Speech, voice and swallowing
Understand which symptom family applies, how assessment works and what needs a separate or urgent clinical route.
Speech, voice and swallowing
This page covers speech, language and voice symptoms, as well as swallowing, throat, cough and upper-airway problems. They are not one diagnosis and may involve different professionals, including speech and language therapy, ENT, respiratory or digestive care.
Important limit: These symptoms are not one diagnosis. This page cannot determine whether an individual's symptom is functional, structural, neurological, respiratory or caused by something else.
Sources and review information
Status: Owner released - source checked
Evidence check: Mapped to checked master-register claims
Jurisdiction: UK
Last checked: Check the linked live source
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Corrections: Use the site correction route without including personal health information.
- WHO ICD-11 2026 — World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 2026-01 release.
- FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
- Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
- WHO ICD-11 CDDR — World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: WHO; 2024.
- SLT consensus — Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92(10):1112-1125.
Last checked: 2026-07-16
Jurisdiction: UK
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Correction route: Report changed or inaccurate information without including personal health information.
Similar words can describe different problems
The page keeps speech, voice, swallowing, throat and breathing symptoms together for navigation while keeping their medical differences clear.
- Speech and language: stuttering or dysfluency, dysarthria-like speech, altered rhythm or prosody, speech arrest and some language errors may occur in functional communication presentations.
- Voice: dysphonia, a strained, weak or whispered voice, and aphonia or loss of voice are recognised functional voice presentations.
- Swallowing and throat: dysphagia, difficulty initiating a swallow and globus or a lump-in-throat sensation require their own assessment.
- Cough and upper airway: functional cough or episodic throat or upper-airway symptoms overlap with ENT and respiratory diagnoses and should remain labelled as related rather than automatically called FND.
- Communication access: text, extra time, alternative formats, an interpreter or agreed supporter involvement can be useful based on need without proving any diagnosis.
Important limit: A catalogue descriptor is a search and routing term. It is not evidence that FND caused an individual's symptom.
Sources and review information
Status: Owner released - source checked
Evidence check: Mapped to checked master-register claims
Jurisdiction: UK
Last checked: Check the linked live source
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Corrections: Use the site correction route without including personal health information.
- WHO ICD-11 2026 — World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 2026-01 release.
- WHO ICD-11 CDDR — World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: WHO; 2024.
- SLT consensus — Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92(10):1112-1125.
- FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
- Overall FND comorbidities review — Guilhem Carle-Toulemonde, Julie Goutte, Nathalie Do-Quang-Cantagrel et al. Overall comorbidities in functional neurological disorder: A narrative review. Encephale. 2023;49(4S):S24-S32.
- Cognition across FND, fibromyalgia and CFS — Tiago Teodoro, Mark J Edwards, Jeremy D Isaacs A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry. 2018;89(12):1308-1319.
- FND manifestations and comorbidities survey — Alexandra Ducroizet, Ioanna Zimianti, Dawn Golder et al. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci. 2023;110:116-125.
- International FND patient survey — Matthew Butler, Oliver Shipston-Sharman, Mathieu Seynaeve et al. International online survey of 1048 individuals with functional neurological disorder. Eur J Neurol. 2021;28(11):3591-3602.
- NICE adult autism guideline — National Institute for Health and Care Excellence. Autism spectrum disorder in adults: diagnosis and management. CG142. Updated 14 June 2021.
- BPS FND psychology guidance — British Psychological Society. Functional Neurological Disorder: Neuropsychological and psychological management in children and adults. Division of Neuropsychology Policy Unit FND Working Group. 2024.
- Wales FND national optimal pathway — NHS Wales Performance and Improvement, Neurological Conditions Network. National Optimal Pathway for Functional Neurological Disorder: adults aged 16 and over. March 2026.
- UK community OT barriers — Nicholson C, Francis J, Nielsen G, Lorencatto F. Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: an interview study with occupational therapists in the United Kingdom. Br J Occup Ther. 2022;85:262-273.
- Journey to diagnosis and care — Pritomanova S, et al. The journey to diagnosis and care of functional neurological disorder. PLoS One. 2026;21:e0328321.
- Scotland FND pathway — NHS Scotland Centre for Sustainable Delivery. Functional Neurological Disorder pathway. Current at 14 July 2026.
- NHS patient-experience service evaluation — O'Keeffe S, Chowdhury I, Sinanaj A, et al. A service evaluation of the experiences of patients with functional neurological disorders within the NHS. Front Neurol. 2021;12:656466.
- DfE inclusive research — Department for Education. Inclusive research. User Research Manual.
