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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

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Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

Five Common Speech Disorders in Children

You have determined that your child has more than just a speech delay, now what? How do you determine what kind of speech disorder your child has and more importantly, what do you do about it? We have listed below five common speech disorders in children. Of course, we always recommend a visit to your pediatrician if you feel your child has any of these symptoms, and an appointment with an SLP may be necessary to begin an effective speech therapy treatment plan.

5 Common Speech Disorders in Children:

Articulation Disorder: An articulation disorder is a speech sound disorder in which a child has difficulty making certain sounds correctly.  Sounds may be omitted or improperly altered during the course of speech. A child may substitute sounds (“wabbit” instead of “rabbit”) or add sounds improperly to words. Young children will typically display articulation issues as they learn to speak, but they are expected to “grow out of it” by a certain age.  If the errors persist past a standard developmental age, which varies based on the sound, then that child has an articulation disorder.

The most common articulation disorders are in the form of a “lisp” – when a child does not pronounce the S sound correctly – or when a child cannot pronounce the R sound correctly. He may say “wabbit” instead of “rabbit” or “buhd” or instead of “bird.”

Apraxia of Speech is a communication disorder affecting the motor programming system for speech production.  Speech production is difficult – specifically with sequencing and forming sounds. The person may know what he wants to say, but there is a disruption in the part of the brain that sends the signal to the muscle for the movement necessary to produce the sound.  That leads to problems with articulation as well as intonation and speaking stress and rhythm errors. Apraxia of Speech can be discovered in childhood (CAS), or might be acquired (AOS) resulting from a brain injury or illness in both children and adults.

Fragile X Syndrome (FXS) is an inherited genetic disorder that is the most common cause of inherited intellectual disabilities in boys as well as  autism  (about 30% of children with FXS will have autism). It also affects girls, though their symptoms tend to be milder. It is greatly under-recognized and second only to  Down syndrome  in causing intellectual impairment.

FXS occurs when there is a mutation of FMRI gene and is an inherited disorder.  If a child received a pre-mutated X chromosome from one of his parents (as a carrier), then he is at greater risk of developing FXS.  Diagnosing Fragile X Syndrome is not easy for parents and doctors at the beginning of a child’s life.  Few outward signs are noticeable within the first 9 months. These signs may include an elongated face and protruding eyes.

Intellectual disabilities, speech and language problems, and social anxiety occur most frequently in children with Fragile X. Speech symptoms include repetition of words and phrases, cluttered speech and difficulties with the pragmatics of speech. All of FXS’s symptoms can range from mild to very severe.

Stuttering occurs when speech is disrupted by involuntary repetitions, prolonging of sounds and hesitation or pausing before speech. Stuttering can be developmental, meaning it begins during early speech acquisition, or acquired due to brain trauma. No one knows the exact causes of stuttering in a child.  It is considered to have a genetic basis, but the direct link has not yet been found. Children with relatives who stutter are 3 times as likely to develop stuttering. Stuttering is also more typical in children who have congenital disorders like  cerebral palsy .

A child who stutters is typically not struggling with the actual production of the sounds—stress and a nervousness trigger many cases of stuttering. Stuttering is variable, meaning if the speaker does not feel anxious when speaking, the stuttering may not affect their speech.

Language disorders can be classified in three different ways: Expressive Language Disorder (ELD), Receptive Language Disorder (RLD) or Expressive-Receptive Language Disorder (ERLD).  Children with Expressive Language Disorder do not have problems producing sounds or words, but have an inability to retrieve the right words and formulate proper sentences. Children with Receptive Language Disorder have difficulties comprehending spoken and written language. Finally, children with Expressive-Receptive Language Disorder will exhibit both kinds of symptoms. Grammar is a hard concept for them to understand and they may not use of articles (a, the), prepositions (of, with) and plurals. An early symptom is delay in the early stages of language, so if your child takes longer to formulate words or starting to babble, it can be a sign of ELD.

Children with Receptive Language Disorder may act like they are ignoring you or just repeat words that you say; this is known as “echolalia.” Even when repeating the words you say, they may not understand.  An example of this is if you say, “Do you want to go to the park?” and they respond with the exact phrase and do not answer the question. They may not understand you or the fact that you asked them to do something.

Children with Expressive-Receptive Language Disorder can have a mix of these symptoms

These are some of the most common speech disorders in children. No child is the same and you know your child best. If you feel that your child has a speech disorder, contact your pediatrician to discuss treatment options.

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Speech impairment in adults

Speech and language impairment may be any of several problems that make it difficult to communicate.

Considerations

The following are common speech and language disorders.

Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after strokes or traumatic brain injuries. It can also occur in people with brain tumors or degenerative diseases that affect the language areas of the brain. This term does not apply to children who have never developed communication skills. There are many different types of aphasia.

In some cases of aphasia, the problem eventually corrects itself, but in others, it doesn't get better.

With dysarthria , the person has problems expressing certain sounds or words. They have poorly pronounced speech (such as slurring) and the rhythm or speed of speech is changed. Usually, a nerve or brain disorder has made it difficult to control the tongue, lips, larynx, or vocal cords, which make speech.

Dysarthria, which is difficulty pronouncing words, is sometimes confused with aphasia, which is difficulty producing language. They have different causes.

People with dysarthria may also have problems swallowing.

VOICE DISTURBANCES

Anything that changes the shape of the vocal cords or the way they work will cause a voice disturbance. Lump-like growths such as nodules, polyps, cysts, papillomas, granulomas, and cancers can be to blame. These changes cause the voice to sound different from the way it normally sounds.

Some of these disorders develop gradually, but anyone can develop a speech and language impairment suddenly, usually due to a stroke or trauma.

• Alzheimer disease
• Brain tumor (more common in aphasia than dysarthria)
• Head trauma
• Transient ischemic attack (TIA)
• Alcohol intoxication
• Diseases that affect nerves and muscles (neuromuscular diseases), such as amyotrophic lateral sclerosis (ALS or Lou Gehrig disease), cerebral palsy, myasthenia gravis, or multiple sclerosis (MS)
• Facial trauma
• Facial weakness, such as Bell's palsy or tongue weakness
• Head and neck cancer surgery
• Nervous system (neurological) disorders that affect the brain, such as Parkinson disease or Huntington disease (more common in dysarthria than aphasia)
• Poorly fitting dentures
• Side effects of medicines that act on the central nervous system, such as narcotics, phenytoin, or carbamazepine
• Growths or nodules on the vocal cords
• People who use their voice heavily (teachers, coaches, vocal performers) are more likely to develop voice disorders.

For dysarthria, ways to help improve communication include speaking slowly and using hand gestures. Family and friends need to provide plenty of time for those with the disorder to express themselves. Typing on an electronic device or using pen and paper can also help with communication.

For aphasia, family members may need to provide frequent orientation reminders, such as the day of the week. Disorientation and confusion often occur with aphasia.Using nonverbal ways of communicating may also help.

It's important to maintain a relaxed, calm environment and keep external stimuli to a minimum.

• Speak in a normal tone of voice (this condition is not a hearing or emotional problem).
• Use simple phrases to avoid misunderstandings.
• Don't assume that the person understands.
• Provide communication aids, if possible, depending on the person and condition.

