Psychiatry’s Role in Stuttering: Experts Call for Treatment Guidelines and Better Clinical Support

Stuttering remains an underrecognized condition in psychiatric practice, with limited clinical guidance for assessment and treatment, according to Thomas J. Valente, MD, an adult and geriatric psychiatrist who participated in the first Interdisciplinary Clinical Advisory Meeting of the Stuttering Treatment and Research Society (STARS) in Portugal.

One of the central challenges facing clinicians is the absence of standardized treatment frameworks, Valente told Psychiatric Times. “There's a lack of understanding, information, education, knowledge,” and “there's a lack of treatment options. There's no treatment guidelines. There's no stepwise instructions.” As a result, clinicians treating stuttering may rely on individual approaches rather than evidence-based algorithms.

The international clinical advisory board was brought together by STARS to address that gap by developing guidance that clinicians across disciplines can use in practice, Valente said.

After the first day of the meeting, Valente was hopeful the organization would ultimately be able to not only establish evidence-based medicine, but also provide recommendations and treatment algorithms—a standard of care. He added he believed that clinicians across disciplines and throughout the world will be able to look to STARS for the critical information that is missing to best support individuals who stutter.

For psychiatrists, being aware and attentive is key to best supporting individuals who stutter, as stuttering frequently presents alongside other psychiatric conditions, he said. Valente described his experience treating 2 adolescent sisters, who were referred to him via STARS founder, Gerald A. Maguire, MD. The sisters developed stuttering following post-streptococcal autoimmune complications consistent with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), he said. Both patients had significant psychiatric comorbidities, including obsessive-compulsive disorder, depression, and anxiety.

In those cases, psychiatric symptoms and speech disfluency reinforced each other. “The girls' depression and anxiety worsened, and the worsening of their depression and anxiety worsened the stuttering. So it became a chicken and egg circular problem without treatment,” Valente told Psychiatric Times.

Effective management required a multimodal approach, he explained. In addition to psychotherapy and behavioral interventions, Valente initiated pharmacotherapy and later pursued genetic testing when one patient showed limited response to treatment. That evaluation identified a methylenetetrahydrofolate reductase (MTHFR) variant. As a result, vitamin supplementation was initiated and proved to be helpful. Ultimately, he said, both patients improved.

Beyond treatment, Valente emphasized the importance of addressing stigma and misconceptions surrounding stuttering. “I think one of the myths around stuttering or when people stutter is this idea that they're not intelligent,” he told Psychiatric Times.

Valente also discussed a medical student who was referred to him for depression after academic performance declined during clinical training because attendings misinterpreted speech disfluency as a lack of competence. Greater clinical awareness, Valente said, could also support appropriate academic and workplace accommodations.

Ultimately, he views interdisciplinary collaboration and improved clinical guidance as essential steps toward better outcomes for individuals who stutter. “Growing the education is part of the mission,” Valente said.

STARS is Strategic Alliance Partner with Psychiatric Times and Neurology Live.

Dr Valente is a psychiatrist in Leesburg, Florida.