Stuttering, Research, and the Push for FDA-Approved Therapies: A Conversation With Dr. Gerald McGuire, MD

Stuttering is a complex neurodevelopmental speech disorder that affects more than 1% of adults and an estimated 4% of children worldwide. Despite its prevalence and clear neurologic underpinnings—often linked to basal ganglia dysfunction and dopaminergic signaling—it remains an overlooked condition with no FDA-approved therapies. The Stuttering Treatment and Research Society (STARS) was founded to address this gap, bringing together physicians, researchers, and allied specialists to raise awareness, improve physician education, and drive much-needed research toward effective treatments.

During the 1^st annual STARS meeting, held September 13^th in California, founder Gerald McGuire, MD, sat down to discuss some topics related to stuttering. McGuire, professor and chair of psychiatry and neuroscience at UC Riverside School of Medicine, answered questions on the mission behind STARS, the limited but evolving treatment landscape, as well as ways clinicians can help treat comorbidities in patients with stuttering. Furthermore, he spoke about the importance of distinguishing stuttering from anxiety disorders while addressing associated conditions such as social anxiety or ADHD.

NeurologyLive: Can you talk to us a little bit about the unmet needs and why STARS was started?

Stuttering is a unique condition in that it’s recognized in both the ICD and DSM, yet we still don’t have any truly effective, FDA-approved treatments. This is despite the fact that stuttering has existed since the dawn of human history. We know, for example, that Demosthenes, the great ancient Greek orator, was also a person who stuttered. Stuttering has no known boundaries—it’s occurred throughout recorded history, across every language, and in all cultures.

And yet, despite this universality, we still don’t have evidence-based, FDA-approved treatments that can address the disorder. There’s some suggestion that early speech therapy can help children who stutter, but when it comes to adults, there’s an even bigger unmet need. Unfortunately, the medical community has largely ignored stuttering as a condition. That was one of the main drivers behind creating the Stuttering Treatment and Research Society, or STARS. I share this condition personally with more than 1% of adults worldwide, and more than 4% of children are affected. We started STARS to educate physicians, spur research, and bring more attention to a disorder that’s been largely left behind.

What are some of the treatments currently available?

We do know that some forms of speech therapy can be helpful for certain individuals. But stuttering is much more complex than just one condition—it has different causes, courses, and comorbidities. Childhood-onset stuttering, for instance, is often the first form physicians encounter, and the first responsibility of a physician in that situation is to consider what may be causing it.

There are also medications commonly prescribed for comorbid conditions, like ADHD, OCD, or tic disorders, that can actually worsen stuttering in some cases. So, part of our role as physicians is to evaluate whether a patient is on a medication that might be exacerbating their stuttering. There are even rare cases where stuttering may have an autoimmune component, triggered by an infection that cross-reacts with the nervous system.

We also know stuttering frequently coexists with other conditions such as ADHD, OCD, social anxiety disorder, and tics. Treating those underlying or coexisting conditions is essential. The majority of research suggests a link between stuttering and elevated dopamine activity, especially in the basal ganglia, which interferes with the timing and initiation of speech. That’s why medications that act on dopamine pathways—particularly dopamine antagonists—have shown benefit in smaller randomized trials, even though nothing is FDA-approved yet.

For psychiatrists, we can also turn to cognitive behavioral therapy, particularly to address the social anxiety that so often develops in people who stutter. CBT can be a very effective adjunct, helping patients manage the anxiety without worsening the stuttering itself. There’s also some early research into device-based therapies, like TMS, but again, nothing is yet approved. The bottom line is that physicians need to approach stuttering in a multifaceted way—rule out exacerbating factors, treat comorbid conditions, and consider both behavioral and pharmacologic strategies, even though we don’t yet have a gold standard therapy.

For psychiatrists seeing patients with comorbid anxiety, ADHD, or other conditions, what does the evidence say in terms of treatments they should try or avoid?

That’s a really important question. First, I want to clarify that stuttering is not highly associated with schizophrenia, though dopamine medications used in schizophrenia can sometimes overlap with treatments we consider for stuttering. I would say stuttering is more comparable to Tourette’s disorder, where dopamine-active medications can reduce symptoms.

SSRIs, for example, can be very helpful in treating coexisting social anxiety, but they don’t address the stuttering itself. Anti-anxiety medications, similarly, don’t address the core neurologic disorder. Stuttering is not an anxiety disorder—it’s a speech motor disorder with neurologic underpinnings. The anxiety that develops is secondary, often because of the social impact.

So, the goal of treatment is to carefully assess which medications a patient is on, identify any that might worsen the stutter, and then consider adding a dopamine antagonist or partial agonist where appropriate. That approach has the best evidence so far. For the coexisting anxiety, OCD, or tics, we can certainly address those, but we can’t make the mistake of assuming that treating the anxiety alone will resolve the stuttering.

Is there anything else you’d like to share?

Yes—please stay tuned to the work of STARS. This organization was formed to fill a huge gap in research and clinical education around stuttering. We’ll be hosting CME events, building collaborations with physicians, neurologists, psychiatrists, speech-language pathologists, and psychologists, and really pushing to make sure stuttering is no longer ignored.

I speak as both a physician and as a person who stutters when I say that this community has suffered too long in silence. We need FDA-approved treatments, we need better evidence-based care, and we need to work together across disciplines to make that happen. That’s what STARS is all about, and I look forward to building this future with colleagues across medicine.

Transcript was edited for clarity.