Mental health counseling may help with depression or frustration that many people with speech impairment have.

When to Contact a Medical Professional

Contact the provider if:

• Impairment or loss of communication comes on suddenly
• There is any unexplained impairment of speech or written language

What to Expect at Your Office Visit

Unless the problems have developed after an emergency event, the provider will take a medical history and perform a physical exam. The medical history may require the assistance of family or friends.

The provider will likely ask about the speech impairment. Questions may include when the problem developed, whether there was an injury, and what medicines the person takes.

Diagnostic tests that may be performed include the following:

• Blood tests
• Cerebral angiography to check blood flow in the brain
• CT or MRI scan of the head to check for problems such as tumor
• Electroencephalogram (EEG) to measure electrical activity of the brain
• Electromyography ( EMG ) to check the health of the muscles and the nerves that control the muscles
• Lumbar puncture to check the cerebrospinal fluid that surrounds the brain and spinal cord
• Urine tests
• X-rays of the skull

If the tests find other medical problems, other specialist doctors will need to be consulted.

For help with the speech problem, a speech and language therapist or social worker will likely need to be consulted.

Alternative Names

Language impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphonia voice disorders

Kirshner HS. Dysarthria and apraxia of speech. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Kirshner HS, Wilson SM. Aphasia and aphasic syndromes. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice.  8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Rossi RP, Kortte JH, Palmer JB. Speech and language disorders. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation . 4th ed. Philadelphia, PA: Elsevier; 2019:chap 155.

Review Date 5/2/2022

Updated by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related MedlinePlus Health Topics

• Speech and Communication Disorders

On this page

When to see a doctor, complications.

Aphasia is a disorder that affects how you communicate. It can impact your speech, as well as the way you write and understand both spoken and written language.

Aphasia usually happens suddenly after a stroke or a head injury. But it can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage (degenerative). The severity of aphasia depends on a number of things, including the cause and the extent of the brain damage.

The main treatment for aphasia involves treating the condition that causes it, as well as speech and language therapy. The person with aphasia relearns and practices language skills and learns to use other ways to communicate. Family members often participate in the process, helping the person communicate.

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Aphasia is a symptom of some other condition, such as a stroke or a brain tumor.

A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that don't make sense
• Substitute one word for another or one sound for another
• Speak unrecognizable words
• Have difficulty finding words
• Not understand other people's conversation
• Not understand what they read
• Write sentences that don't make sense

Patterns of aphasia

People with aphasia may have different strengths and weaknesses in their speech patterns. Sometimes these patterns are labeled as different types of aphasia, including:

• Broca's aphasia
• Wernicke aphasia
• Transcortical aphasia
• Conduction aphasia
• Mixed aphasia
• Global aphasia

These patterns describe how well the person can understand what others say. They also describe how easy it is for the person to speak or to correctly repeat what someone else says.

Aphasia may develop slowly over time. When that happens, the aphasia may be labeled with one of these names:

• Logopenic aphasia
• Semantic aphasia
• Agrammatism

Many people with aphasia have patterns of speech difficulty that don't match these types. It may help to consider that each person with aphasia has unique symptoms, strengths and weaknesses rather than trying to label a particular type of aphasia.

Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you or a loved one suddenly develop:

• Difficulty speaking
• Trouble understanding speech
• Difficulty with word recall
• Problems with reading or writing

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The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language.

Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A transient ischemic attack (TIA) occurs when blood flow is temporarily blocked to an area of the brain. People who've had a are at an increased risk of having a stroke in the near future.

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Relationships
• Day-to-day function

Difficulty expressing wants and needs can result in embarrassment, frustration, isolation and depression. Other problems may occur together, such as more difficulty moving around and problems with memory and thinking.

Jun 11, 2022

• Clark DG. Approach to the patient with aphasia. https://www.uptodate.com/contents/search. Accessed May 24, 2022.
• Aphasia. Merck Manual Professional Edition. http://www.merckmanuals.com/professional/neurologic_disorders/function_and_dysfunction_of_the_cerebral_lobes/aphasia.html#v1034169. Accessed May 24, 2022.
• Clark DG. Aphasia: Prognosis and treatment. https://www.uptodate.com/contents/search. Accessed May 24, 2022.
• Aphasia. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/aphasia/. Accessed May 24, 2022.
• Aphasia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/Pages/aphasia.aspx. Accessed May 24, 2022.
• Crosson B, et al. Neuroplasticity and aphasia treatments: New approaches for an old problem. Journal of Neurology, Neurosurgery and Psychiatry. 2019; doi:10.1136/jnnp-2018-319649.
• Elsner B, et al. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. Cochrane Database of Systematic Reviews. 2019; doi:10.1002/14651858.CD009760.pub4.
• Botha H, et al. Classification and clinicoradiologic features of primary progressive aphasia (PPA) and apraxia of speech. Cortex. 2015. doi:10.1016/j.cortex.2015.05.013.
• Kasselimis DS, et al. The unbridged gap between clinical diagnosis and contemporary research on aphasia: A short discussion on the validity and clinical utility of taxonomic categories. Brain and Language. 2017; doi:10.1016/j.bandl.2016.10.005.
• Clark H (expert opinion). Mayo Clinic. May 30, 2022.
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• Slurred Speech

6 Causes of Slurred Speech

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Take a quiz to find out what's causing your slurred speech.

6 most common cause(s)

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What is slurred speech?

Slurred speech is when you have trouble speaking, your words are slow or garbled, or your words run together. When you talk, many components of your nervous system work together to form words. When these parts don’t work correctly, your speech can become distorted, or “slurred.” The medical term for slurred speech is dysarthria.

Slurred speech includes problems pronouncing words and regulating the speed or pace of your speech. It can range from a barely noticeable problem to one that’s so severe that others can’t understand what you’re saying.

People often describe slurred speech as feeling like you’re trying to talk with your mouth full of marbles.

Common causes of slurred or slow speech include drinking too much alcohol and not getting enough sleep. In these cases, the slurring will stop once you’re sober again and have gotten rest, respectively.

There are also other causes of slurred speech such as a stroke (a medical emergency), brain tumor, Bell’s palsy, or a serious migraine.

Does slurred speech always need to be treated?

"People often think slurred speech is a minor symptom that does not need a medical evaluation. As our speech and ability to speak is our main form of communication, it is important to look for correctable causes." — Dr. Karen Hoerst

Should I go to the ER for slurred speech?

You should call 911 if:

• Your slurred speech starts suddenly.
• You have other symptoms, such as a sudden or severe headache and weakness or numbness of one side of your body.
• Your tongue, face, or lips are swelling, which could mean you’re having an allergic reaction.

1. Stroke or TIA (transient ischemic attack)

• Slurred speech
• Drooping of one side of the face
• Weakness or trouble controlling one side of the body
• Numbness in the face , arm , or leg
• Difficulty walking
• Sudden loss of vision or double vision
• Sudden, severe headache

A stroke occurs in the brain because the blow flow in a blood vessel is blocked. It can also happen when a blood vessel ruptures or leaks. This affects the blood supply to parts of the brain, which leads long-term damage. If it affects the area of the brain responsible for speech, it can cause slurred speech.

