My son has quite a severe stutter. He has the hardest time getting out the very first sound, he gets stuck and sometimes no sound comes out at all the first few tries, then the rest flows for a while and then he'll get stuck again. He has started using some coping strategies, for example will replace certain sounds (ex: "Th" is very difficult so he often will replace it with a T or D sound. "Tank-you" "Movie teatre" "Dis" "Dat"...) He tilts and turns his head when he gets stuck and squints his eyes. He often adds an H sound in the middle of a word. ("To-hoo-day at schoo-hoo-hool", or "Ca-ha-han we go-ho see a moo-hoovie today?) When he speaks slowly he is a little more fluent, but when he is excited or in a conversation with multiple people, where he fears he may be cut off, he struggles most.