Epidemiology of Stuttering in

the Community Across the

Entire Life Span

Ashley Craig
Karen Hancock
A randomized and stratified investigation was conducted into the epidemiology of
Yvonne Tran stuttering in the community across the entire life span. Persons from households in
Magali Craig the state of New South Wales, Australia, were asked to participate in a telephone
Karen Peters interview. Consenting persons were given a brief introduction to the research, and
Department of Health Sciences details were requested concerning the number and age of the persons living in
University of Technology the household at the time of the interview. Interviewees were then given a
Sydney, Australia description of stuttering. Based on this description, they were asked if any person
living in their household stuttered (prevalence). If they answered “yes,” a number
of corroborative questions were asked, and permission was requested to tape
over the telephone the speech of the person who stutters. Confirmation of
stuttering was based on (a) a positive detection of stuttering from the tape and (b)
an affirmative answer to at least one of the corroborative questions supporting the
diagnosis. Results showed that the prevalence of stuttering over the whole
population was 0.72%, with higher prevalence rates in younger children (1.4–
1.44) and lowest rates in adolescence (0.53). Male-to-female ratios ranged from
2.3:1 in younger children to 4:1 in adolescence, with a ratio of 2.3:1 across all
ages. The household member being interviewed was also asked whether anyone
in the household had ever stuttered. If the answer was “yes,” the same corrobora-
tive questions were asked. These data, along with the prevalence data, provided
an estimate of the incidence or risk of stuttering, which was found to range from
2.1% in adults (21–50 years) to 2.8% in younger children (2–5 years) and 3.4%
in older children (6–10 years). Implications of these results are discussed.
KEY WORDS: stuttering, incidence, prevalence, fluency disorders

I
t is important that clinicians, researchers, and health administra-
tors know the prevalence and incidence (risk) of a disorder in the
community in order to allocate sufficient resources for managing prob-
lems associated with that disorder. Stuttering is a communication dis-
order involving involuntary disfluency. It is ordinarily diagnosed early—
around age 2 in the majority of cases—and it can become a chronic
condition for up to 20% of those who stutter in their childhood (Andrews
et al., 1983; Bloodstein, 1995). Therefore, resources must be allocated to
manage stuttering in young children, adolescents, and adults. However,
the extent of the population who stutter over the total life span is not
clear, as the prevalence of stuttering in the community has only been
estimated based on studies of children (Bloodstein, 1995).
In this paper, prevalence is defined as the number of confirmed cases
of stuttering in a sample at the time the sample is interviewed. This is
known as point prevalence (Slome, Brogan, Eyres, & Lednar, 1986, p. 34).

Journal of Speech, Language, and Hearing Research • Vol. 45 • 1097–1105 • December 2002 • ©AmericanCraig
Speech-Language-Hearing
et al.: Epidemiology ofAssociation
Stuttering 1097
1092-4388/02/4506-1097