A transient ischemic attack , or TIA, is sometimes called a "mini stroke." A TIA is a temporary interruption of blood flow that causes the same symptoms as a stroke, but improves without any permanent damage to the brain or symptoms.

For example, if you have slurred speech because of a TIA, once the blood flow is restored to that area of the brain, the slurred speech goes away. But people who have a TIA are at a high risk of having a stroke in the future, especially if their risk factors are not treated. Risk factors are the same for stroke and TIA and include smoking, obesity, and cardiovascular disease.

It’s extremely important to call 911 right away if you suddenly have slurred speech. Getting immediate treatment is critical to minimizing permanent damage. Paramedics can begin treating you in the ambulance on the way to the hospital, so it’s better to call 911 than go to the ER yourself.

Treatments for strokes and TIAs include medications to break up blood clots and surgery to remove blood clots from the vessels. If your stroke is from bleeding in the brain, you may need surgery to repair a blood vessel.

Following treatment, your doctor will recommend medications to prevent another TIA or stroke. These typically include drugs that prevent clots from forming in the blood (like aspirin or other blood thinners) and cholesterol medication to prevent plaque from building up on the walls of the blood vessels. You may also need to take medication to control your blood pressure.

Speech therapy is recommended to help treat problems with speech.

It may not be a stroke

"There are so many possible causes of slurred speech. Most of the time we need a detailed history and physical exam to guide the diagnosis and treatment." — Dr. Hoerst

2. Bell’s palsy

• Drooping of the face
• Drooping of the eye
• Changes in taste or hearing

Bell’s palsy is a relatively common condition that affects the facial nerve, which is responsible for movement of your face.

In Bell’s palsy, the nerve gets inflamed typically because of a recent viral infection. This inflammation can cause the facial nerve to not work as well, leading to drooping and slurred speech.

Bell’s palsy usually improves in a few months, but medications such as steroids and antiviral drugs are typically given to help speed the process. If nerve problems continue, physical therapy is recommended. In rare instances, surgery may be needed to help improve facial muscle function.

3. Brain tumor

• Slurred speech or speech difficulties
• New or changing headaches
• Weakness or coordination and balance problems
• Abnormal vision

A brain tumor is an abnormal growth of cells in the brain. A brain tumor may be cancerous (malignant) or noncancerous (benign). Both types can cause symptoms including slurred speech.

The diagnosis of a tumor in the brain or spinal cord is based on an exam and imaging of the brain, such as an MRI or CT scan. A biopsy (tissue sample) may be needed to determine what type of tumor it is.

Some tumors, such as a small noncancerous tumor, do not need treatment, though your doctor will recommend periodic MRI scans to make sure it hasn’t changed.

Most larger or cancerous tumors do require treatment, which may consist of chemotherapy, radiation, or surgery. If you develop physical or cognitive (mental) problems from the tumor, rehabilitation such as physical therapy, occupational therapy, or speech therapy may be needed.

4. Multiple sclerosis

• Blurred vision or decreased vision, typically in one eye
• Weakness or trouble walking
• Numbness or pins-and-needles sensation on your face, arm, or leg (typically on one side)
• A band-like squeezing sensation around the chest or abdomen
• Difficulty focusing

Multiple sclerosis, or MS, is a central-nervous system disease that affects the cells of the brain and spinal cord. In MS, a fatty tissue that surrounds nerve fibers (myelin) is attacked. Myelin helps to insulate the electrical signals sent through the nerves. When there is a problem with this fatty tissue, information sent to and from the brain can be disrupted.

MS is most common in young adults between the ages of 20 and 50, according to the National MS Society .

MS is not curable , but treatments have dramatically improved the ability to control MS, so people usually have fewer symptoms and less disability.

Treatment includes medications that may be taken orally or injected or infused through an IV line. Physical therapy and speech therapy are commonly used to help in physical recovery, and medications can be used to treat other symptoms, such as depression, pain, and fatigue.

5. Amyotrophic lateral sclerosis (ALS)

• Difficulty with speech, including slurred speech
• Progressive weakness and difficulty balancing
• Muscle cramps, twitching, and stiffness
• Difficulty swallowing

Amyotrophic lateral sclerosis (ALS) is also known as Lou Gehrig’s disease. It affects nerve cells called motor neurons that control your movement.

The disease primarily causes a loss of strength, impaired swallowing and speech, and in most cases, difficulty breathing because of impaired respiratory muscles. It is a progressive disease, meaning that symptoms are mild at first and worsen over time.

Previously, it was thought that ALS doesn’t affect a person’s mental ability. But it’s now known that people with ALS can get a specific type of dementia called frontotemporal dementia (FTD). That condition can affect behavior, mood, and speech.

Symptoms of ALS can develop in adults of any age, but it’s most commonly diagnosed in people who are between the ages of 40 and 70, according to the ALS Association .

While there are some medications that can be used to delay the progression of the disease, there is currently no cure for ALS. Treatment includes rehabilitation with physical therapy, occupational therapy, speech therapy, and respiratory therapy.

6. Migraine

• Sensitivity to light and sound
• Visual disturbances

A migraine causes a severe headache that is often accompanied by nausea and sensitivity to light or sound. But some migraines don’t cause head pain.

Other symptoms that involve the nervous system can occur. Some of these sensory symptoms are called “auras.” These distortions can cause visual changes , including flashing lights or distorted vision. People may feel tingling or numbness of their face, arm, or leg.

In some types of migraine, people may even develop slurred speech and weakness of the face, arm, or leg. These are also symptoms of a stroke, so it may be hard to figure out which condition you have. If you develop sudden slurred speech or weakness, go to the ER immediately.

In an acute migraine attack, medications can be used to stop a migraine that has already started, such as triptans or newer medications called CGRP inhibitors. These medications can be in pill form, inhaled form, or injectable medications.

Migraine prevention can include taking medications for blood pressure, anticonvulsants, or even antidepressants. In some instances, Botox treatments are used to prevent migraine.

Behavior and lifestyle changes such as exercise, improved sleep, and healthy diet or weight loss are also often recommended to help decrease the number of migraine headaches you experience.

Other possible causes

Slurred speech may occur from alcohol intoxication or tiredness. It can also be a side effect of medications like high dose pain medications, antipsychotic medications or even some allergy medications like antihistamines. Other causes include:

• Infections such as urinary tract infections or electrolyte imbalances (particularly in elderly people).
• Brain infections such as meningitis or encephalitis.
• Problems that affect your mouth or throat, such as poorly fitting dentures, dental infections, dental numbing medications, swelling in your throat, or muscle or nerve problems.
• An allergic reaction , especially if you notice slurred speech along with tongue swelling , lip swelling, or shortness of breath.

"Early speech therapy can not only help with early improvement but also with diagnosis. Speech-language pathologists have special training in detecting the various types of slurred speech, which helps to determine the possible causes."— Dr. Hoerst

Specialty treatment options

• Speech therapy is the most common treatment for slurred speech.
• Injected medications such as Botox are sometimes used, depending on the cause of slurred speech.
• Medications to improve nerve and muscle function.

While it's important to follow your healthcare provider's guidance, here are some over-the-counter (OTC) options that might provide extra support.

