For anyone paying attention to politics in the United States, it is no mystery that Secretary of Health and Human Services Robert F. Kennedy Jr. has a speech condition that results in staggered speaking.
That condition is called spasmodic dysphonia, which occurs when the vocal folds cramp closed when someone is speaking, creating an interruption in the sound, according to speech pathologist Gwen Merrick.
“The vocal folds have a small muscle as one of the layers of the vocal fold,” she told HuffPost. “That muscle… goes into spasm, which interrupts the flow of the voice.”
She said the cause of the spasm is neurological — the wiring from the brain isn’t sending a consistent signal — so the muscle has a little cramp.
Kennedy first noticed a change in his voice when he was 42 in 1996, teaching at Pace University School of Law in White Plains, New York, according to the Los Angeles Times.
Even though Kennedy has had the disorder for decades, it remains a topic of conversation given his prominence in Donald Trump’s administration. In a Senate hearing on Wednesday, Kennedy could be heard breathing through his microphone as others spoke.
Merrick, though, asserts that the noise people heard was not caused by spasmodic dysphonia — which is related to speaking and not breathing — and that many people with the condition have no problem breathing quietly. So any health-related explanation for Kennedy’s breathing noises at the hearing, which at least one person on social media described as “horrifying,” remains unclear.
What To Know About Spasmodic Dysphonia
The cause of the disorder is not known, Merrick said, but there is a correlation with experiencing an acutely stressful situation.
Onset usually occurs between the ages of 30-50, more often in women than men, according to Merrick. There could be a gradual onset at first that worsens over time and then plateaus.
“Some people will find that sometimes the anxiety of knowing that they are going to speak makes them tense up… which tends to make the spasm worse,” Merrick said.
Diagnosis of the condition is difficult, according to Kimberly Kuman, the executive director of the nonprofit Dysphonia International. She said there’s no good diagnostic test and that spasmodic dysphonia is often misdiagnosed because there are different manifestations of the disorder.
“Oftentimes, diagnosis is really based on listening to the voice and hearing the breaks or the spasms in the voice,” she told HuffPost. “There’s no blood test or anything like that that can diagnose it at this time.”
She estimates about 50,000–70,000 people have the condition in the U.S. Currently, treatment can include speech therapy, as well as surgery and Botox injections.
Botox works to prevent spasms of the muscles that control the vocal folds by blocking nerve impulses at the muscle receptor site, according to Dysphonia International. The Botox treatment can last three to four months before it has to be repeated.
Kennedy told the LA Times that he had received Botox injections every three to four months for 10 years, but would lose his voice entirely after an injection. He said it would return days later, a little smoother.
He had surgery in Japan in 2022 that implanted a titanium bridge between his vocal folds to keep them from pressing together. He said in a YouTube interview that his voice was getting better afterward, but that the procedure is not available in the U.S.
Merrick works with clients on breath support, improving the coordination of their breath and reducing tension when they speak. She said that when you try harder with the disorder, it can make it worse.
“It has such a tremendous impact on people’s quality of life,” she said. “It affects their ability to work. It affects their sense of self and their own identity. It’s socially isolating.”
