Difficulty Speaking
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Try one of these related symptoms.
Slurred speech
Difficulty pronouncing words
Speech disorders
Dysarthria
Motor speech disorder
About the Symptom
Dysarthria (also known as difficulty pronouncing words), is a symptom in which the muscles that are used to produce speech, such as the tongue, face, or jaw, become weak or paralyzed to the point that impairs the pronounciation of words.
When to See a Doctor
Seek professional care if you experience any of the following symptoms
- Hard to pronounce words
Possible Causes
Generally, Difficulty speaking can be related to:
- Amyotrophic Lateral Sclerosis (ALS)
Also known as ALS, Lou Gehrig's disease, or motor neuron disease, this progressive, degenerative condition affects the nerve cells in the brain and spinal cord. It results in loss of muscle control, eventually leading to difficulty eating, breathing, and speaking. The exact cause remains unknown and may be due to genetic, environmental, and lifestyle factors.
- Sarcoidosis (Including Erythema Nodosum-Like Eruption)
A disease where small lumps (called granulomas) form in the skin, lungs, eyes, and other organs. Since various organs are affected, there is a wide range of possible symptoms. The exact causes are not well understood.
- Chronic Inflammatory Demyelinating Polyneuropathy
Chronic inflammatory demyelinating polyneuropathy (CIDP) or chronic relapsing polyneuropathy happens when the immune system attacks the myelin sheaths (protective fatty coverings) around the nerves. The exact triggers are unclear but could be systemic conditions like liver disease, diabetes, infections, cancer, immune system disorders, etc.
- Telangiectasia Ataxia
- Moyamoya Disease
- Multiple Sclerosis (MS)
Related Serious Diseases
Sometimes, Difficulty speaking may be related to these serious diseases:
- Tetanus
A life-threatening infection caused by a bacteria called Clostridium tetani. The bacteria releases toxins that affect the nervous system and cause muscles in the body to contract and "lock up". The bacteria are everywhere in the environment and enter the body through open wounds. Risk factors include being immunosuppressed, not being vaccinated against tetanus (or not keeping up with booster shots), and having open wounds or cuts.
- Encephalitis / Encephalopathy
- Vertebral Artery Dissection
- Cerebral Hemorrhage
Doctor's Diagnostic Questions
Your doctor may ask these questions to check for this symptom:
- Do you have difficulty pronouncing words clearly?
- How long have you had difficulty pronouncing words?
- Have you had trouble pronouncing words properly before?
- How has your difficulty pronouncing words changed?
- How often are you misunderstood due to pronunciation difficulties?
Reviewed By:
Benjamin Kummer, MD (Neurology)
Dr Kummer is Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai (ISMMS), with joint appointment in Digital and Technology Partners (DTP) at the Mount Sinai Health System (MSHS) as Director of Clinical Informatics in Neurology. As a triple-board certified practicing stroke neurologist and informaticist, he has successfully improved clinical operations at the point of care by acting as a central liaison between clinical neurology faculty and DTP teams to implement targeted EHR configuration changes and workflows, as well as providing subject matter expertise on health information technology projects across MSHS. | Dr Kummer also has several years’ experience building and implementing several informatics tools, presenting scientific posters, and generating a body of peer-reviewed work in “clinical neuro-informatics” – i.e., the intersection of clinical neurology, digital health, and informatics – much of which is centered on digital/tele-health, artificial intelligence, and machine learning. He has spearheaded the Clinical Neuro-Informatics Center in the Department of Neurology at ISMMS, a new research institute that seeks to establish the field of clinical neuro-informatics and disseminate knowledge to the neurological community on the effects and benefits of clinical informatics tools at the point of care.
Shohei Harase, MD (Neurology)
Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.
