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Persistent stuttering is characterized by stuttering that continues after seven years of age, when the rate of achieving normal fluency slows significantly. At this point, the primary goal of therapy shifts from achieving fluency to developing effective compensatory techniques and eliminating ineffective secondary behaviors. While many therapies have been developed for persistent stuttering, the variability in neurological causes and individual reactions to stuttering necessitates an individualized approach. Therapy focuses on helping the patient accept stuttering, control their communication, and reduce or eliminate dysfunctional secondary behaviors, such as word avoidance and mannerisms.

PERSISTENT STUTTERING
Rates of stutter resolution by seven years of
age range from 65% in a prospective study to
87.5% in cohort studies, regardless of whether
the child received treatment.4
By seven years of
age, the growth and remodeling of the brain is
largely complete, although childhood-onset fluency disorder occasionally starts after this age.23
Stuttering that continues after seven years of
age is classified as persistent stuttering. At this
point, the rate of achieving normal fluency slows
significantly.1
For many people with persistent stuttering,
the inability to predictably communicate is the
most debilitating effect, and regaining a sense
of control over communication is often their
principal goal in therapy.26 As stuttering persists, the patient may begin to develop ineffective
secondary behaviors, including word avoidance
and mannerisms such as grimacing. This makes
speech and appearance even more dysfunctional;
therefore, reducing or eliminating these secondary behaviors is also an important therapeutic
goal.1
Another important component of therapy
is helping the patient accept that it is okay to be
a person who stutters.27 The goal of therapy for
persistent stuttering transitions from a principal emphasis on achieving fluency to developing
effective compensatory techniques and eliminating ineffective secondary behaviors.28
Many different speech therapies have been
developed, partly because of the variety of neurologic deficits that can cause stuttering and the
many ways that people who stutter react to their
disability. A systematic review of available therapies found that most interventions are beneficial for at least some people and thus the focus of
speech therapy should be individualized.