sounds in the words you choose or the speed and ease with which you will be able to say them. Then, something happens, perhaps a stroke, and suddenly, on top of everything else that can stem from a medical event such as that, you develop a stutter. It becomes more challenging to communicate and, perhaps, more anxiety inducing. The combined stigmas of stuttering and age can lead to perceived and real judgment from others and social withdrawal by the individual. It can change the way a person’s life, even at an advanced age, is lived. Stuttering is not uncommon. It affects an estimated 80 million individuals worldwide and 3 million in the United States alone. But it’s most typically thought of in connection with children. In fact, the National Institute on Deafness and Other Communication Disorders reports that stuttering “occurs most often in children between the ages of 2 and 6 as they are developing their language skills. Approximately 5% to 10% of all children will stutter for some period in their life, lasting from a few weeks to several years.”1 Approximately 75% of children who stutter will stop stuttering, with just 25% of them continuing to stutter into adulthood. However, childhood onset or developmental stuttering is not the only type. Stuttering can also develop in an adult without a history of childhood stuttering. Under the umbrella of the term acquired stuttering, such an occurrence is typically the result of a neurological medical event such as a stroke or psychological trauma. While both manageable and potentially treatable, an acquired stutter can have a hard-felt impact on an older adult as they struggle to come to terms with the difference between who they were, who they now are, and who they will be as a communicator. Acquired Stuttering That does not mean, however, that acquired stuttering is unusually rare. It occurs with some frequency in individuals who experience specific physical and emotional medical events. “The emergence of stuttering in adulthood, particularly over the age of 65 as the only problem the person is having is really quite rare, but on the other hand, a degree of stuttering following stroke is not uncommon. Following a traumatic brain injury, stuttering is not terribly uncommon, and it occurs fairly frequently in conditions like Parkinson’s disease as well,” according to Joe Duffy, PhD, BC-ANCDS, emeritus consultant and a professor of speech pathology at the Mayo Clinic. “But usually in those conditions stuttering is only one of a number of problems. How you approach management of the stuttering depends a good deal on the other problems present.” The type of acquired stuttering that occurs after neurological damage from a medical event, such as those Duffy mentions, is neurogenic stuttering. While there may not be data on how often it occurs, specifically in older adults, the majority of diagnoses that can lead to it are more common in older adults. For instance, the average age of onset for Parkinson’s disease is 60 years old, a 2024 study from the University of California found that 13% of adults older than 65 have a traumatic brain injury, and the risk of stroke doubles every decade after age 45, with 70% of all strokes occurring after age 65. Other diagnoses that can lead to the development of a neurogenic stutter include multiple sclerosis, tumors or cysts, and diseases such as meningitis. In addition to neurogenic stuttering, there is also psychogenic or emotional stuttering. John A. Tetnowski, PhD, CCC-SLP, BCS-SCF, ASHA-F, Jeanette Sias Endowed Chair in Speech Pathology, a professor in the department of communication sciences and disorders, and director of the Stuttering Research and Treatment Lab at Oklahoma State University, explains that psychogenic stuttering happens “following a severe traumatic event—something that has really been a big emotional trauma in their lives.” This could easily apply to is a soldier, for example. “We have a lot of soldiers fighting all over the world, and they’re exposed to roadside bombs. They can have a concussive injury that can lead to a neurogenic stuttering, but in the absence of neurogenic documentation, [it is possible] that they were so emotionally impacted by that event that they can indeed start to stutter, as well,” he explains. In older adults, emotional trauma may occur as the result of the loss of a spouse, the loss of one’s home or independence, elder abuse and neglect, or after a terminal diagnosis. Duffy describes psychogenic stuttering, instead, as functional stuttering. He notes that with functional stuttering, the stutter can develop with an explanatory psychological event but can also develop when a condition cannot be identified. “It’s one of the reasons the term functional is now used by many in place of psychogenic,” he says. Heather Grossman, PhD, CCC-SLP, BCS-F, executive director of the American Institute for Stuttering and a board-certified specialist in fluency disorders, adds, “Another category is pharmacological. Changes in medications and how they’re received can result in a stutter.” The Behavior “With psychogenic stuttering and neurogenic stuttering, all bets are off,” he continues. You can still classify repetitions and prolongations, fewer blocks, but you can still classify them. But you may see them in the middle of a word. You may see them at the end of a word. You may see them with a stereotyped sort of sound to them that sounds different than regular stuttering. You just don’t necessarily see the expected patterns.” And it’s important to note that the stutter itself is not the only symptom. Tetnowski describes the ABCs of stuttering to explain the complexity of it. They are the following: • Affective—the feelings that go along with the stutter; • Behavioral—the physical responses, such as the prolongations, repetitions, and blocks that