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 Incidence is usually defined as the occurrence of new
cases during a specified period of time (Slome et al., 1986,
p. 98). Although the research reported in this paper is
not prospective in design and is therefore not primarily
designed to assess the risk of stuttering (Moscicki, 1984),
it may be possible to use the data to compute an esti-
mate of the risk. This estimate was determined from
the number of confirmed stuttering cases at the time of
interview (prevalence) and the number of persons who
stuttered in the past but who did not stutter at the time
of the interview. Incidence is, therefore, defined as the
risk of the person in the sample population ever stutter-
ing over the period of the person’s life span; it is based
on confirmed cases of current stuttering as well as cases
of past stuttering.
This paper does not attempt to review the large
number of prevalence studies that have been conducted
over the past century. For this, the reader is referred to
Bloodstein (1995, pp. 105–107), who has provided a suc-
cinct review. The aim of this paper is to analyze a small
number of more recent studies that have contributed to
the current understanding of the epidemiology of stut-
tering. The review concentrates on prevalence rates in
children, adolescents, and children/adolescents with dis-
ability in addition to stuttering, in that order. The sex
ratio and risk of stuttering are also addressed.
Although a number of studies determined childhood
stuttering prevalence, there are few, if any, randomized,
stratified studies that investigated the extent of stut-
tering in the total population (Andrews et al., 1983;
Bloodstein, 1995). Currently, estimates of prevalence
are based on cross-sectional or survey research on
schoolchildren. For example, Andrews and Harris (1964)
surveyed 7,358 schoolchildren from 9 to 11 years old in
Newcastle upon Tyne, England. They relied on school-
teachers to identify children who stuttered and then
assessed each child selected by the teacher. Although
86 children were identified by teachers, only 80 chil-
dren were subsequently confirmed as children who stut-
ter. Bloodstein (1995, p. 107) reports a prevalence of
1.2% for this study (based on 86 children), but the cor-
rect prevalence rate is almost 1.1% based on 80 chil-
dren. Leavitt (1974) conducted two surveys among
Puerto Rican schoolchildren. The first was in 12 schools
in San Juan, Puerto Rico (N = 10,449, comprising 5,476
boys and 4,973 girls). The second involved Puerto Rican
children from 19 schools in New York (N = 10,455, with
5,270 boys and 5,185 girls). Leavitt also relied on school-
teachers to identify children who stuttered and then
conducted assessments to confirm the diagnosis. She
found an overall prevalence rate of 1.5% in the Puerto
Rican children living in San Juan (2.17% in boys and
0.76% in girls) and an overall rate of 0.84% in the Puerto
Rican children living in New York (1.44% in boys and
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0.23% in girls). Aron (1962), using teacher referral to
select children who stutter, surveyed 6,581 schoolchil-
dren (3,105 males and 3,476 females from 6 to 21 years
old) in 13 schools in Johannesburg and found an over-
all prevalence rate of 1.26% (83 who stuttered, 62
males and 21 females). Gillespie and Cooper (1973)
surveyed junior high and high school students in Ala-
bama. They interviewed 5,054 students (grades 7–12
by convenience sampling) and found a prevalence rate
of 2.1%. Boyle, Decoufle, and Yeargin-Allsopp (1994)
conducted a large survey of 17,110 children, from the
very young to age 17. Children were invited to partici-
pate from a register established by the National Health
Interview Survey (NHIS). The NHIS involves an on-
going survey of households within the United States
and uses a sampling procedure that is believed to be
representative of the civilian non-institutionalized
population (Boyle et al., 1994). The study was designed
to assess a number of disabilities, such as developmen-
tal disability, deafness, learning disability, and stut-
tering. The researchers found a stuttering prevalence
of 1.89% (N = 297). In contrast, Brady and Hall (1976)
conducted a survey on a very large sample (N =
187,420) of schoolchildren in Illinois and found only a
0.35% prevalence rate.
Of the above seven studies, the mean prevalence
rate in children is 1.29%. However, Bloodstein (1995)
listed 17 U.S. studies that report a mean prevalence rate
of 0.97% for school-age children and 21 non-U.S. stud-
ies that report a mean prevalence rate of 1.28%. Andrews
et al. (1983) suggested the difference between the two
rates may be due to the higher proportion of U.S. chil-
dren who remain in school after puberty. Conversely,
the difference may also be due to error arising from the
sampling and assessment methods used by many of
these studies. When the sample is not randomized and
stratified, it is not a reliable representation of the
broader population.
Although adolescent prevalence rates have rarely
been studied, Ardila et al. (1994) found a 2% prevalence
rate in 1,879 Spanish-speaking university students.
Porfert and Rosenfield (1978) found a 2.1% prevalence
rate in 2,107 students at a U.S. university. However,
both studies employed non-randomized sampling,
thereby increasing the likelihood of obtaining unrepre-
sentative samples, and both studies failed to confirm
the stuttering cases.
Prevalence rates have varied widely in studies con-
ducted on populations with disabilities. Stansfield (1990)
conducted a non-randomized survey of adult psychiat-
ric wards and relied on medical staff to send back infor-
mation on patients who had speech problems. Stansfield
then assessed the speech of a percentage of those believed
to have speech problems and found a 6.3% prevalence