- DfE language and BSL research — Department for Education. Research with users with limited English and sign-language users. User Research Manual.
What a proper assessment looks for
A trained assessment may find positive patterns, such as speech or voice working differently in automatic or distracted situations. Those findings only make sense alongside the full history and examination.
- Speech and language assessment considers the history, communication pattern and possible neurological, structural, hearing, cognitive and medicine-related explanations.
- Voice assessment may also require examination of the larynx and other ENT causes.
- Swallowing and upper-airway symptoms may need speech and language therapy, medical, ENT or respiratory assessment depending on the presentation.
- Any test should answer a defined question, and the results conversation should explain what was found, what remains uncertain and what happens next.
Important limit: No word list, reading task, voice recording, imitation, home swallow test, photograph or short video proves FND. This page does not teach self-examination.
Sources and review information
Status: Owner released - source checked
Evidence check: Mapped to checked master-register claims
Jurisdiction: UK
Last checked: Check the linked live source
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Corrections: Use the site correction route without including personal health information.
- WHO ICD-11 CDDR — World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: WHO; 2024.
- Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
- Practical review for physicians — Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder for the general physician. Clin Med (Lond). 2021;21(1):28-36.
- Current concepts — Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol. 2018;75(9):1132-1141.
- Positive-sign accuracy review — Patwal R, Jolly AJ, Kumar A, Yadav R, Desai G, Thippeswamy H. Diagnostic accuracy of clinical signs and investigations for functional weakness, sensory and movement disorders: a systematic review. J Psychosom Res. 2023;168:111196.
- Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
- Seizure semiology meta-analysis — Muthusamy S, Seneviratne U, Ding C, Phan TG. Using semiology to classify epileptic seizures vs psychogenic nonepileptic seizures: a meta-analysis. Neurol Clin Pract. 2022;12(3):234-247.
- Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
- Explanation as treatment — Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol. 2016;139:543-553.
- NICE NG217 epilepsy diagnosis — National Institute for Health and Care Excellence. Epilepsies in children, young people and adults: diagnosis and assessment (NG217). Updated 30 January 2025.
- Motor and sensory FND lived experience — Bailey C, Tamasauskas A, Bradley-Westguard A, et al. What are the experiences of people with motor and sensory FND? A systematic review and thematic synthesis of qualitative studies. Disabil Rehabil. 2025;47(1):1-15.
- SLT consensus — Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92(10):1112-1125.
- WHO ICD-11 2026 — World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 2026-01 release.
Swallowing and breathing safety comes first
Progressive swallowing difficulty, repeated choking, suspected aspiration, weight loss, pain on swallowing, persistent voice change or breathing difficulty are not settled by an FND diagnosis and need appropriate clinical assessment.
- Describe whether the problem involves starting a swallow, food or drink sticking, coughing or choking, pain, voice change or breathing.
- Explain what is new, worsening or different from the person's established pattern.
- Use ordinary urgent or emergency routes when swallowing or breathing cannot be managed safely or the presentation is otherwise medically concerning.
Important limit: This page provides no swallow-safety test, food or drink modification, breathing exercise, aspiration decision or universal emergency threshold.
Sources and review information
Status: Owner released - source checked
Evidence check: Mapped to checked master-register claims
Jurisdiction: UK
Last checked: Check the linked live source
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Corrections: Use the site correction route without including personal health information.
- SLT consensus — Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92(10):1112-1125.
- NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.
- NICE FND quality statement — National Institute for Health and Care Excellence. Quality statement 5: Functional neurological disorders in adults (QS198). 2021.
- Misdiagnosis in both directions — Walzl D, Carson AJ, Stone J. The misdiagnosis of functional disorders as other neurological conditions. J Neurol. 2019;266(8):2018-2026.
- Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
- UCLH FND videos — University College London Hospitals NHS Foundation Trust. Functional Neurological Disorder self-help videos. Accessed 14 July 2026.
Sudden speech changes need urgent attention
FND can affect speech and can sometimes resemble stroke. That does not make it safe to assume that a sudden change is FND.
- Treat sudden new speech loss, marked slurring or another acute focal neurological change through the ordinary NHS urgent or emergency route.
- Keep established FND, stroke risk, migraine, Parkinsonism, motor neurone disease, multiple sclerosis, laryngeal disease, hearing impairment and other diagnosed or unresolved conditions visible.
- Ask whether the current FND diagnosis is intended to explain this exact speech, language or voice symptom.
Important limit: This page is not a stroke test and cannot tell whether a sudden change is functional.
