What Psychiatrists Need To Know About Stuttering and Psychiatric Comorbidities

Stuttering shares neurodevelopmental pathways and psychiatric comorbidities that should directly inform assessment and medication management, according to faculty at the first Interdisciplinary Clinical Advisory Meeting of the Stuttering Treatment & Research Society (STARS) in Portugal.

Tiago Proença dos Santos, MD, a pediatric neurologist, joined speech-language pathologists Gonçalo Leal and Cátia Catita in reminding psychiatric clinicians to conceptualize stuttering within a broader brain-based framework rather than as an isolated speech problem.

“Remember that stuttering is a medical condition. You should be aware of it; you should identify it. And as is very common in neurodevelopmental diseases, they are comorbid,” dos Santos told Psychiatric Times. It is important, he added, that if you see stuttering, you should think about ADHD, Tourette disorder, tics disorder, depression, and anxiety and vice versa.

Another key takeaway is to consider covert stuttering, Leal added. “People think of stuttering as only fluency, but it is also important to look for what we call covert stuttering.” Leal explained individuals who stutter look for ways to avoid difficult words. “We know that people who have covert stuttering can develop extreme anxiety and depression,” he added. With that in mind, it is important to think beyond the classic examples of stuttering and talk to individuals about their individual experiences.

Catita, who works with Leal and dos Santos at SpeechCare in Portugal, said families may also need support. Parents may not fully appreciate what stuttering is and may come to the clinic with guilt, she said.

“This is a neurological disorder with some dysfunction at the basal ganglia,” dos Santos told Psychiatric Times, adding that commonly prescribed medications for depression and anxiety can “mix it up a little bit,” resulting in either improving or inadvertently exacerbating fluency, depending on mechanism and individual vulnerability.

The presenters repeatedly returned to the need for multidisciplinary collaboration. Given overlapping pathways among stuttering, ADHD, tic disorders, mood disorders, and anxiety disorders, psychiatrists are uniquely positioned to identify comorbidity, optimize medication regimens with speech effects in mind, and coordinate care with speech-language pathologists.

Read more from the Stuttering Treatment and Research Society (STARS).