Stuttering is not just a technical difficulty with speech; it is an invisible burden that a person constantly carries. It changes self-esteem, relationships, professional opportunities, and often affects even self-identity. Society, which equates fluent speech with speed of thought and intelligence, often fails to notice the effort and internal struggle behind every word spoken.
Today, on World Stuttering Awareness Day, we should reflect not only on how speech sounds but on how we listen.
The condition once called “logoneurosis” is today recognized as a multifactorial neurodevelopmental disorder that requires an integrated approach, empathy, and modern therapeutic intervention.
On this topic, we speak with Tekla Ghonghadze, a Speech-Language Pathologist and specialist at the “Logomed – Center for Speech Development and Correction,” who works directly with people who have to cope daily with this invisible, yet very real, difficulty.
In your experience, how has the attitude towards so-called logoneurosis or stuttering changed in Georgia over the years? How has the perspective developed from the Soviet-era terminology to the definition of a speech disorder recognized by modern international classifications?
Today, worldwide, public awareness about stuttering has increased sharply, however, the quality and intensity of this process differ across countries. Developed countries have numerous non-governmental organizations, educational programs, and support platforms that promote increased social inclusion, the expansion of therapeutic services, and the creation of an adapted work environment.
A relatively different picture is found in low- and middle-income countries, including Georgia, where therapeutic resources, professionals, and public knowledge are somewhat limited. It is true that teletherapy and online platforms have successfully developed in recent years, increasing accessibility, but it is still not enough.
Stuttering is an invisible burden; in its essence, it transcends a speech problem, fundamentally changing a person’s social identity, cultural expectations, educational opportunities, and participation in professional life. That is why a culturally sensitive society is obligated to help everyone carry this burden, which is unimaginable without the active participation of the whole society, clergy, doctors, and teachers in the process.
In Georgia, as in many other countries, unfortunately, social stigma for people who stutter remains an acute problem. In our culture, continuous and fluent speech is associated with wisdom, self-confidence, and social attractiveness. Accordingly, when a speech impediment appears in a person’s speech—be it the repetition of a sound, syllable, word, or phrase, sing-song speech, pauses, or silent blocks—it is often assessed as unpreparedness, incompetence, or mental instability, despite modern research refuting this.
Children are particularly vulnerable. Children who stutter are often ridiculed and excluded by peers. For example, according to research from Georgia State University, more than 80% of children who stutter are victims of bullying. Such negative social feedback often leads to decreased self-esteem, social anxiety, and avoidance of public activity, which further exacerbates the condition in the long run. In adulthood, these symptoms often turn into so-called “anticipatory anxiety”—the expectation of a speech situation arouses fear, causing people to avoid communication. They often change words or completely refuse public speaking, which leads to a reduction in professional opportunities, personal relationships, and social engagement.
When a speech disorder is accompanied by concomitant behaviors—facial grimaces, changes in expression, involuntary body hyperkinesia, accessory maneuvers, eye blinking—society perceives this as a sign of nervousness or insincerity, which makes people feel unacceptable, misunderstood, and excluded.
Regarding terminology, in post-Soviet countries, stuttering was perceived as a synonym for logoneurosis, as it was considered a neurosis of speech—logoneurosis. Stuttering is also discussed as neurotic stuttering in the psychiatric encyclopedia authored by Akaki Gamkrelidze, where it is considered a form of neurosis.
Today, logoneurosis is no longer used as a synonym for stuttering, as it represents a multifactorial disorder that develops through the interaction of genetic/epigenetic, neurodevelopmental, speech motor/sensorimotor, linguistic/cognitive, and emotional/social factors.
Stuttering, in the modern sense, is a complex neurodevelopmental disorder in which the free fluency, tempo, and rhythm of speech are disrupted due to a deficit in motor planning and execution.
What are the main therapeutic approaches used for the treatment of stuttering in your practice? Since every language is different, is an individual approach required for Georgian-speaking patients, and adaptation to cultural norms of speech?
Today, the gold standard for stuttering treatment is considered to be complex therapy, which aims to regulate all speech motor acts: breathing, voice production, phonation, resonance, articulation, and the tempo and rhythm of speech.
All of this is achieved through breathing exercises, diction exercises, autogenic training, correction of speech muscle tone, physiotherapeutic procedures, regulation of speech tempo and rhythm, computerized correction, and special applications created for smartphones, which allow them to implement therapeutic techniques regardless of their constant location.
An individual approach is naturally needed to take into account the cultural norms of the language, specifically orthoepyand prosodic features. In general, stuttering is a problem where, in the correction process, linguistic differentiation is considered to a relatively lesser degree, unlike specific articulatory disorders.
What impact does early intervention have on the progress of speech therapy? At what age is it desirable to start therapy, and what differences do you notice between patients who start treatment at an early age and those who seek help later?
I would highlight favorable and less favorable periods for the treatment of stuttering. It is recommended to start treatment from the age of 4-4.5 years; this is the most favorable period, as the child’s fixation on the speech impediment is minimal or completely zero. There is practically no fear of speech, logophobia, which greatly simplifies the therapeutic process and the stabilization of the optimal tempo and rhythm of speech.
A less favorable period is puberty—adolescence—when due to serious endocrine shifts occurring in the body, the nervous system cannot fully control the processes, and the elimination of the speech impediment becomes very difficult due to increased emotionality and sensitivity. Furthermore, in this period, the adolescent’s fixation on the speech deficit is much higher, and logophobia manifests to the highest degree, which also complicates the achievement of the desired result.
The age after 20 is quite a favorable period, when, more or less, coexisting with the deficit proceeds with moderate calmness, everything is understood, and there is a readiness not to spare oneself. Therapy is much more effective at this age, and a much more stable result is achieved.
Stuttering is often accompanied by emotional and social difficulties—anxiety, avoidance of public gatherings, or low self-esteem. How do you integrate the management of these psychological aspects with the technical exercises for speech skills in your therapeutic process?
In adolescents and adults, due to high fixation on the speech impediment, the need for additional psycho- and auxiliary medication therapy often emerges. However, it is enough for them to believe in their own abilities, that they can avoid blocks, and they already manage self-control and fluent speech—all anxiety first decreases, and then disappears.
In your opinion, how do slang terms such as: “enablu,” “bluquni” (Georgian slang terms for stuttering) and others affect the attitude of patients and their families toward this condition? Does this affect their readiness to seek help from a specialist or the expectations they have for therapy?
I will reiterate that stuttering is an invisible burden, so any such assessment not only exacerbates it but makes it impossible to bear. They are forced to hide their speech and hide themselves. Stuttering is an attempt to hide that you stutter; accordingly, the more you hide it, the more you stutter, and the person begins to revolve in a vicious circle, which makes their existence unbearable.
In one case, they seek specialists; in another, they are ashamed to go to a specialist, and a sense of hopelessness and helplessness, and distrust towards everything appears. In the fight against stuttering, a person’s state of mind is practically decisive.
Outwardly, it seems like a technical speech impediment, but in real life, it is a severe socio-emotional problem: isolation, anxiety, stigma, and self-limitation.
We all must remember that solving the problem requires not only therapy but also an integrated approach, culturally adapted education, advocacy, the expansion of technological support, and widespread public awareness.
Tekla Ghonghadze, Speech-Language Pathologist at the “Logomed – Center for Speech Development and Correction”
