The question of prognosis of stuttering patients must be discussed from two points of view -- the child whose experience with stuttering has been brief, the adult whose stuttering experience has persisted through the years with disastrous effects on the thought, emotion, and general behavior of the patient.

In the first place, 40% of stuttering children need not worry a clinician because before the age of eight, through general cerebral maturation assisted by developmental factors in the environment, stuttering subsides. In a few of these individuals there appear to be but slight remnants of an earlier severe type of stuttering. But the bugaboo is, how is a clinician going to know which patient is going to end his sojourn as a stutterer at the age of eight. It is not predictable. The least one can say is that a speech clinician managing young stutterers ought to have a favorable prognosis in 40% of his cases.

After fifteen years of experience with some 5,000 stutterers, I am forced to say that an absolute cure in adult patients is very rare. By absolute cure I would mean the elimination of all symptoms, fear, sensitivity, habit patterns, avoidance and postponement devices, psychologic and physiologic crutches, the short rapid neurologic spasm, all of which the adult stutterer has fallen heir to.

One Is not surprised at this hopeless picture when one envisages the seriousness of this disorder in adults. The experience of stuttering has not only more deeply imbedded the original neurologic pattern disintegrated as it probably was in the beginning, but habit patterns and emotional adjustments have likewise been preserved behind a host of ruses, masks, and ingenious hiding devices to soften the scourge and allay the fear of stuttering. Yes, stereotyped habit patterns and behavior reactions not only are inevitable in a person whose journey is constantly frustrated by exploiting and ravishing social and communicative situations, but are also extremely difficult to manage, uproot, and salvage in clinical procedures. The more hopeful outlook for adult patients is that of setting up goals for improvement in their speech and personality. For after all a person need not necessarily think of himself as inefficient and inadequate because his speech patterns do not approximate the smoothness and synthesis of the speech of others. He rises or falls in relation to his point of view of himself as a stutterer.

Just what can be done along this line? The so-called secondary reactions already alluded to, which the stutterer has attached to his original primary neurologic spasms, can be eliminated. This can be done to the point where for all practical purposes his speech and emotional adjustments will serve him well in social and professional situations.

On the average this program takes about three months. The prognosis for improvement in the stuttering person is more hopeful, if the patient possesses the following qualities:

1. Sufficient intelligence to gain adequate insight into the goals and practices in clinical procedure.
2. A degree of determination which so few people possess. It means sticking to a task unmolested by ordinary diversions of the clinic or society at large.
3. Self-discipline in fulfilling the requisites essential in the performance of duties which oft times are unpleasant and very difficult.

If these qualities are present in the patient, we can feel more certain that when bad habits of adjustment have been altered, when secondary involvements have been minimized, and when the emotional and psychologic "under brush" has been cleared, a more integrated functioning of cortical dominance is more likely to obtain.

With the young stutterer we have a more hopeful prognosis. We deal here for the most part with stuttering in the "raw." The primary neurologic spasm is our most important consideration. Here, too, we have the help of nature, who so graciously manages 40% of our patients into free speech.