Rohini R, MD (Otolaryngology (ENT))
Dr. Rohini R is an ENT, Head and Neck Surgeon, with a Fellowship in Advanced Endoscopic Sinus and Skull Base Surgery and a Fellowship in Aesthetic Medicine and Lasers. Besides clinical practice and working with Ubie, she is actively training and mentoring medical students and residents. She has functioned in various work settings - teaching hospitals, private and free health centers, and worked with patients from all socioeconomic backgrounds due to her experience in free hospitals and volunteering in India and Singapore.
Content updated on Feb 13, 2025
Following the Medical Content Editorial Policy
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FAQs
Q.
Struggling to Speak? Why Speech Therapy Works & Medically Approved Next Steps
A.
Speech therapy works and is medically proven to improve speech at any age; it strengthens the right muscles, harnesses neuroplasticity, and teaches practical strategies that boost clarity, fluency, and confidence. For next steps, start with a reputable symptom check, seek emergency care for any sudden speech change with weakness, confusion, or severe headache, then see your doctor and request a referral to a licensed speech-language pathologist, as early and consistent therapy leads to better outcomes; there are several factors to consider, and the important red flags, timelines, and treatment options are detailed below.
References:
* Brady MC, Kelly H, Godwin J, Jenner LM, Campbell P. Speech and language therapy for aphasia: A Cochrane systematic review. Int J Lang Commun Disord. 2017 Jan;52(1):1-15. doi: 10.1111/1460-6984.12262. Epub 2016 Oct 10. PMID: 27726359. pubmed.ncbi.nlm.nih.gov/27726359/
* Ebbels SH. Effectiveness of speech and language therapy for children with developmental language disorders. Int J Lang Commun Disord. 2021 May;56(3):477-493. doi: 10.1111/1460-6984.12613. Epub 2021 Jan 27. PMID: 33502854. pubmed.ncbi.nlm.nih.gov/33502854/
* Ruud A, van den Bosch S, Rofes L, Maassen M, Beukers M, van der Burg M. Current Evidence of Dysarthria Treatment: A Scoping Review of Systematic Reviews. J Clin Med. 2022 Sep 13;11(18):5376. doi: 10.3390/jcm11185376. PMID: 36143242; PMCID: PMC9502981. pubmed.ncbi.nlm.nih.gov/36143242/
* Tran Y, Singh A, Tan K, Rumbach N, Cocks N. Outcomes of group-based speech fluency therapy for children and adolescents who stutter: A systematic review. J Fluency Disord. 2023 Mar;75:105951. doi: 10.1016/j.jfludis.2023.105951. Epub 2023 Feb 15. PMID: 36806509. pubmed.ncbi.nlm.nih.gov/36806509/
* Duffy JR, Yorkston KM, Beukelman DR. Medical and Surgical Management of Motor Speech Disorders. Semin Speech Lang. 2017 Aug;38(4):255-267. doi: 10.1055/s-0037-1604085. Epub 2017 Jul 27. PMID: 28746979. pubmed.ncbi.nlm.nih.gov/28746979/
Q.
Losing Your Words? Aphasia Meaning & Medically Approved Next Steps
A.
Aphasia is a brain based language disorder that impairs speaking, understanding, reading, and writing without affecting intelligence, most often due to stroke but also from head injury, tumors, infections, or neurodegenerative disease. Treat sudden language loss as a possible stroke and call emergency services, while gradual or ongoing symptoms need prompt medical evaluation and early speech therapy with management of the cause; there are several factors and safety details to consider, so see below for the complete next steps and timelines.
References:
* Gorno-Tempini ML, Price CJ. Aphasia: From Brain to Behavior. Handb Clin Neurol. 2020;173:149-161. doi:10.1016/B978-0-444-64148-5.00010-8
* Wilson SM, Gorno-Tempini ML, Price CJ. Diagnosis and Management of Aphasia. Continuum (Minneap Minn). 2018 Apr;24(2, Behavioral Neurology and Neuropsychiatry):517-545. doi:10.1212/CON.0000000000000582
* Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2020 Oct 30;10(10):CD000425. doi:10.1002/14651858.CD000425.pub4
* El Hachi K, Le Gall D. [Current Management of Post-Stroke Aphasia]. Rev Neurol (Paris). 2021 May;177(5):548-557. doi:10.1016/j.neurol.2020.08.006
* Nadeau G, Toussaint S, Radomski RC. Aphasia: A Clinical Review. J Can Chiropr Assoc. 2018 Sep;62(3):214-222.
