FND and Your Speech, Voice and Swallowing: A simple introduction
Written by Mariya Kika, M.H.Sc., Reg. CASLPO, Speech-Language Pathologist
Table of Contents
After decades of talking without a second thought, you started stuttering over sounds. Or, maybe your vocal folds move paradoxically, slamming shut without warning. Testing came back clear, and you were stumped. Then a neurologist used a term you'd never heard: functional neurological disorder (FND).
Within the realm of speech language pathology (SLP), FND symptoms can change speech, voice and swallowing in ways that feel sudden and hard to explain. This guide covers what those changes can look like, how FND is diagnosed, and what FND speech therapy involves.
In plain language: Functional neurological disorder (FND) is a recognized neurological condition. The nervous system has trouble sending and receiving signals, even though nothing is structurally damaged. FND can affect speech, voice and swallowing, and symptoms often vary from day to day. Speech therapy for FND focuses on helping these movements become automatic again.
What is FND?
FND is a condition where the nervous system has trouble sending and receiving signals correctly. Scans look normal because the structures are intact. What's disrupted is the functioning of the system. When there is a disruption with the way the brain sends and receives signals, movements that are normally automatic, like speaking or swallowing, stop running smoothly.
A common comparison is a computer with working hardware and a software glitch. The comparison has limits, but essentially the brain is the hardware with all the pieces intact and undamaged. But, software can have a glitch in the code or programming, leading to the functional difference. This provides a clear comparison to frame clear tests with symptoms that are real and disabling.
FND isn't faking, or made up, or “all in your head”. Importantly, it isn't a sign of weakness. Stress or illness can be a trigger for some people. Many others can't identify the inciting trigger at all.
You may see older terms such as conversion disorder or psychogenic symptoms. Most neurologists now prefer "functional," because it names the problem itself: a change in function. If a provider is still using such terms, it may be a sign that they are not yet caught up on the ongoing FND research or changes in treatment approaches.
Can FND affect speech?
FND speech difficulties can take several forms. Some individuals may have one overarching difficulty, while others may have multiple difficulties. When speech is the main system affected, clinicians may call it a functional speech disorder.
Slurred speech: Words run together, sounds don’t get finished. You may sound like you’re mumbling, but feel like you’re putting in extra effort. It can worsen with fatigue or other symptoms.
Stuttering that starts in adulthood: Functional stuttering can mean repeating sounds or whole words, getting stuck partway through a word, or stretching sounds out. Sometimes, individuals switch to short, clipped phrases or start avoiding conversations.
A change in accent or rhythm: Sometimes called foreign accent syndrome, this is when speech suddenly sounds as if it comes from another region or country.
Effortful speech: Talking comes out slow or choppy and takes noticeable work.
Childlike speech: Speech sounds like a young child, with differences present in certain sounds such as ‘r’, ‘l’, and ‘s’.
These symptoms often vary. Speech might be close to your normal first thing in the morning and much harder by late afternoon. It may be easier when you're absorbed in a conversation than when you're focused on how you sound. It might be affected by triggers, or the trend may not be immediately obvious. That variability is typical of FND, and it's one of the features clinicians look for.
Can FND affect your voice?
Yes. FND voice changes ranges from a hoarse, strained voice to no voice at all:
Functional Dysphonia: A whisper or hoarse voice that sounds similar to one having a sore throat. Changes in volume are difficult.
Functional Aphonia: Complete loss of voice. It can happen across days, within the span of a day, or change intermittently.
Sudden Vocal Fold Movement: A strained, squeezed voice that breaks partway through sentences
Many people with functional voice loss can still regular automatic sounds like laughing or coughing. That's a useful clue. It shows the vocal cords can move, and that the difficulty lies in conscious control of the voice when you try to speak.
When a voice change doesn't settle, an ear, nose and throat (ENT) doctor usually examines the vocal cords to rule out other causes. While not always required, this is recommended and it can be beneficial to take a look at the physical structures before voice therapy starts.
Can FND affect swallowing?
Yes. FND can change how swallowing feels, even when swallowing function and structures look normal on visual imaging:
A lasting sense of a lump in the throat when nothing is there (globus)
Swallowing that feels slow or effortful, as though each swallow has to be planned
Fear of choking, which can lead people to avoid certain foods or eat less over time
A new swallowing problem should be checked by a doctor first, especially if it comes with weight loss, coughing or choking on food or drink, or chest infections.
How is FND diagnosed?
In Ontario, FND is typically diagnosed by a neurologist. It rests on specific signs in the examination that indicate the presence of FND, not just the absence of other diagnoses. Clear scans support the diagnosis, but FND should not be a label given when doctors run out of other explanations.
SLPs can contribute to this process. Our assessment looks closely at how speech, voice and swallowing are working, and that detail shapes the therapy plan. Speech therapy can start based on your symptoms and their impact on your day-to-day communication or swallowing, not on a specific label. For many people, therapy and the diagnostic process happen alongside each other, not one after the other.
What does speech therapy for FND involve?
Speech therapy for FND combines education, direct work on the symptoms, and attention to the habits that can keep symptoms going. In practice, sessions often cover:
Understanding the diagnosis: Knowing how FND affects speech makes the rest of therapy easier to follow.
Reducing effort: Pushing harder to get words out does not always make it easier to get them out. Therapy looks at the breathing patterns and muscle tension that get in the way.
Building from what works: Therapy finds what’s still available and present and shapes those automatic sounds into words.
Shifting attention: Monitoring every word can make speaking harder, so practice often includes speaking while your attention is elsewhere.
Practising in real situations: Carryover and practice includes using strategies in phone calls, medical appointments, meetings at work and more.
Planning for setbacks: Create a list of triggers, and the strategies to use when a setback occurs.
Speech therapy can run alongside physiotherapy, occupational therapy or psychology, or on its own. Sessions usually become less frequent as goals are met.
FND Frequently Asked Questions
Is FND "all in my head"?
No. FND involves a real change in how the nervous system functions. Stress can contribute for some people, as it can in many medical conditions. It isn't present for everyone, and it doesn't make symptoms any less real.
Why do my FND symptoms change from day to day?
Variability is one of the defining features of FND. Fatigue, illness, pain and closely monitoring your own speech can all make symptoms worse. The easier moments are useful in therapy, because they show what your system can still do.
Do I need a referral to see an SLP for FND?
In Ontario, you can usually book directly with a private SLP. If you haven't seen a neurologist about your symptoms, the clinician may recommend it so that you can begin the process of receiving a diagnosis.
Can speech therapy for FND be done online?
Yes. Much of the work is listening, speaking and practising everyday tasks, which suits video. Practising at home can also make it easier to carry new skills into daily life.
About the author
Mariya Kika is a registered speech-language pathologist and the founder of Cognicare Speech Therapy, operating virtually across Ontario. She holds a Master of Health Science from the University of Toronto. She has previously worked in hospital settings providing intensive outpatient neurorehabilitation support. She is a member of FND Hope, FND Society, the Canadian Concussion Network, Ontario Brain Injury Association, Toronto Brain Injury Association, and Canadian Telerehab Community of Practice.
For more on FND, see the FND Services Page.