• Proper nutrition supports overall health, including nerve function. Supplements like B vitamins may support neurological health.
• Staying hydrated is key, especially if speech difficulties make it hard to drink. Consider a no-spill, easy-sip water bottle designed for easy grip.
• Engaging in exercises to improve speech clarity can be helpful. Explore speech therapy tools and resources that you can use at home.

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Dysarthria (difficulty speaking)

Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines. Speech and language therapy can help.

Immediate action required: Call 999 if:

• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a stroke, which is a medical emergency. The symptoms of a stroke usually come on suddenly.

Check if it's dysarthria

The main symptom of dysarthria is unclear speech. This can make it difficult for you to make yourself understood.

Your speech may only be slightly unclear, or you may not be able to speak clearly at all.

Other symptoms include:

• difficulty moving your mouth, tongue or lips
• slurred or slow speech
• difficulty controlling the volume of your voice, making you talk too loudly or quietly
• a change in your voice, making it nasal, strained or monotone
• hesitating a lot when talking, or speaking in short bursts instead of full sentences

Being stressed or tired may make your symptoms worse.

Dysarthria is not the same as dysphasia, although you can have both conditions at the same time. Dysphasia, also known as aphasia , is where you have difficulty understanding words or putting them together in a sentence.

Non-urgent advice: See a GP if:

• you've noticed gradual changes to your or your child's speech and you're worried

They'll examine you and may refer you to a specialist for further tests.

Causes of dysarthria

Dysarthria is usually caused by damage to the brain or conditions that affect the nervous system. It can happen at any age.

Common causes include:

• stroke , severe head injury and brain tumours
• Parkinson's disease , multiple sclerosis and motor neurone disease
• cerebral palsy and Down's syndrome

It can also be a side effect of certain medicines, such as some medicines to treat epilepsy.

Treatment for dysarthria

If you have dysarthria, you'll usually be referred to a speech and language therapist. They'll offer therapy to help your speech and communication.

The therapy you're offered will be different depending on the cause of your dysarthria and how severe it is.

Some people may find therapy does not help their symptoms, or their speech may get worse as their condition progresses. Their therapy may focus on helping communication in other ways.

Speech and language therapy may include:

• exercises to strengthen the muscles used for speech
• strategies to make your speech easier to understand, such as slowing down when you're talking
• using communication aids, such as an alphabet board or a voice amplifier

Find out more

• Headway: communication problems after brain injury
• Stroke Association: communication tools

Page last reviewed: 17 February 2023 Next review due: 17 February 2026

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Voice, Speech, and Language

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• Apraxia of Speech
• Auditory Processing Disorder
• Autism Spectrum Disorder: Communication Problems in Children
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Voice, Speech, and Language in the News: NIDCD-Supported Research

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Study reveals brain mechanisms behind speech impairment in Parkinson’s

Most Parkinson’s disease patients struggle with speech problems. New research by Stanford Medicine scientists uncovers the brain connections that could be essential to preserving speech.

May 28, 2024 - By Nina Bai

Research by Stanford Medicine scientists may explain why some treatments for Parkinson’s — developed mainly to target motor symptoms — can improve speech impairments while other treatments make them worse. Lightspring /Shutterstock.com

Parkinson’s disease is most well-known and well-studied for its motor impairments — tremors, stiffness and slowness of movement. But less visible symptoms such as trouble with memory, attention and language, which also can profoundly impact a person’s quality of life, are less understood. A new study by Stanford Medicine researchers reveals the brain mechanisms behind one of the most prevalent, yet often overlooked, symptoms of the disease — speech impairment.

Based on brain imaging from Parkinson’s patients, the researchers identified specific connections in the brain that may determine the extent of speech difficulties.

The findings , reported May 20 in the Proceedings of the National Academy of Sciences , could help explain why some treatments for Parkinson’s — developed mainly to target motor symptoms — can improve speech impairments while other treatments make them worse.

More than a motor disorder

“Parkinson’s disease is a very common neurological disorder, but it’s mostly considered a motor disorder,” said Weidong Cai , PhD, clinical associate professor of psychiatry and behavioral sciences and the lead author of the new study. “There’s been lots of research on how treatments such as medications and deep brain stimulation can help improve motor function in patients, but there was limited understanding about how these treatments affect cognitive function and speech.”

Over 90% of people with Parkinson’s experience difficulties with speech, an intricate neurological process that requires motor and cognitive control. Patients may struggle with a weak voice, slurring, mumbling and stuttering.

“Speech is a complex process that involves multiple cognitive functions, such as receiving auditory feedback, organizing thoughts and producing the final vocal output,” Cai said.

The senior author of the study is Vinod Menon , PhD, professor of psychiatry and behavioral sciences and director of the Stanford Cognitive and Systems Neuroscience Laboratory .

The researchers set out to study how levodopa, a common Parkinson’s drug that replaces the dopamine lost from the disease, affects overall cognitive function. They focused on the subthalamic nucleus, a small, pumpkin-seed-shaped region deep within the brain.

Weidong Cai

The subthalamic nucleus is known for its role in inhibiting motor activity, but there are clues to its involvement in other functions. For example, deep brain stimulation, which uses implanted electrodes to stimulate the subthalamic nucleus, has proven to be a powerful way to relieve motor symptoms for Parkinson’s patients — but a common side effect is worsened speech impairment.

Same test, different scores

In the new study, 27 participants with Parkinson’s disease and 43 healthy controls, all older than 60, took standard tests of motor and cognitive functioning. The participants with Parkinson’s took the tests while on and off their medication.

As expected, the medication improved motor functioning in the patients, with those having the most severe symptoms improving the most.

The test for cognitive functioning offered a surprise. The test, known as the Symbol Digit Modalities Test, is given in two forms — oral and written. Patients are provided with nine symbols, each matched with a number — a plus sign for the number 7, for example. They are then asked to translate a string of symbols into numbers, either speaking or writing down their answers, depending on the version of the test.

As a group, the patients’ performance on both versions of the cognitive test was little affected by medication. But taking a closer look, the researchers noticed that the subset of patients who performed particularly poorly on the spoken version of the test without medication improved their spoken performance on the medication. Their written test scores did not change significantly.

“It was quite interesting to find this dissociation between the written and oral version of the same test,” Cai said.

The dissociation suggested that the medication was not enhancing general cognitive functions such as attention and working memory, but it was selectively improving speech.

“Our research unveiled a previously unrecognized impact of dopaminergic drugs on the speech function of Parkinson’s patients,” Menon said.

Uncovering connections

Next, the researchers analyzed fMRI brain scans of the participants, looking at how the subthalamic nucleus interacted with brain networks dedicated to various functions, including hearing, vision, language and executive control.

Vinod Menon

They found that different parts of the subthalamic nucleus interacted with different networks.

In particular, they discovered that improvements on the oral version of the test correlated with better functional connectivity between the right side of the subthalamic nucleus and the brain’s language network.

Using a statistical model, they could even predict a patient’s improvement on the oral test based on changes in their brain’s functional connectivity.

“Here we’re not talking about an anatomical connection,” Cai explained. Rather, functional connectivity between brain regions means the activity in these regions is closely coordinated, as if they are talking to each other.