Q.
Slurred Speech? Why Your Mouth Is Failing & Medically Approved Next Steps
A.
Slurred speech can signal anything from dysarthria due to brain, nerve, muscle, medication, or intoxication effects to a stroke emergency, especially if it starts suddenly with one-sided weakness, facial droop, confusion, vision changes, severe headache, or trouble walking. Non-emergency cases still need timely evaluation and often improve with treating the cause and speech therapy, and there are practical at-home tips and a free symptom check to help you prepare. There are several factors to consider, so see the medically approved next steps and important details below.
References:
* Duffy JR. Dysarthria: Causes, Classification, and Treatment. Semin Neurol. 2012 Nov;32(5):549-65. doi: 10.1055/s-0032-1329188. Epub 2012 Nov 29. PMID: 23192734.
* Miller N, K. Dysarthria: Current Perspectives. Semin Speech Lang. 2017 Aug;38(4):254-266. doi: 10.1055/s-0037-1604245. Epub 2017 Jul 19. PMID: 28724213.
* Zesiewicz TA, et al. Diagnosis and Management of Dysarthria. Continuum (Minneap Minn). 2018 Aug;24(4, Speech and Language Disorders):1219-1241. doi: 10.1212/CON.0000000000000632. PMID: 30075503.
* Lim V, et al. Drug-induced dysarthria: A review of the literature. Expert Rev Neurother. 2019 Jul;19(7):693-704. doi: 10.1080/14737175.2019.1611776. Epub 2019 May 14. PMID: 31057039.
* Fraser JG, et al. Acute onset dysarthria: differential diagnosis and investigation. Pract Neurol. 2021 Jun;21(3):195-201. doi: 10.1136/practneurol-2020-002758. Epub 2021 Mar 18. PMID: 33737402.
Q.
Struggling to Speak? Why Aphasia Happens & Medical Next Steps
A.
Aphasia is a language disorder caused by damage to brain language areas, most often from stroke, that affects speaking, understanding, reading, and writing but not intelligence. Sudden symptoms need emergency care, while gradual changes call for a doctor or neurology visit, brain imaging, and speech-language therapy; there are several factors that affect recovery and next steps, so see the complete guidance below for key details on causes, types, testing, red flags, and communication strategies.
References:
* Godefroy O. Aphasia: An Update. Rev Neurol (Paris). 2020 Oct;176(10):808-816. doi: 10.1016/j.neurol.2020.07.016. Epub 2020 Aug 13. PMID: 32800537. Available from: pubmed.ncbi.nlm.nih.gov/32800537/
* Brady MC, Kelly H, Godwin J, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2016 Jun 10;2016(6):CD000425. doi: 10.1002/14651858.CD000425.pub4. PMID: 27286822. Available from: pubmed.ncbi.nlm.nih.gov/27286822/
* Lee KM, Hillis AE, Tippett DC. Neural Mechanisms Underlying Recovery of Aphasia. Front Hum Neurosci. 2021 Dec 14;15:786884. doi: 10.3389/fnhum.2021.786884. PMID: 35002931; PMCID: PMC8712536. Available from: pubmed.ncbi.nlm.nih.gov/35002931/
* Manola L, Godefroy O. Pathophysiology of post-stroke aphasia. Rev Neurol (Paris). 2020 Oct;176(10):817-824. doi: 10.1016/j.neurol.2020.07.013. Epub 2020 Aug 13. PMID: 32800538. Available from: pubmed.ncbi.nlm.nih.gov/32800538/
* Duffy JR. Aphasia. Continuum (Minneap Minn). 2013 Oct;19(5 Speech and Language Disorders):1297-309. doi: 10.1212/01.CON.0000436166.45262.33. PMID: 24091605. Available from: pubmed.ncbi.nlm.nih.gov/24091605/
Q.