Sources and review information
Status: Owner released - source checked
Evidence check: Mapped to checked master-register claims
Jurisdiction: UK
Last checked: Check the linked live source
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Corrections: Use the site correction route without including personal health information.
- FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
- Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
- Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
- Epilepsy and functional seizures coexist — Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta-analysis. Epilepsy Behav. 2018;89:70-78.
- Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
- Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
- Practical review for physicians — Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder for the general physician. Clin Med (Lond). 2021;21(1):28-36.
- SLT consensus — Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92(10):1112-1125.
- WHO ICD-11 2026 — World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 2026-01 release.
- NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.
- NICE FND quality statement — National Institute for Health and Care Excellence. Quality statement 5: Functional neurological disorders in adults (QS198). 2021.
- Misdiagnosis in both directions — Walzl D, Carson AJ, Stone J. The misdiagnosis of functional disorders as other neurological conditions. J Neurol. 2019;266(8):2018-2026.
- Functional stroke mimics meta-analysis — A T Jones, N K O'Connell, A S David Epidemiology of functional stroke mimic patients: a systematic review and meta-analysis. Eur J Neurol. 2020;27(1):18-26.
- Functional stroke symptom cohort — Abbeygail Jones, Abigail Smakowski, Nicola O'Connell et al. Functional stroke symptoms: A prospective observational case series. J Psychosom Res. 2020;132:109972.
Prepare for the next conversation
A short description and clear communication preferences can make the next appointment easier. You do not need to test or deliberately provoke the symptom.
- Use your own words for what happens to speech, language, voice, swallowing, cough or breathing.
- Record when it began, whether it is constant or episodic and what situations change it without deliberately provoking the symptom.
- List relevant diagnoses, medicines, assessments and what each test was intended to answer.
- Describe one conversation, meal, drink, activity or environment the symptom interrupts.
- Record access needs such as text, extra time, an interpreter, alternative formats or agreed supporter involvement.
Important limit: Preparation does not establish a diagnosis, determine swallowing safety, select therapy or replace individual assessment.
Sources and review information
Status: Owner released - source checked
Evidence check: Mapped to checked master-register claims
Jurisdiction: UK
Last checked: Check the linked live source
Prepared by: Project editorial team
Owner release date: 2026-07-22
Independent review: Not independently reviewed
Corrections: Use the site correction route without including personal health information.
- Motor and sensory FND lived experience — Bailey C, Tamasauskas A, Bradley-Westguard A, et al. What are the experiences of people with motor and sensory FND? A systematic review and thematic synthesis of qualitative studies. Disabil Rehabil. 2025;47(1):1-15.
- Explanation as treatment — Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. Handb Clin Neurol. 2016;139:543-553.
- SLT consensus — Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. J Neurol Neurosurg Psychiatry. 2021;92(10):1112-1125.
- WHO ICD-11 2026 — World Health Organization. ICD-11 for Mortality and Morbidity Statistics, 2026-01 release.
- UCLH FND videos — University College London Hospitals NHS Foundation Trust. Functional Neurological Disorder self-help videos. Accessed 14 July 2026.
- BPS FND psychology guidance — British Psychological Society. Functional Neurological Disorder: Neuropsychological and psychological management in children and adults. Division of Neuropsychology Policy Unit FND Working Group. 2024.
- Wales FND national optimal pathway — NHS Wales Performance and Improvement, Neurological Conditions Network. National Optimal Pathway for Functional Neurological Disorder: adults aged 16 and over. March 2026.
- UK community OT barriers — Nicholson C, Francis J, Nielsen G, Lorencatto F. Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: an interview study with occupational therapists in the United Kingdom. Br J Occup Ther. 2022;85:262-273.
- Journey to diagnosis and care — Pritomanova S, et al. The journey to diagnosis and care of functional neurological disorder. PLoS One. 2026;21:e0328321.
- UK functional communication SLT survey — McKenzie K, Hilari K, Behn N. An exploration of UK speech and language therapists' treatment and management of functional communication disorders: a mixed-methods online survey. Int J Lang Commun Disord. 2024;59:2752-2765.
- Scotland FND pathway — NHS Scotland Centre for Sustainable Delivery. Functional Neurological Disorder pathway. Current at 14 July 2026.
- NHS patient-experience service evaluation — O'Keeffe S, Chowdhury I, Sinanaj A, et al. A service evaluation of the experiences of patients with functional neurological disorders within the NHS. Front Neurol. 2021;12:656466.
- DfE inclusive research — Department for Education. Inclusive research. User Research Manual.
- DfE language and BSL research — Department for Education. Research with users with limited English and sign-language users. User Research Manual.