 rate of stuttering in the adult psychiatric population.
Montgomery and Fitch (1988) sent survey forms to 150
schools for the hearing impaired. Only children who had
been diagnosed as having a stutter by a qualified speech
professional were counted in the survey. Just over half
the schools replied. Only 12 children out of a total of
9,930 were reported to have a stutter, and all but one
had congenital hearing loss. Montgomery and Fitch
found a prevalence rate of 0.12% in school-age children
with hearing disorders. Due to the non-randomized sam-
pling methods used, these two studies do not provide
reliable stuttering population rates for disabled persons.
Male-to-female ratios were investigated by Aron
(1962), who found a 2.9:1 (male:female) child ratio;
Andrews and Harris (1964) found a similar ratio.
Gillespie and Cooper (1973) found a child male-to-fe-
male ratio of 2.7:1, and Porfert and Rosenfield (1978)
found a ratio of 2.4:1 in university students. The major-
ity of studies have found child stuttering male-to-female
ratios of about 2.5:1 to 3:1 (Bloodstein, 1995).
Incidence studies are less common than prevalence
studies. Andrews and Harris (1964) investigated inci-
dence in a sample of 1,000 children followed from birth
up to age 15 in England (incidence was defined as the
percentage of the 1,000 children who stuttered at any
time in their life). However, there was a 25.8% attri-
tion rate over the first 5 years. The resulting sample of
875 included 43 children who were thought to stutter,
providing a 4.9% risk estimate. Ingham (1976) ques-
tioned the reliability of the incidence data from this
study for several reasons, including uncertainty
whether 16 of the 43 children actually stuttered. If the
16 are removed, the estimate of the lifetime risk of stut-
tering in the Andrews and Harris (1964) study reduces
to about 3.1%.
Mansson (2000) studied the incidence of stuttering
in Denmark. All children born on the island of Bornholm
in 1990 and 1991 were assessed for stuttering when they
turned 3 years old. The total population of this island
was 45,000. Although 1,042 children were born, only
1,021 participated in the third year. Fifty-one were be-
lieved to stutter, and only two additional cases were iso-
lated in surveys conducted 2 years later (age 5) and 4
years later (age 9). As a result, Mansson suggested the
incidence for this group of children was 5.19%. This study
is to be commended for its prospective design and sam-
pling rate. However, Mansson acknowledged that the
island’s geographic isolation and homogeneous ethnic
population limit the generalizability of the findings.
Mansson also failed to report reliability of the assess-
ment of stuttering or a definition of stuttering. Based
on a number of studies, Bloodstein (1995) and Andrews
et al. (1983) concluded that the risk of stuttering is
around 4 to 5%.
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In summary, little is known about the prevalence or
incidence of stuttering throughout the entire life span.
It is important to conduct research designed to estimate
reliably the number across all ages as well as the sex
ratio of those persons who stutter in the community. This
paper presents a study that investigated the prevalence
and sex ratio of stuttering in an ethnically heterogeneous
sample. The study also provided an estimate of the inci-
dence of stuttering.
Method
Participants and Random
Sampling Procedure
The study consisted of a random and stratified selec-
tion of households in New South Wales (NSW), Australia.
The population of NSW consisted of approximately 6 mil-
lion people during 1995 to 1996 when the data were col-
lected. The population was composed of primarily city and
suburban dwellers (74%). Almost 77% of people in NSW
were born in Australia, though the population is ethni-
cally diverse, with the most common groups in NSW in
rank order being people of European/British, Asian,
Middle Eastern, and Indian descent. Families living in
city, suburban, and rural areas across NSW were randomly
selected, so that (a) all families had equal chances of be-
ing selected and (b) the distribution of people in the sample
from these three types of areas was proportional to the
known population spread in NSW.
Our hypothesized proportion of people who stutter
in the community was 1% (0.01), and we planned to
identify up to 100 people who stutter (as this would
provide sufficient and stable numbers of people who
stutter to determine the epidemiology of stuttering).
This implies we needed a sample size of 10,000 (100/
0.01) people from whom to collect epidemiological data
regarding stuttering. As stuttering is now believed to
be genetic in origin (Ambrose, Cox, & Yairi, 1997), the
randomness of the selection process could be negatively
influenced by cluster sampling. Therefore, we aimed to
collect a larger sample than 10,000 in order to over-
come any possible influence of cluster sampling. The
final number of participating families was 4,689, con-
sisting of 12,131 individuals.
Families were selected (using 1995/96 telephone
directories) until enough households had been contacted
who agreed to participate in the survey. In accordance
with the population distribution of NSW (Australian
Bureau of Statistics, 1998), three-quarters of the sample
were from city/suburban areas in NSW, whereas the
remaining sample came from rural areas in NSW. Table
1 shows the regions sampled. If a survey is strategi-
cally conducted according to known distributions of a
Craig et al.: Epidemiology of Stuttering 1099
 Table 1. Breakdown of regions in New South Wales that were was followed (see results for response rate). The time and
selected for the survey. day of interviews was varied through the week to ensure
a high penetration rate.
Region Males Females Total