“We discovered that these medications influence speech by altering the functional connectivity between the subthalamic nucleus and crucial language networks,” Menon said. “This insight opens new avenues for therapeutic interventions tailored specifically to improve speech without deteriorating other cognitive abilities.”

This newly identified interaction between the subthalamic nucleus and the language network could serve as a biological indicator of speech behavior — in Parkinson’s as well as other speech disorders like stuttering.

Such a biomarker could be used to monitor treatment outcomes and inspire new therapies. “Of course, you can directly observe the outcome of a medication by observing behavior, but I think to have a biomarker in the brain will provide more useful information for the future development of drugs,” Cai said. 

The findings also provide a detailed map of the subthalamic nucleus, which could guide neurosurgeons performing deep brain stimulation in avoiding damage to an area critical to speech function. “By identifying key neural maps and connections that predict speech improvement, we can craft more effective treatment plans that are both precise and personalized for Parkinson’s disease patients,” Menon said.

The study received funding from the National Institutes of Health (grants P50 AG047366, P30 AG066515, RF1 NS086085, R21 DC017950-S1, R01 NS115114, R01 MH121069 and K99 AG071837) and the Alzheimer’s Association.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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FACT SHEET: President   Biden Announces New Actions to Secure the   Border

New actions will bar migrants who cross our Southern border unlawfully from receiving asylum Biden taking action as Congressional Republicans put partisan politics ahead of national security, twice voting against toughest reforms in decades

Since his first day in office, President Biden has called on Congress to secure our border and address our broken immigration system. Over the past three years, while Congress has failed to act, the President has acted to secure our border. His Administration has deployed the most agents and officers ever to address the situation at the Southern border, seized record levels of illicit fentanyl at our ports of entry, and brought together world leaders on a framework to deal with changing migration patterns that are impacting the entire Western Hemisphere.  Earlier this year, the President and his team reached a historic bipartisan agreement with Senate Democrats and Republicans to deliver the most consequential reforms of America’s immigration laws in decades. This agreement would have added critical border and immigration personnel, invested in technology to catch illegal fentanyl, delivered sweeping reforms to the asylum system, and provided emergency authority for the President to shut down the border when the system is overwhelmed. But Republicans in Congress chose to put partisan politics ahead of our national security, twice voting against the toughest and fairest set of reforms in decades. President Biden believes we must secure our border. That is why today, he announced executive actions to bar migrants who cross our Southern border unlawfully from receiving asylum. These actions will be in effect when high levels of encounters at the Southern Border exceed our ability to deliver timely consequences, as is the case today. They will make it easier for immigration officers to remove those without a lawful basis to remain and reduce the burden on our Border Patrol agents. But we must be clear: this cannot achieve the same results as Congressional action, and it does not provide the critical personnel and funding needed to further secure our Southern border. Congress still must act. The Biden-Harris Administration’s executive actions will:   Bar Migrants Who Cross the Southern Border Unlawfully From Receiving Asylum

• President Biden issued a proclamation under Immigration and Nationality Act sections 212(f) and 215(a) suspending entry of noncitizens who cross the Southern border into the United States unlawfully. This proclamation is accompanied by an interim final rule from the Departments of Justice and Homeland Security that restricts asylum for those noncitizens.
• These actions will be in effect when the Southern border is overwhelmed, and they will make it easier for immigration officers to quickly remove individuals who do not have a legal basis to remain in the United States.
• These actions are not permanent. They will be discontinued when the number of migrants who cross the border between ports of entry is low enough for America’s system to safely and effectively manage border operations. These actions also include similar humanitarian exceptions to those included in the bipartisan border agreement announced in the Senate, including those for unaccompanied children and victims of trafficking.

Recent Actions to secure our border and address our broken immigration system: Strengthening the Asylum Screening Process

• The Department of Homeland Security published a proposed rule to ensure that migrants who pose a public safety or national security risk are removed as quickly in the process as possible rather than remaining in prolonged, costly detention prior to removal. This proposed rule will enhance security and deliver more timely consequences for those who do not have a legal basis to remain in the United States.

Announced new actions to more quickly resolve immigration cases

• The Department of Justice and Department of Homeland Security launched a Recent Arrivals docket to more quickly resolve a portion of immigration cases for migrants who attempt to cross between ports of entry at the Southern border in violation of our immigration laws.
• Through this process, the Department of Justice will be able to hear these cases more quickly and the Department of Homeland Security will be able to more quickly remove individuals who do not have a legal basis to remain in the United States and grant protection to those with valid claims.
• The bipartisan border agreement would have created and supported an even more efficient framework for issuing final decisions to all asylum seekers. This new process to reform our overwhelmed immigration system can only be created and funded by Congress.

Revoked visas of CEOs and government officials who profit from migrants coming to the U.S. unlawfully

• The Department of State imposed visa restrictions on executives of several Colombian transportation companies who profit from smuggling migrants by sea. This action cracks down on companies that help facilitate unlawful entry into the United States, and sends a clear message that no one should profit from the exploitation of vulnerable migrants.
• The State Department also imposed visa restrictions on over 250 members of the Nicaraguan government, non-governmental actors, and their immediate family members for their roles in supporting the Ortega-Murillo regime, which is selling transit visas to migrants from within and beyond the Western Hemisphere who ultimately make their way to the Southern border.
• Previously, the State Department revoked visas of executives of charter airlines for similar actions.

Expanded Efforts to Dismantle Human Smuggling and Support Immigration Prosecutions

• The Departments of State and Justice launched an “Anti-Smuggling Rewards” initiative designed to dismantle the leadership of human smuggling organizations that bring migrants through Central America and across the Southern U.S. border. The initiative will offer financial rewards for information leading to the identification, location, arrest, or conviction of those most responsible for significant human smuggling activities in the region.
• The Department of Justice will seek new and increased penalties against human smugglers to properly account for the severity of their criminal conduct and the human misery that it causes.
• The Department of Justice is also partnering with the Department of Homeland Security to direct additional prosecutors and support staff to increase immigration-related prosecutions in crucial border U.S. Attorney’s Offices. Efforts include deploying additional DHS Special Assistant United States Attorneys to different U.S. Attorneys’ offices, assigning support staff to critical U.S. Attorneys’ offices, including DOJ Attorneys to serve details in U.S. Attorneys’ Offices in several border districts, and partnering with federal agencies to identify additional resources to target these crimes.

Enhancing Immigration Enforcement

• The Department of Homeland Security has surged agents to the Southern border and is referring a record number of people into expedited removal.
• The Department of Homeland Security is operating more repatriation flights per week than ever before. Over the past year, DHS has removed or returned more than 750,000 people, more than in every fiscal year since 2010.
• Working closely with partners throughout the region, the Biden-Harris Administration is identifying and collaborating on enforcement efforts designed to stop irregular migration before migrants reach our Southern border, expand investment and integration opportunities in the region to support those who may otherwise seek to migrate, and increase lawful pathways for migrants as an alternative to irregular migration.

