Over the past few years, I have had the opportunity to work with two adults living with a relatively rare condition called Functional Neurological Disorder (FND). Although both experienced communication difficulties, their stories were very different.
One client’s symptoms appeared suddenly and without an obvious explanation. The other developed communication changes following a head injury. Despite these very different beginnings, both experienced symptoms that had a significant impact on their daily lives. One experienced significant dysphonia (voice change/disorder) and the other had difficulties with speech processing and word finding.
Before meeting these clients, FND was not something I had encountered often. But I learned that speech-language pathologists (SLPs) can play an important role in helping people with FND regain their voice, speech, swallowing, and confidence.
If you have recently been diagnosed with FND, or are wondering whether it could explain your symptoms, you probably have many questions. This post briefly explains what FND is, how it can affect communication, and how speech-language therapy can help.
What Is Functional Neurological Disorder?
Functional Neurological Disorder is a condition that affects how the brain sends and receives messages throughout the body. The nervous system itself is structurally intact, but the brain has difficulty accessing or controlling normal movement and sensation.
As one of the clients I mentioned explained to me, based on what their neurologist had told them: a helpful way to think about it is to imagine a computer. The hardware is working, but there is a problem with the software. In FND, the brain still has the ability to speak, swallow, move, or produce voice, but those movements are no longer being accessed efficiently. This is different from conditions such as stroke, Parkinson’s disease where there can be structural damage or disease affecting the nervous system. One of the most important things to understand is that FND symptoms are genuine. They are not imagined, or under voluntary control. People with FND are not choosing to experience these symptoms. Research over the past two decades has led to a much better understanding of this condition. The diagnosis, usually from a neurologist or other medical specialist, is made using positive clinical signs rather than simply ruling out other conditions.
How Can FND Affect Communication?
FND can affect several different aspects of communication and swallowing. Some people experience only one symptom, while others experience several. Voice changes are common (as was the case with one client). Someone may suddenly lose their voice, develop a whisper, notice severe hoarseness, or find that their voice becomes unusually strained. Others notice that speaking requires tremendous effort, even though medical examinations show that the vocal folds are healthy.
Speech fluency can also be affected. A person who has never stuttered before may suddenly develop repetitions, blocks, or hesitations that interfere with communication. Some people experience changes to speech clarity. Words may sound slurred, sounds may become distorted, or speech may suddenly take on an unusual rhythm despite no evidence of neurological damage that would explain these changes.
Others develop swallowing difficulties. They may feel as though food gets stuck or become fearful of swallowing despite normal swallowing found in assessments. Breathing and chronic cough may also be part of FND. Because breathing, voice, and swallowing all rely on closely coordinated muscles, changes in one system can influence another. These symptoms can be very distressing. Many people worry that they have a progressive neurological disease. Receiving an accurate diagnosis can brings some relief but also more uncertainty.
For some people, symptoms begin after an illness, surgery, concussion, or even a viral infection. Others notice symptoms after a period of increased stress. Sometimes there is no obvious trigger at all. Modern research suggests that FND develops because the brain temporarily loses efficient control over normal movement patterns. The movements become interrupted. Activities that are normally automatic, such as speaking, swallowing, or producing voice, become difficult because the brain begins trying too hard to control processes that normally happen without conscious effort. This is why symptoms often fluctuate. Someone may struggle to produce voice during conversation but laugh normally a few moments later. A person who cannot say a word intentionally may produce it automatically during another activity. These inconsistencies are actually helpful clinical signs because they demonstrate that the nervous system retains the ability to perform the movement.
How Is FND Diagnosed?
In the past, people were sometimes told that all of their tests were normal and therefore nothing was wrong. This understandably left many patients feeling dismissed. Today, neurologists (with the help of other professionals) diagnose FND by looking for positive features that are characteristic of the condition.
For speech and voice disorders, this often means looking for situations where normal movement briefly returns. Someone who cannot produce voice while speaking may cough or laugh with a strong voice. A person who struggles during formal speech tasks may suddenly speak more easily while laughing, singing, or becoming distracted, or even when lying flat on their back. These observations provide evidence that the muscles and nervous system remain capable of normal movement. The difficulty lies in accessing those movements consistently.
What Does a Speech-Language Pathologist Do?
For FND, speech therapy focuses on helping the brain rediscover efficient, automatic movement patterns rather than exercising muscles that are weak or damaged. During the assessment, your SLP will listen carefully to your symptoms, learn how they began, and identify situations where communication becomes easier or more difficult. They will also explore how your symptoms affect daily life. Education is an important part of treatment. Understanding why symptoms occur often reduces fear and helps people approach therapy with greater confidence. Treatment is highly individualized because no two people experience FND in exactly the same way. For voice changes, elements of voice therapy come into play, for word retrieval other strategies will be used.
A major goal of therapy is to help you experience moments of normal movement. For voice disorders, this may involve making easy, natural sounds such as laughing, sighing, humming, coughing, or producing relaxed vocalizations. These activities often bypass the patterns that are interfering with normal voice production. Once voice begins to return, the SLP gradually shapes those sounds into words, phrases, sentences, and conversation.
For functional stuttering, therapy often focuses on reducing unnecessary physical effort, increasing forward airflow, and helping speech become smoother without forcing fluency. Sometimes techniques that temporarily shift attention away from speech allow more natural communication to emerge.
For articulation or speech clarity difficulties, therapy may include activities that encourage easier, more automatic speech while reducing excessive tension. Often, therapy helps build confidence that normal movement is possible and can become increasingly reliable.
Why Does Attention Matter?
One of the most interesting findings in FND research is the role of attention.
Normally we do not consciously think about every movement involved in speaking. The brain coordinates thousands of tiny muscle movements automatically. During therapy, the therapist may deliberately use activities that shift attention elsewhere while encouraging natural speech or voice. This is a way of helping the brain reconnect with movement patterns that are already present and help them become stronger and more consistent. Eventually they begin to carry over into everyday situations.
Often, an SLP is just one part of the team, as there are psychologists who specialize in working with FND patients.
Can People Recover?
Over time, yes. Many people improve with appropriate treatment. But recovery is rarely perfectly linear. It is common for symptoms to fluctuate or temporarily return during illness, fatigue, or periods of stress. One of the goals of speech therapy is helping people recognize early signs of recurrence and use the same strategies that worked previously. Many people become increasingly skilled at managing setbacks independently.
Final Thoughts
Living with Functional Neurological Disorder can feel frustrating, especially if you have spent months or years searching for answers. The encouraging news is that FND is now much better understood than it was previously. We know that the symptoms are real, that they have identifiable clinical features, and that many people improve with evidence-based treatment.
If FND has affected your voice, speech, or communication, working with an SLP can provide practical strategies, reassurance for one’s confidence, and be a part of the path toward recovery.
References
- Baker, J., Barnett, C., Cavalli, L., Dietrich, M., Dixon, L., Duffy, J. R., Elias, A., Fraser, D. E., Freeburn, J. L., Gregory, C., McKenzie, K., Miller, N., Patterson, J., Roth, C., Roy, N., Short, J., Utianski, R., van Mersbergen, M., Vertigan, A., … McWhirter, L. (2021). Management of functional communication, swallowing, cough and related disorders: Consensus recommendations for speech and language therapy. Journal of Neurology, Neurosurgery & Psychiatry, 92(12), 1285–1297. https://doi.org/10.1136/jnnp-2021-326767
- McWhirter, L., & Baker, J. (2021, July 20). Speech and language therapy. Neurosymptoms.org. https://neurosymptoms.org/en/treatment/speech-and-language-therapy/