Sydney region 3,625 3,648 7,274

Central coast 277 259 536
Stuttering Definition and
South coast 111 115 226 Interviewing Procedure
Windsor area 85 80 165
Five professionals were trained to conduct the in-
Campbelltown area 289 272 561
terviews. An interview began with a brief scripted state-
Penrith area 298 312 610
Southern tablelands 103 110 213
ment of the purpose of the survey and identified the
Albury area 96 112 208 university represented. The scripted introduction in-
Bathurst area 176 169 346 cluded informed verbal consent—the interviewer asked
Cooma area 78 79 157 the person who answered the telephone for permission
Singleton area 288 269 557 to be interviewed. If the person gave consent but said
Northern rivers 186 173 359 that another time was more convenient, a new time was
New England area 158 186 344 arranged for the interviewer to call. If a young child
Western plains 102 119 221 answered the telephone, the interviewer asked to speak
Southwest plains 128 160 288 to a parent for the interview. All refusals were recorded
Broken Hill area 35 31 66
as missing data as were “no answers.” The interview
Total 6,035 6,096 12,131
was structured to include forced-choice questions so that
Note. The number of persons interviewed in each region was based on responses could be categorized. The results from each
the population distribution across the state so that the numbers sampled telephone interview were recorded on provided response
in each area of the study were proportional to the population spread forms (see the questionnaire in the Appendix).
(total N = 12,131).
Stuttering was defined to all interviewees in detail
using a standard definition (Craig et al., 1996). It was
defined as repetitions of syllables, part or whole words
population, then regional coverage rates are higher and
or phrases; prolongations of speech; or blocking of
therefore are believed to be valid representations of
sounds. Associated symptoms such as embarrassment
the population (Cannell, 1985).
and anxiety were also discussed. If requested, the inter-
Households were contacted by telephone and inter- viewer gave a demonstration over the telephone of a
views were then conducted (either during this initial con- repetition and a block. The interviewees (if not children)
tact or at a convenient follow-up time). As over 95% of were asked whether they or a member of their house-
Australian households had a telephone in 1995/96, a high hold stuttered. If they were not sure, they were encour-
penetration rate in the community was assured. There- aged to speak to other members of the family and an
fore, only a small chance existed of introducing popula- alternative time was arranged to call to complete the
tion bias into the sample. The procedure used (Dillman, interview. If the people answering the telephone believed
1978) involved the estimation of the total length of col- they or a member of their household stuttered, a num-
umns of listings for each of the telephone directories used ber of corroborative questions were then asked directly
in NSW. A sampling distance (in centimeters) was com- of the person believed to stutter, or of parents if a young
puted by dividing this estimated length by the proposed child stuttered. Questions included (a) “Has the stut-
sample size from that region. For each telephone direc- tering persisted for the last three months?”, (b) “Has
tory, a different starting point was selectd using random the stuttering caused fear and avoidance of situations?”,
numbers. This proposed sample size was then used as (c) “Has the person consulted a speech professional?”,
the sampling interval between each pair of selected tele- and (d) “Has the person had therapy for stuttering?” If
phone numbers in the telephone books. Using this proce- someone in the family was believed to stutter, the inter-
dure ensures that most of names in each directory have viewer asked for permission to speak to that member
the potential to be selected for the study (Dillman, 1978). and to tape the person’s speech over the telephone for
Table 1 shows the breakdown for the regions sampled as up to 5 minutes. If the person was a child, the inter-
well as the final sample sizes surveyed from each region. viewer asked the parents for permission to tape their
Families in which no member could speak English well child’s speech. Taping involved the interviewer engag-
enough to complete the interview were not included in ing the person believed to stutter in conversation for at
the study. If this occurred, the interviewer noted this and least 5 minutes, during which they taped the person’s
proceeded to another number. Telephone numbers that speech. During this interview, the interviewer also lis-
were disconnected or where there was no answer after tened for stuttering.
three attempts were also noted and the same procedure