Seizing Fentanyl at our Border

• Border officials have seized more fentanyl at ports of entry in the last two years than the past five years combined, and the President has added 40 drug detection machines across points of entry to disrupt the fentanyl smuggling into the Homeland. The bipartisan border agreement would fund the installation of 100 additional cutting-edge inspection machines to help detect fentanyl at our Southern border ports of entry.
• In close partnership with the Government of Mexico, the Department of Justice has extradited Nestor Isidro Perez Salaz, known as “El Nini,” from Mexico to the United States to face prosecution for his role in illicit fentanyl trafficking and human rights abuses. This is one of many examples of joint efforts with Mexico to tackle the fentanyl and synthetic drug epidemic that is killing so many people in our countries and globally, and to hold the drug trafficking organizations to account.

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Every Word of Emma Stone’s 2024 Best Actress Oscars Speech: ‘It’s Not About Me’

Emma Stone is officially a two-time Best Actress winner—and she used her speech to turn the focus on all the people who worked with her on Poor Things .

“Yorgos [Lanthimos, Poor Things ’ director] said to me, ‘Please take yourself out of it,’ and he was right, because it’s not about me,” she said. “It’s about a team that came together to make something greater than the sum of its parts. And that is the best part about making movies, is all of us together. And I am so deeply honored to share this with every cast member, with every crew member, with every single person who poured their love and their care and their brilliance into the making of this film.”

She also gave her family, including her husband, Dave McCary, and daughter, a shout-out at the end of her speech. “I really just want to thank my family, my mom, my brother, Spencer, my dad, my husband, Dave. I love you so much,” she said. “And most importantly, my daughter, who’s gonna be three in three days and has turned our lives technicolor. I love you bigger than the whole sky, my girl. So thank you so much. Don’t look at the back of my dress. Thank you.”

Stone, who first won the award in 2017 for La La Land , took home the honor again for her work in Poor Things .

Here, her full remarks:

Hoo boy, my dress is broken. I think it happened during “I’m Just Ken.” I’m pretty sure. Oh, boy, this is really, this is really overwhelming. Sorry. My voice is also a little gone, whatever! The women on the stage, you are all incredible, and the women in this category: Sandra [Hüller], Annette [Bening], Carey [Mulligan], Lily [Gladstone], I share this with you. I am in awe of you, and it has been such an honor to do all of this together. I hope we get to keep doing more together. I don’t know what I’m saying. Oh my God, I’m totally—OK, the other night I was panicking as you can kind of see—it happens a lot—that maybe something like this could happen. And Yorgos [Lanthimos, Poor Things ’ director] said to me, “Please take yourself out of it,” and he was right, because it’s not about me. It’s about a team that came together to make something greater than the sum of its parts. And that is the best part about making movies, is all of us together. And I am so deeply honored to share this with every cast member, with every crew member, with every single person who poured their love and their care and their brilliance into the making of this film. And Yorgos, thank you for the gift of a lifetime in Bella Baxter. I am forever thankful for you. Thank you for inviting all of us to be members of this team. Thank you. Oh, wait, I just—I know I have to wrap up, but I really just want to thank my family, my mom, my brother, Spencer, my dad, my husband, Dave [McCary]. I love you so much. And most importantly, my daughter who’s gonna be three in three days and has turned our lives technicolor. I love you bigger than the whole sky, my girl. So thank you so much. Don't look at the back of my dress. Thank you.

Watch her speech below:

Stone opened up about the rehearsal process for Poor Things and contrasted it to her experience working on La La Land in a February interview with Variety .

“For La La Land , we did a ton of rehearsals for a very long time, but it was very specific: dancing and singing,” Stone said. “But when Yorgos was talking about rehearsal, I didn’t know what exactly that entailed. And it turns out that his rehearsals, they have nothing to do with what you’ll ultimately do on the day. But what it does, I think, subconsciously or in a subterranean way, is it lets everybody feel very comfortable with each other. You’re playing a lot of games.”

“I loved it. I loved it. Yeah,” Stone added of the process. “And I realized by the time that we were on set, we all felt very close to each other. We had all gotten to know each other in a much more intimate way than we would’ve if we’d just been blocking and saying our lines over and over.”

Oscars 2024 Guide

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Kendall Jenner Wore Sheer Corset Dress Out

Anya Taylor-Joy Wears LBD to Oscar After-Party

Margot Robbie Wears Mugler to VF Oscar Party

Kim K and EmRata Match at Oscar After-Party

Why Timothée Didn’t Join Kylie at Oscar Parties

Lupita Nyong’o’s Oscars Getting-Ready Diary

Florence Pugh Went Braless at Oscar Party

Jennifer Goes Regency at Oscar After-Party

Emma Stone Changed Into Second Dress

Taylor and Travis Secretly Attended Oscar Party

'These are bad people': Trump unloads after his historic guilty verdict

Less than 24 hours after being found guilty on 34 felony counts , Donald Trump stood in front of a backdrop of American flags and was ready to get weeks of frustration off his chest.

The pugilistic former president spent 40 minutes unloading rambling comments peppered with mistruths and distortions to defend himself in news conference Friday at Trump Tower in Manhattan.

The event was the beginning of a new reality: Trump is now the first former president to be convicted of a crime.

“This is all done by Biden and his people,” Trump said to open the news conference, continuing without evidence to directly blame President Joe Biden for his legal woes. “This is done by Washington. No one has ever seen anything like this.”

In the wake of a New York jury finding Trump guilty on all 34 felony counts of falsifying business records around payments he made to an adult film star during the 2016 election, Trump expressed his discontent, using the Truth Social platform to once again call his prosecution a “witch hunt.” In another fundraising email, he referred to himself as a “political prisoner.”

But the news conference offered Trump the first opportunity for an extended airing of grievances.

He called Manhattan District Attorney Alvin Bragg “failed,” and once again blasted Judge Juan Merchan as “conflicted.” 

Trump would not discuss the perceived conflict, saying he could not because of a gag order Merchan put on him earlier in the trial. (In the past, Trump and his allies have gone after Merchan for a $15 donation he gave to Biden in 2020, and the fact that the judge's daughter worked with a Democratic-aligned group.)

The gag order prevented Trump from commenting publicly about witnesses, jurors, court staff and other attorneys (excluding Bragg) and all their family members, but it did not include a prohibition on talking about Merchan himself. 

“I am not allowed to talk about it,” Trump said of the perceived conflict. “There has never been anyone so conflicted as this.”

Trump violated the gag order on 10 separate occasions during the trial costing him $10,000 in fines and prompting Merchan to threaten him with jail time.

Trump also claimed he wanted to testify, something he ultimately did not do over concerns he would perjure himself. On Friday, he justified the decision by saying even George Washington would never testify on his own behalf.

“I would have testified. I wanted to testify. The theory is you never testify,” Trump said. “If it were George Washington, don’t testify. Because they will get you on something you said slightly wrong.”

He also called his former attorney Michael Cohen, who was a key witness for the prosecution, a “sleaze bag,” but would not directly use his name, once again citing the gag order. Cohen was Trump’s longtime attorney, but he turned on his former boss and ended up doing 13 months in prison after pleading guilty in 2018 for lying to Congress and around campaign finance charges tied to work he did for Trump.

Trump also leaned into a theme he's been pushing throughout his campaign, portraying himself as a victim of rigged system that's out to get him — and anyone who supports him.

