Why Psychiatrists Should Screen for Stuttering Before Treating Anxiety, OCD, or ADHD

Stuttering is frequently overshadowed in psychiatric practice by the very comorbidities it helps drive, Gus Alva, MD, Medical Director of ATP Clinical Research, told Psychiatric Times at the first Interdisciplinary Clinical Advisory Meeting of the Stuttering Treatment & Research Society (STARS) in Portugal.

“Advancing an understanding of stuttering is ultimately what this is all about,” Alva said, describing the meeting as an effort to move disfluency out of the margins and into routine clinical awareness. Although information exists, he suggested it has remained “somewhat arcane” and insufficiently prioritized in everyday practice.

For psychiatrists, the core issue is diagnostic sequencing. “Oftentimes we end up treating the comorbidities that exist with the problem, whether that be social anxiety disorder, whether that be OCD, whether that be ADHD,” Alva explained. In many cases, stuttering is identified only after treatment for these conditions has begun. “We’re typically just addressing those comorbidities and then subsequently kind of teasing out, ‘Oh, well, wait, there's stuttering going on as well.’”

Alva argued that this order should be reversed. When persistent stuttering is not directly addressed, downstream consequences may include negative self-feelings, even suicidal thoughts, limited opportunities, he said. For psychiatrists, this reframes disfluency as more than a communication issue; it may be a driver of mood symptoms, avoidance, and functional impairment.

He also acknowledged the stigma surrounding stuttering, comparing it to how psychiatric disorder are sometimes treated— “like the ugly stepchild.” Yet, as with other once-marginalized conditions, improved recognition can shift outcomes. “The important thing is recognition, and then subsequently, the desire to do something that can shape somebody's life in a more positive manner,” Alva said.

Central to that effort is interdisciplinary care. Alva praised STARS’ vision of integrating neurology, psychiatry, psychology, speech therapy, and educational disciplines to create “a better conduit for people to have more information” and access appropriate interventions, whether speech therapy, cognitive behavioral therapy, or pharmacologic treatment.

For practicing psychiatrists, the takeaway from Alva is practical: Screen intentionally for stuttering in patients presenting with anxiety, OCD, ADHD, or social withdrawal; consider its role as a primary driver of distress; and collaborate across disciplines to address both fluency and psychiatric sequelae in tandem.

Dr Alva is a board-certified psychiatrist and the Mood Disorders Section Editor for Psychiatric Times.

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