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 As a person who stutters may be less likely to an-
swer the telephone, it is probable that someone in the
house who does not stutter will answer. If the person
answering believed he or she or someone else in the
household had stuttered at some previous time (that is,
is not presently stuttering), the interviewer asked for
permission to speak to the person who formerly stut-
tered and asked this person similar corroborative ques-
tions. In most cases, the interviewer was able to speak
to the person who was believed to have formerly stut-
tered. If not, the interviewer requested the information
from a person in the household who could answer the
corroborative questions.
Reliability of the Interviews
Reliability of the survey itself was also an impor-
tant consideration, and a 1-week test-retest reliability
measure conducted on 15 interviews showed 100% agree-
ment on the prevalence interview. This involved recon-
tacting families who had participated in the study. In-
terviewers were trained in the interview protocols, with
emphasis placed on establishing rapport with the re-
spondent. Interview structure and rapport are impor-
tant in ensuring the validity and reliability of telephone
sampling compared to face-to-face and self-administered
modes (Quine, 1985). Traditionally, personal interviews
are regarded as more valid and reliable than telephone
interviews. However, several studies reported no signifi-
cant differences between these modes of interview in
outcome and also in socio-demographic data obtained
(Aneshensel, Frerichs, Clark, & Yokopenic, 1982;
Cannell, 1985; Paulsen, Crowe, Noyes, & Pfohl, 1988;
Quine, 1985). Low response rate is a possible disadvan-
tage when conducting telephone interviews, but it is a
disadvantage that besets all modes of interview. Stud-
ies conducted in the United States report lower response
rates of only 3–5% for telephone interviewing compared
with face-to-face interviewing (Cannell, 1985). Telephone
samples give higher response rates than mail surveys
and share many of the advantages of the face-to-face
interview over the self-completed questionnaire. In this
study, no one who stuttered refused to be interviewed.
Validation and Reliability of
Stuttering Assessment
An accurate determination of prevalence and risk
depends on a valid and robust method of detecting stut-
tering. The five interviewers were trained in the inter-
view protocol and in the detection of stuttering. All fam-
ily or household members who were believed to stutter
were consequently interviewed for up to 5 minutes or
until at least 500 syllables were taped. During the in-
terview, and based on the above definition of stuttering,
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the interviewer decided whether the person stuttered.
The interviewer taped the speech using digital technol-
ogy (Sony Pro II TCD D10, Sony condenser microphone,
ECM-MS5) to ensure high-quality recording. The inter-
viewer then passed the tape to a co-researcher “rater”
who had over 15 years of experience in treating and di-
agnosing stuttering. The rater qualitatively and quan-
titatively evaluated the tape of the participant’s speech.
If both the interviewer and the rater agreed that the
person stuttered, they determined the frequency of stut-
tering (percent syllables stuttered or %SS) and speech
rate (syllables per minute or SPM). This was the pri-
mary measure of stuttering. To ensure reliability, an
independent rater (that is, neither the interviewer nor
the original rater) assessed a proportion of the rated
tapes for %SS and SPM. The interrater reliability of the
rater was demonstrated. The interrater reliability, us-
ing Pearson correlation coefficients with the second ex-
perienced rater, was 0.93 for %SS and 0.91 for SPM on
15 randomly selected tapes (that is, 17% of the total
number of tapes). If stuttering was diagnosed from the
tape, the corroborative evidence mentioned above was
then used to confirm the diagnosis of stuttering. The
rater and independent rater demonstrated over 96%
agreement on the diagnosis of stuttering from the tape.
When there was disagreement or no corroborative evi-
dence, the case was not considered confirmed as a per-
son who stuttered. Only confirmed stuttering cases were
used in the analysis to determine prevalence and to es-
timate incidence. Obviously, taping speech on the tele-
phone will not assess secondary aspects of stuttering
such as facial grimace, and so on. However, secondary
symptoms are extremely variable and are not generally
considered necessary to measure frequency of stutter-
ing (Bloodstein, 1995).
Results
Response rate for telephone calls was considered
satisfactory, with 63% of the telephone numbers initially
selected resulting in completed interviews (for a minor-
ity of numbers interviews were completed after 2–3
calls). This meant that for 37% of initially selected tele-
phone numbers, a second or third alternate telephone
number had to be randomly selected. Of the 37% of calls
where interviews did not occur, 19% of respondents re-
fused, giving no reason, 0.15% were too busy or unwell,
and 6.9% did not speak English well enough to com-
plete an interview. The remaining 10.95% could not be
contacted due to disconnected lines or unanswered calls.
After three attempts without contact, a new number was
selected.
The mean %SS for the sample of those who stut-
tered (n = 87) was 5.04 %SS (range of 0.5 to 24.7, SD =
Craig et al.: Epidemiology of Stuttering 1101
 3.8), and the mean SPM was 169 (range of 88 to 218,
SD = 26). All interviewees whose stuttering was con-
firmed were asked if they had ever sought treatment
(e.g., speech pathology, medical, psychological, hypno-