"This is a case where if they can do this to me, they can do this to anyone," Trump said opening his remarks. "These are bad people."

Trump also said he could serve time in prison up to 187 years, but some legal experts told NBC News there's a chance he won't be imprisoned at all based on his age, lack of a criminal record and other factors. And while each count does carry a term of four years, it's expected that any sentence would be imposed concurrently, instead of consecutively.

Shortly after Trump’s guilty verdicts were read, the expected political battle lines were drawn.

Democrats and the vocal set of Republicans who are notably anti-Trump quickly took victory laps , proclaiming that justice had been served, while Trump’s already intense Republican base became further outraged at what they see as a political persecution and vowed to take revenge. 

Rep. Mike Collins, R-Ga., said Republican law enforcement officials should "get busy."

“Time for Red State AGs and DAs to get busy,” Collins posted on X.

After Trump's press conference Friday, Biden campaign spokesman Michael Tyler issued a statement saying, "Trump is consumed by his own thirst for revenge and retribution."

"America just witnessed a confused, desperate, and defeated Donald Trump ramble about his own personal grievances and lie about the American justice system, leaving anyone watching with one obvious conclusion: This man cannot be president of the United States," he said.

There were, however, concrete signs that, as Trump predicted, a guilty conviction would further energize his political base.

The Trump campaign and the Republican National Committee said the verdict led to historic fundraising levels for the GOP operation — more than $34.8 raised in the hours between the verdict and Thursday at midnight. While those numbers cannot be independently verified due to lags in campaign finance reporting requirements, an RNC spokesperson told NBC News that total represented what Trump’s joint fundraising committee with the RNC raised through the online fundraising platform WinRed.

“From just minutes after the sham trial verdict was announced, our digital fundraising system was overwhelmed with support, and despite temporary delays online because of the amount of traffic, President Trump raised $34.8 million dollars from small dollar donors,” read a statement from top Trump campaign officials.

There are also signs that the party’s biggest rainmakers are also prepared to come rally around Trump.

After the verdict was read, Trump attended a Manhattan fundraiser hosted by Pepe Fanjul, a South Florida sugar baron and longtime major Republican donor, according to a campaign official.

Shawn McGuire, a partner at hedge fund Sequoia Capital who in 2016 voted for Hillary Clinton, also announced publicly he is donating $300,000 to Trump’s campaign efforts.

“Back in 2016 I had drunk the media Kook-Aid and was scared out of my mind about Trump,” he posted on X. “As such I donated to Hillary’s campaign and voted for her.” 

“Now, in 2024, I believe this is one of the most important elections of my lifetime, and I’m supporting Trump,” he added.

Matt Dixon is a senior national politics reporter for NBC News, based in Florida.

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Wordle Review No. 1,080, June 3, 2024

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By New York Times Games

Welcome to The Wordle Review. Be warned: This page contains spoilers for today’s puzzle. Solve Wordle first , or scroll at your own risk.

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The difficulty of each puzzle is determined by averaging the number of guesses provided by a small panel of testers who are paid to solve each puzzle in advance to help us catch any issues and inconsistencies.

Today’s average difficulty is 3.8 guesses out of 6, or easy breezy.

For more in-depth analysis, visit our friend, WordleBot .

Today’s Word

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Today’s word is STARK, an adjective. According to Webster’s New World College Dictionary, it means “sharply outlined or prominent.”

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Election latest: Sir Keir Starmer challenged to make 'lying PM' claim 'stick' - as minister doubles down on row

Amid the raging tax row, a former Scottish Labour leader has told Sky News that if Sir Keir Starmer can "make it stick" with voters that the PM "lies", he'll have won the argument. Meanwhile, a Treasury minister has denied that the Tory party's claim about Labour's tax plans is false.

Wednesday 5 June 2024 23:28, UK

• General Election 2024

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Election news

• Battle For No 10: PM and Starmer taking part in Sky News special
• Bulletin: Catch up on the latest news from the campaign trail
• Exclusive: Reform gains ground on Tories in new poll
• Starmer accuses PM of lying | Watchdog 'looking into' tax claim
• Treasury minister denies that Sunak lied | Starmer challenged to 'make it stick'
• Welsh FM won't quit after losing confidence vote
• Top chef explains Labour backing
• Live reporting by Ben Bloch and (earlier)  Faith Ridler

Expert analysis

• Adam Boulton: Starmer's been given licence to say 'liar'
• Sophy Ridge: No party's being honest about challenges to come
• Jon Craig: Starmer needs to be a bit less Mark Darcy
• Ed Conway : The £13,000 omission in PM's tax warning

Election essentials

• Have your say: Be in the audience for our election leaders event
• Trackers: Who's leading polls? | Is PM keeping promises?
• Campaign Heritage: Memorable moments from elections gone by
• Follow Sky's politics podcasts: Electoral Dysfunction | Politics At Jack And Sam's
• Read more: Who is standing down? | Key seats to watch | How to register to vote | What counts as voter ID? | Check if your constituency is changing | Your essential guide to election lingo | Sky's election night plans

Thank you for joining us for live coverage of another busy day on the general election campaign trail.

For a short burst of everything that happened today, see our evening round-up here .

Join us again from 6am as the battle for the keys to No 10 continues.

The Liberal Democrats are tonight weighing in on the tax row that has engulfed the general election campaign since last night's testy debate.

Rishi Sunak claimed that Labour's policies will see a £2,000 tax hike if it wins power - but that is highly disputed by experts,  including Sky's economics and data editor Ed Conway .

Sarah Olney, Treasury spokesperson for the Lib Dems, is seemingly siding with Labour in this row, saying in a statement that the Tories are "fooling absolutely nobody".

"Their chaos and mismanagement have damaged the economy and left British families worse off, saddling them with £41bn of unfair stealth taxes worth hundreds of pounds for every household," she said.

"Hard-working families deserve so much better. Voters will never forgive the Conservative Party for saddling them with unfair tax hikes and failing to tackle the cost of living crisis, while giving tax cuts to the big banks and oil and gas giants."

David Duguid has said on social media that the Scottish Conservatives have prevented him from standing again as a candidate for the party.

He served as the MP for Banff and Buchan from 2017 until parliament was dissolved for this general election, but has spent many weeks in hospital receiving treatment in intensive care for a spinal illness and pneumonia.

The general election "came as a surprise", but on 23 May, he announced that he would stand to win his seat once again.

Although he said he would be able to campaign, he also said he would not be able to canvass in person as he remains in a rehabilitation ward.

He said on social media this evening that although he was selected by local party members as their candidate once again, the Scottish Conservatives told him "that they have decided not to put me forward as their chosen candidate for Aberdeenshire North and Moray East" (the name of his former constituency following the boundary review).

A spokesperson for the Scottish Conservatives said: "David Duguid is unfortunately unable to stand in this election.

"David has been an excellent MP and great local representative for the last seven years.

"We thank David for all his hard work for the party, we look forward to his recovery to full health, and hope that he will want to rejoin frontline politics in the future."

It is understood that the party feels it is taking the decision in the best interests of Mr Duguid's health.

By  Faye Brown , political reporter

Rishi Sunak has pledged to cut rail fares for veterans and "enshrine their rights in law" in an election offering on the 80th anniversary of D-Day.