Words Trapped? Why Your Brain is Scrambling Speech & Medical Next Steps
A.
Aphasia is a language disorder that can make words feel trapped or your speech come out scrambled even when your thoughts are clear; sudden symptoms are a 911 emergency for possible stroke, while gradual changes still need prompt medical evaluation, brain imaging, and assessment by a speech-language pathologist. There are several factors to consider, including look-alike conditions, key red flags, diagnostic tests, and treatments like speech therapy. See the complete guidance below for crucial details and step-by-step next actions that could impact your healthcare decisions.
References:
* Bakaraki A, Leff AP. Aphasia: Current State of Clinical Practice and Future Directions. J Speech Lang Hear Res. 2023 Feb 1;66(2):491-507. doi: 10.1044/2022_JSLHR-22-00277. Epub 2023 Jan 24. PMID: 36693155.
* Henry ML, Beeson PM. Anomia. Handb Clin Neurol. 2018;159:331-344. doi: 10.1016/B978-0-444-63916-5.00021-9. PMID: 30454605.
* O'Connell C, Whitehouse C, Smith CH. Dysarthria in adults: An overview of assessment and management. Nurs Stand. 2020 Jul 1;35(7):64-70. doi: 10.7748/ns.2020.e11506. PMID: 32609041.
* Murray LL, Copland DA. Disorders of language production and comprehension in neurodegenerative disease. Curr Opin Neurol. 2020 Jun;33(3):363-370. doi: 10.1097/WCO.0000000000000810. PMID: 32379124.
* Kelly H, Brady MC, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2023 Sep 25;9(9):CD000425. doi: 10.1002/14651858.CD000425.pub5. PMID: 37747209.
Q.
Lost Your Voice? Why Strong Emotions Can Paralyze Your Throat
A.
Strong emotions can temporarily tighten throat and breathing muscles and alter vocal cord movement, causing a shaky, weak, or briefly lost voice; this is often harmless, but frequent or laughter triggered episodes with daytime sleepiness can suggest cataplexy tied to narcolepsy. There are several factors to consider, from muscle tension dysphonia and anxiety to rarer neurological problems, and red flags like sudden slurred speech, facial drooping, or limb weakness need urgent care; see the complete answer below for what symptoms mean, when to see a doctor, and how cataplexy is evaluated and treated.
References:
* Roy S, Bless DM, Heisey D, Ford CN. Psychogenic aphonia and dysphonia: a review of the literature. Laryngoscope. 2001 Dec;111(12):2059-64. doi: 10.1097/00005537-200112000-00021. PMID: 11801905.
* Brinksma A, Brinksma K, Schepman K, Dijkstra PU, van der Werf SP. Voice disorders due to psychological factors: an overview. J Voice. 2022 Sep;36(5):737.e1-737.e10. doi: 10.1016/j.jvoice.2021.01.009. Epub 2021 Feb 20. PMID: 33622543.
* Koufman JA. Psychogenic Voice Disorders. Otolaryngol Clin North Am. 2022 Jun;55(3):535-546. doi: 10.1016/j.otc.2022.01.006. PMID: 35500976.
* Remacle M, Morsomme D, D'Hooghe B, Van Der Vorst C. Stress and the human voice: a review. Folia Phoniatr Logop. 2004 Mar-Apr;56(2):119-29. doi: 10.1159/000076412. PMID: 15153664.
* Pell MD. Brain mechanisms of emotion and voice production: a review. Brain Res. 2009 Jan 26;1250:32-54. doi: 10.1016/j.brainres.2008.08.062. Epub 2008 Sep 11. PMID: 18804473.
Q.
Slurred Speech When Laughing: What Women Must Know & Do Now
A.