therapy) for their stuttering, and around 30% replied
that they had at some time received treatment (just
over 50% had never received treatment and about 20%
were unsure). Frequency of stuttering was shown to
correlate significantly and positively with seeking treat-
ment (point biserial r = 0.23, p < .05). This suggests
that those with more severe stuttering had sought treat-
ment. Table 2 also shows age and sex breakdowns in
the sample. The sample of 4,689 families consisted of
12,131 persons (6,023 males, mean age 35.5 years, SD
= 21.6, age range from less than 1 year to 95 years;
6,108 females, mean age 37.3, SD = 22.1; age range
from less than 1 year to 99 years). There was an aver-
age of 2.9 members in each of the 4,689 families inter-
viewed. There was a total of 1,638 participants age 10
or younger (13.5%)—though only children who were at
least 2 years old were included, as stuttering usually
begins around age 2—resulting in a sample of 1,622.
There was a total of 1,881 participants age 11 to 20
(15.5%), and the majority of participants (n = 8,612)
were age 21 or over (71%).
Table 2 also shows prevalence rates as well as male-
to-female stuttering ratios for all age categories. Preva-
lence was highest in the 2–5 (1.4%) and 6–10 (1.44%)
age groups and lowest in the 11–20 (0.53%) and 51 and
older (0.37%) age groups. The overall prevalence rate
for the entire sample was 0.72% (95% confidence inter-
vals (CIs) of 0.57 to 0.87). Bloodstein (1995) presented
data on the prevalence in school-age children (approxi-
mately 5–18 years) of around 1%. In this study, the
prevalence of stuttering in this same age group (5–18
years inclusive; n = 2553 with 23 persons who stuttered)
was found to be 0.9% (95% CI of 0.54 to 1.26%). Table 2
also shows sex ratios by age group. Over the total sample,
the male-to-female sex ratio was 2.3:1. It was highest in
the 11–20 age group (4:1 male:female) and lowest in the
51 and older age group (1.4:1).
Table 2. Breakdown of age by stuttering cases (SC), prior stuttering cases (PSC), prevalence, male-to-female stuttering ratios, and an estimate
of the incidence or risk of stuttering.
Age (yrs) SC PSC Total N # males
2–5 10 10 720 389
6–10 13 18 902 465
11–20 10 32 1,881 1006
21–50 42 71 5,405 2607
51+ 12 45 3,207 1556
All ages 87 176 12,131 6023
Note. There are 16 missing cases in the 2–5 age breakdown as children less than 2 years old were not included in the analysis.
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Prior cases of stuttering (those believed to stutter
in the past) are also shown in Table 2 . This allows es-
timation of the incidence of stuttering. Risk over the
entire sample was 2.2%, with, as would be expected,
the highest risk in young children (2.8% in 2- to 5-year-
olds) and older children (3.4% in 6- to 10-year-olds).
Lowest risk was in those over 50 years old (1.8%). The
risk in 5- to 18-year-olds (n = 2553 with 71 current-
stuttering and prior-stuttering cases) was determined
to be 2.8% (95% CI of 2.16 to 3.44). Data on recovery
rates can also be derived from this research. Table 2
shows that there were 87 people identified as currently
stuttering and 176 identified as stuttering in the past.
Therefore, these data provide a 67% recovery rate over
the entire life span (176/263).
Discussion and Conclusion
This paper presents epidemiological data on the
prevalence, sex ratio, and estimated risk of stuttering.
The study was conducted within an ethnically hetero-
geneous population in Australia, strengthening its ap-
plicability to other populations that are also ethnically
heterogeneous. Furthermore, it provides the first at-
tempt to estimate the prevalence of stuttering across
the entire life span using randomly selected households
that are stratified for region (city, suburban, and rural).
The prevalence of stuttering over the entire life span
(from age 2 on) was found to be 0.72% with at least a
50% higher prevalence rate of stuttering in males (2.3:1
male-to-female ratio). A 0.72% prevalence rate is rea-
sonable given that it is accepted that many children
naturally recover from stuttering (Bloodstein, 1995). A
higher prevalence rate of around 1.4% was found in chil-
dren (2 to 10 years), with male children again having a
higher prevalence of stuttering (2.3 to 3.3:1). In adoles-
cence (11 to 20 years), the prevalence rate fell substan-
tially to 0.53%, with boys much more likely to stutter
(4:1 ratio). However, prevalence increased in adulthood
(21–50 years) to 0.78% (2.2:1 ratio), falling once again
Prevalence (95% CI) M:F ratios Risk (95% CI)
1.4% (0.54–2.26) 2.3:1 2.8% (1.6–4.0)
1.44% (0.66–2.22) 3.3:1 3.4% (2.2–4.6)
0.53% (0.20–9.86) 4:1 2.2% (1.5–2.9)
0.78% (0.55–1.01) 2.2:1 2.1% (1.7–2.5)
0.37% (0.16–0.58) 1.4:1 1.8% (1.3–2.3)
0.72% (0.57–0.87) 2.3:1 2.2% (1.3–2.3)
 in late middle to older age (0.37% for 51+ years), with
males again stuttering more frequently than females
(1.4:1 ratio). It is interesting to note the 95% confidence
intervals for all the prevalence data in Table 2. The
prevalence rates found by the majority of studies re-
viewed in this paper fall within these 95% confidence
intervals. It is also interesting to note that the 95% con-
fidence intervals for the prevalence of school-age chil-
dren found in this study (5–18 years; 0.9% prevalence,
CI range from 0.54% to 1.26%) covers the estimates
quoted by Bloodstein (1995), who suggested that the
prevalence in the United States was 0.97% and outside
of the United States was 1.28%.
The results of this study highlight two possibilities,
that (a) the accepted prevalence of around 1% in younger
children is too low and (b) the accepted prevalence of
around 1% in adolescence is too high. The prevalence