The prime minister has announced a raft of measures aimed at making the UK "the best place in the world" to have served in the armed forces.

This includes reducing the price of the Veterans Railcard from £30 per year to £21, bringing it in line with how much serving personnel pay for the HM Forces Railcard.

The Tories also want to extend the existing national insurance relief for employers who hire ex-military members, in a move the party said will incentivise companies to continue offering jobs to veterans.

But Labour said the Tory record on veterans is "shameful" and their election plans "mean no change".

The measures will be covered by a new Veterans Bill, which will also ensure military qualifications have an equal standing with civilian qualifications in law for the first time.

Read more here:

It's been a day of fiery fallout from last night's debate between the prime minister and Labour leader.

Rishi Sunak has faced backlash over his claims that Labour's plans will cost households £2,000 more in tax, with Sky's economics and data editor Ed Conway among those questioning the figures.

Here's everything you need to know about what happened in the general election today:

• We'll start with Labour's no-nonsense response to Rishi Sunak's claims about their tax plans last night, which peaked with Sir Keir Starmer accusing the prime minister of repeatedly lying ;
• Mr Sunak's claim is also being looked into by the UK's statistics watchdog, while doubt has been cast on his allegation by a top Treasury official, who said the civil service had nothing to do with it;
• The Tories have stood by the claim that households will pay an extra £2,000 , but Labour insist working families won't be out of pocket;
• Ed Conway has written about why you should probably be sceptical of those claims and says even if true, the amount is nowhere near the extra burden placed upon taxpayers in recent years;
• But tonight, the Tories are doubling down, and making more pledges around taxes on housing, which you can read here .
• Nigel Farage's return to frontline politics this week has also dragged down the Tories' ratings in our latest election polling;
• Our exclusive survey from YouGov shows Mr Farage's party have pulled within two points of the Conservatives , with Labour on 40%, the Tories on 19% and Reform on 17%;
• Speaking of Mr Farage, a woman has been charged after he had a milkshake thrown over him in Clacton yesterday.
• Elsewhere, the Welsh first minister has lost a vote of no confidence , having been left in tears as the Senedd debated his future;
• Vaughan Gething faced the vote after concerns were raised about a campaign donation he received, allegations he misled the COVID Inquiry, and Plaid Cymru withdrawing from its co-operation deal with Labour - but he has said he won't quit ;
• In Scotland, Scottish Labour has been extolling the virtues of the party's plan for Great British Energy , which would be headquartered in the country;
• Campaigning has been quieter in England, as party leaders assembled with royalty and veterans for D-Day commemorations in Portsmouth.

Sky News has also had its own announcement to make this evening, with Rishi Sunak and Sir Keir Starmer agreeing to take part in a special leaders' programme .

The Battle For Number 10 will air from 7pm next Wednesday.

Here are some other stories you might want to read:

Our essential political podcast,  Politics At Jack And Sam's ,  is going out every week day through the election campaign to bring a short burst of everything you need to know about the day ahead as this election unfolds -  here is today's edition .

Tap here to follow Politics At Jack At Sam's wherever you get your podcasts .

The Labour Party has hit out at "desperate claims" from Rishi Sunak as the Tories unveil another guarantee not to raise taxes.

The chancellor is tonight announcing what the Tories are calling the "Family Home Tax Guarantee", which is a pledge to:

• Not increase the number of council tax bands, re-evaluate it, or cut existing discounts;
• Maintain the Private Residence Relief - meaning people with one home that has always been their sole residence, and the grounds are less than 5,000 square metres will continue to not pay capital gains tax if it is sold;
• Not increase the rate or level of stamp duty.

The Tories are continuing to claim that Sir Keir Starmer is going to raise taxes on families by £2,094 - something that is highly disputed by experts, including Sky's economics and data editor Ed Conway .

The party also says that shadow chancellor Rachel Reeves proposed changing council tax to a property tax, and are challenging Labour to match this new pledge.

Chancellor Jeremy Hunt said in a statement: "Rachel Reeves has previously called for a range of damaging new taxes on the family home just like Labour are looking at doing in Labour-run Wales; and that means she and Keir Starmer are coming for your family home.

"Only Rishi Sunak and the Conservatives will protect your family home to give you peace of mind with our guarantee that there will be no rises in such taxes for the whole of the next parliament."

But Labour has blasted the claims from the Conservative Party, saying in a statement: "We will not be raising taxes on working people. The Conservatives cannot be trusted on tax and taxes are at a 70-year high on their watch.

"These are more desperate claims from Rishi Sunak who lied to the British people before and is lying to them again."

By Alexandra Rogers , political reporter

Faiza Shaheen, who was blocked from representing the Labour Party in the general election, has announced she will stand as an independent.

Ms Shaheen, who initially won the Labour nomination for Chingford and Woodford Green, said she had decided to run as an independent after voters told her they felt "disenfranchised" by the party's decision to remove her as a candidate.

Labour removed Ms Shaheen as its candidate for the London constituency after she allegedly liked a series of social media posts that downplayed antisemitism accusations.

Yesterday she  announced her resignation from the party , accusing it of embodying a "hierarchy of racism".

She said she was weighing up whether to stand as an independent in Chingford, and on Wednesday afternoon, confirmed that decision.

The Liberal Democrats have announced a rail fare freeze as one of their manifesto commitments.

It would be funded via clamping down on tax avoidance and evasion, which the party says totals £38.5bn a year, and save commuters £115m.

Under the Tories, the Lib Dems say train tickets have soared while services have got worse.

The party's Treasury spokeswoman Sarah Olney said: "From Winchester to Wokingham, it is disgraceful that every day passengers are having to pay more for trains which are increasingly delayed or cancelled."

According to the party's analysis, commuters in Winchester, Hampshire, have seen season ticket prices climb by more than £1,000 since 2019, now standing at £6,432 a year.

In Harpenden, Hertfordshire, train commuters are paying £820 more, with tickets now costing £4,792 a year.

Rail fare reform would be implemented within five years, the party said.

By Sam Doak, OSINT Producer

As the country heads towards a general election, political parties have been competing through social media to get their messages to the public.

Sky News tracked the performance of the six highest polling parties across X (formerly Twitter), Instagram, TikTok, and Facebook to see how the race for online audiences is shaping up in the early days of the election campaign.

You can read about how they're doing below:

By Dan Whitehead , West of England and Wales correspondent

Seventy-eight days into the job and Vaughan Gething has lost the confidence of the Welsh parliament.

It may well be only by a narrow margin and because two Labour members were off sick - but whatever the factors behind this loss, it’s not a great look.

The first minister says he'll carry on, saying the vote was a gimmick. The Tories, Plaid, and Lib Dems here in Wales are all calling for him to resign.

D-Day commemorations tomorrow may put a momentary pause on the controversy - but Mr Gething now has a problem.

Do nothing, and he'll be constantly reminded the Senedd does not have confidence in his leadership. 

Resign, and trigger yet more political upheaval.

It may not be his choice: the Conservatives could put forward another vote of no confidence in the government, not just Mr Gething. They now are considering their next step.

All this amid an election campaign - with four weeks to go, what happens next in the Senedd could have a wider impact in UK politics.

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