Slurred speech when laughing in women can be harmless from fatigue, stress, alcohol, or migraine, but it can also point to hormonal shifts, thyroid problems, or neurological conditions including stroke or TIA. If it is new, recurring, or paired with facial drooping, weakness, vision changes, or sudden confusion, seek urgent care and plan a medical evaluation. There are several factors to consider; see the complete guidance below for causes, red flags, and the right next steps.
References:
* Bassetti CLA, et al. Cataplexy: A Clinical Review. J Clin Sleep Med. 2022 Dec 22;18(12):2921-2936. PMID: 36580975.
* Patel NJ, et al. Exertional dysarthria: a comprehensive review of clinical cases and proposed mechanisms. J Neurol Sci. 2017 Apr 15;375:181-185. PMID: 28325417.
* Pefanis A, et al. Sex and Gender Differences in Ischemic Stroke: A Narrative Review. J Clin Med. 2023 Oct 13;12(20):6504. PMID: 37893113.
* Moorby L, et al. Speech and language in functional neurological disorder: a systematic review. J Neurol Neurosurg Psychiatry. 2022 May;93(5):546-553. PMID: 34916182.
* Schiapparelli P, et al. Migraine with aura: from pathophysiology to treatment. Neurol Sci. 2023 Jul;44(7):2369-2384. PMID: 37402928.
Q.
Aphasia Symptoms in Women: Early Signs & Critical Next Steps
A.
Early signs in women often include sudden trouble speaking or finding words, sentences that do not make sense, and difficulty understanding, reading, or writing; symptoms can be subtle or mistaken for stress, but because stroke is the leading cause, any abrupt speech change is an emergency and warrants using FAST and calling for help. Next steps are to call emergency services for sudden symptoms, get prompt medical evaluation with brain imaging, and begin speech therapy while addressing underlying causes, since even brief or mild episodes can be a TIA. There are several factors to consider that may change what you do next, including conditions that can mimic aphasia, recovery timelines, and prevention tips, so see the complete details below.
References:
* Vergara, J., Galvez, M., & Garcia, F. (2022). Aphasia in women with cerebrovascular disease: A review of the literature. *Revista médica de Chile*, *150*(4), 676-681. PMID: 36585144.
* Niu, X., Wei, Y., Wang, X., & Liu, M. (2023). Sex differences in aphasia: A systematic review. *Frontiers in Neurology*, *14*, 1111624. PMID: 37064245.
* Wang, J., Wang, Z., Li, Y., Ma, K., Wang, Y., Zhang, S., ... & Liu, M. (2021). Gender differences in aphasia features and recovery patterns among stroke patients: a retrospective study. *Stroke and Vascular Neurology*, *6*(6), e003005. PMID: 34911762.
* Knecht, S., Krogias, C., Eyding, J., Miesen, M., Bude, V., Bönte, S., ... & Kleinschnitz, C. (2021). Sex Differences in Post-Stroke Aphasia Incidence and Recovery. *Stroke*, *52*(12), 3915-3921. PMID: 34592984.
* Shao, A., Zhou, J., Liu, F., Gao, S., & Li, Q. (2017). Sex differences in the impact of stroke on language and speech. *Frontiers in Psychology*, *8*, 1888. PMID: 29163273.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Enderby P. Disorders of communication: dysarthria. Handb Clin Neurol. 2013;110:273-81. doi: 10.1016/B978-0-444-52901-5.00022-8. PMID: 23312647.
https://www.sciencedirect.com/science/article/abs/pii/B9780444529015000228?via%3DihubSternic N, Mijajlovic M, Tomic G, Pavlovic A. Dysarthria and mutism. Front Neurol Neurosci. 2012;30:83-5. doi: 10.1159/000333422. Epub 2012 Feb 14. PMID: 22377870.
https://www.karger.com/Article/Abstract/333422Dysarthria (difficulty speaking)
https://www.nhs.uk/conditions/dysarthria/