rates in Table 2 suggest that more realistic figures may
be 1.4% in younger children and only 0.5% in adoles-
cents. The 1.4% prevalence rate in children found in the
current study is substantially higher than Bloodstein’s
(1995) estimate and is closer to the mean prevalence
rate of 1.3% from the seven studies critiqued in the first
section of this paper. The results of the current study
strongly suggest a higher prevalence rate in younger
children be accepted as the status quo. Significant clini-
cal issues arise that will affect the management of stut-
tering in younger children if the prevalence of the disor-
der is underestimated. For example, assuming that 14%
of a population of 200 million people falls in the age range
of 2 to 10 years, a 1% prevalence rate of the number of
children who stutter at any one time is 300,000. How-
ever, if the prevalence is at least 1.4%, then the number
of children stuttering is underestimated by 120,000
(420,000 rather than 300,000 children may be expected
to stutter). If this underestimation of prevalence were
the case, then the clinical load for clinicians treating
children would be high, with long wait times. Services
for adults who stutter would be severely reduced as a
result. This clinical scenario is a reality in Australia.
The lower prevalence rate in adolescents should not
be unexpected given that the trend in the treatment of
children who stutter is to treat the stutter early rather
than wait hoping that spontaneous remission will occur
(Lincoln & Onslow, 1997). In addition, a significant pro-
portion of children’s stuttering is thought to spontane-
ously remit before adolescence (Yairi & Ambrose, 1992).
Recovery from stuttering has been estimated to be at
least 70% from longitudinal research (Yairi & Ambrose,
1992) and is now believed to be both more frequent in
females and genetically transmitted (Ambrose, Cox, &
Yairi, 1997). This study shows an estimated recovery
rate over the entire life span of almost 70%. The increase
in prevalence through early to middle adulthood may
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also be due to relapse (Craig et al., 1996), or to other
factors not yet understood. Perhaps it also reflects a
greater willingness to discuss ones’ stuttering. The de-
crease in prevalence in older ages cannot yet be ex-
plained. As found elsewhere, more males than females
stuttered, but the sex ratio also changed over the life
span (a 3 or 4 to 1 male-to-female ratio in older chil-
dren, with an expected smaller ratio in younger chil-
dren and perhaps unexpectedly, down to 2.2:1 in early
to middle adulthood, and further down to 1.4:1 in older
adults).
Risk of stuttering is best generated from prospec-
tive designs in which new cases of stuttering are deter-
mined over a designated period of time in a population
that is initially nonstuttering. This study provides only
an estimated risk of stuttering, as risk was partly based
on the memories of those interviewed (those who were
believed to stutter in the past). As a result, this study
could only provide a lower bound on the risk of stutter-
ing due to the above design limitations and the assump-
tion that people are unlikely to stutter after adolescence.
The estimated risk in children ranged from 2.8% to 3.4%
in the present study. This is lower than expected if one
accepts the findings of Andrews and Harris (1964) or
Mansson (2000) that the risk is closer to 5% in children.
Inspection of Table 2 shows that the 95% confidence in-
tervals came close (upper limit of 4%) to the figures found
by the above authors. However, it may be, as argued
above, that risk in the Andrews and Harris study is closer
to 3%, a figure that concurs with the findings in the
present study. The Mansson finding of 5% may be over-
estimated due to design limitations or may truly reflect
a high risk in an isolated population. Further research
is needed to determine the risk of stuttering, using a
prospective study conducted on a randomly selected
heterogeneous population in which stuttering is care-
fully diagnosed and assessed. There are no existing data
on risk throughout the life span, so the findings of the
current study await replication. However, as expected,
the adult risk of stuttering was around 2%, almost 1%
less than the childhood risk. The risk was higher in older
children (3.4%) than in young children (2.8%), perhaps
due to new cases emerging in this older age group. Natu-
ral recovery seems to have influenced risk in adolescents
(2.2%). In a population of 140 million adults (if adults
represent 70% of 200 million people), a potential 2.8
million people have a risk of stuttering. Furthermore,
there may be from 600,000 up to 1 million people stut-
tering at any one time in such a population. Given the
potential for stuttering to hinder the psychosocial and
employment prospects for persons who stutter through
their lifetime (Craig, 1990; Craig & Calver, 1991), these
figures argue for the allocation of substantial resources
to treatment facilities for adults who stutter.
Craig et al.: Epidemiology of Stuttering 1103
 Acknowledgments
This research was funded by The University of Technol-
ogy, Sydney, and a Commonwealth Department of Health
Grant (NHMRC). Thanks also to the following funding
bodies who contributed financially to the research: the Big
Brother Movement, the Australian Rotary Health Research
Fund, the Sunshine Foundation, and the Inger Rice Founda-
tion.
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Received May 15, 2002
Accepted July 15, 2002
DOI: 10.1044/1092-4388(2002/088)
Contact author: Ashley Craig, PhD, Department of Health
Sciences, University of Technology, Sydney, Broadway,
New South Wales, Australia 2007.
E-mail: a.craig@uts.edu.au
 Appendix