Yaruss describes; and • Cognitive—the often negative thoughts and beliefs about the stutter. The Impact “With stuttering onset in later life, one often struggles with a lack of understanding and bewilderment,” according to Gerald A. Maguire, MD, DLFAPA, chair/director of residency training in the department of psychiatry at the College Medical Center in Long Beach, California, and the principal investigator at CenEXel-CIT in Bellflower, California. “Older adults might struggle with changes in their self-identity, especially if they previously had fluent speech and now need to adapt to a new way of communicating.” Yaruss agrees, noting that “One of the biggest problems with an acquired stutter is that people can [often] clearly remember a time when they didn’t stutter. They can remember that they used to be able to speak more easily and that can contribute to significant shame, and that can affect a willingness to go out, even more than a willingness to say something.” When older adults withdraw from their activities, whether going to work, seeing friends and family, volunteering, or participating in a community group, because they fear exposing their stutter, they risk socially isolating themselves. Isolation is already a public health concern for older adults, with an estimated one-quarter of individuals considered to be socially isolated. According to the CDC, those individuals are at greater risk for dementia, heart disease, stroke, depression, and suicidal ideations. Treatment Of course, how a stutter is treated depends, as Duffy mentions, on the event that led to it. If an individual had a stroke, for example, they may be more focused on recovering mobility and learning what they will be able to do and not do moving forward. A speech language pathologist is often a part of the care team but may focus on safe swallowing and aphasia, if present, first. With a psychological trauma, a psychiatrist or psychologist will likely be part of the team. For some, Tetnowski says, if they are able to manage their trauma effectively or work through it, the stuttering may stop quickly. When the stuttering is the primary focus, at least for the speech language pathologist, a big first step is helping the individuals understand their stutter. A part of that might even mean helping them realize that the stutter is something to work on and not something with a quick fix, such as a medication or procedure. Stuttering, after all, is complex. Speech is complex. “[Speech] requires a precision of so, so many areas of the brain. We know that it’s not just in one area; it’s the communication between areas. There are a lot more things that could go wrong,” Grossman says. But that can be a challenge to explain to adults with an acquired stutter, especially if they’re getting inaccurate information or feedback about that stutter from other health professionals. “I’ve seen people who have begun to stutter after an auto accident. You say, look, we know something happened. There was this physical event that knocked your system off track, and we know that it was significant because you had this neck injury,” Duffy says. “For one reason or another, this has manifested in your speech as stuttering. And then often a patient will say, ‘Well, my doctors tell me there’s nothing wrong with me.’ “My response to that is ‘Of course there’s something wrong! You can’t talk! If we were to image your brain in a sophisticated way, we would see that your brain would not be acting like a normal brain when you talk. Are you willing to work hard with me in therapy?’ And if they are on board and therapy is undertaken, about half of the patients that I have seen with functional stuttering may normalize their speech in one or two sessions.” The treatment will also focus on enabling the Individual to be more confident with who they are now. “One of the things that we talk a lot about in therapy is self-advocacy,” says Grossman, explaining that they (speech language pathologists) teach individuals how to educate those around them so as to lessen the assumptions and judgments that often come with a stutter. For everyone, what that advocacy is may differ. “They might say ‘I stutter. I need a little more time to say what I want to say.’ That might look like, depending on the person, them having a card in their pocket that reads ‘I am a person who stutters.’ That kind of advocacy can really help a person feel less stressed.” Grossman also emphasizes that there’s no need for perfection. Everyone has disfluencies and errors in their speech. Waiting to speak until it can be perfect will only lead to silence. Support “Older adults who stutter can find comfort and understanding from peers who have similar experiences. This mutual lived experience—and the sharing of it with others—can help reduce feelings of isolation and loneliness. It validates their feelings, helps build friendships, and reduces isolation, which can be common among all people who stutter and especially older adults,” Maguire says. “Being a part of a peer group can also amplify the voices of older adults who stutter,” he continues, “which helps increase awareness of stuttering and reduce the stigma around stuttering that impacts the community.” The National Stuttering Association offers such opportunities with virtual meetings as well as local chapters for potential in-person connections. Through the association, as well as the American Institute for Stuttering, individuals can also obtain assistance finding a stuttering specialist, as those individuals are few and far between. With the right support and treatment, an individual with an acquired stutter may still stutter but will feel more confident and capable and less alone. — Sue Coyle, MSW, is a freelance writer in the Philadelphia suburbs.
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