Prevalence Questionnaire
Date ___ / ___ / ___

Stuttering Telephone Survey

Demographics (d) Did you have therapy for stuttering?

(a) May I ask how many females live in your household at
present?
(b) What are their ages?
(c) How many males live in your household at present?
(d) What are their ages?
The lettered questions could be answered Yes, No, or Not sure.
1. Do you stutter?
If answer to Q1 is no, go to Q2.
(a) Has the stuttering persisted for the past 3 months?
(b) Has the stuttering caused fear and avoidance of
situations?
(c) Have you consulted a health professional? (speech
therapist, psychologist, psychiatrist, GP, etc.)
(d) Have you had therapy for stuttering?
Do you know what types of therapy?____________.
(e) Do you know whether anyone in your close family
ever stuttered? (parents, grandparents, sisters,
brothers, children)
Who are they? ____________________
If the person stutters, ask permission to tape for up to 5
min.
2. Have you ever stuttered?
If answer to Q2 is no, go to Q3.
(a) Did the stuttering persist for at least 3 months?
(b) Did the stuttering cause fear and avoidance of
situations?
(c) Did you consult a health professional? (speech
therapist, psychologist, GP, psychiatrist, etc.)
Do you know what types of therapy? ____________
(e) Do you know whether anyone in your close family
ever stuttered? (as above)
Who are they? _____________
3. Does anyone in your household stutter?
If answer to Q3 is no, go to Q4.
(a) Who are the persons in your household who stutter?
(label F1, M2, etc.)
(b) Has the stuttering persisted for the past 3 months?
(c) Has the stuttering caused fear and avoidance of
situations?
(d) Has the person(s) consulted a speech professional?
(e) Has the person(s) had therapy for stuttering?
(f) Does the person(s) have close family who have ever
stuttered?
If a person in the household stutters, ask permission to
tape them for up to 5 min.
4. Has anyone in your present household ever stuttered?
(a) Who are the persons in your household who have
stuttered in the past? (label F1, M2, etc.)
(b) Did the stuttering persist for at least 3 months?
(c) Did the stuttering cause fear and avoidance of
situations?
(d) Did the person(s) consult a health professional?
(speech therapist, psychologist, GP, psychiatrist,
etc.)
(e) Did the person(s) have therapy for stuttering?
(f) Do you know whether anyone in your close family
ever stuttered?
Who are they?

Craig et al.: Epidemiology of Stuttering 1105

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