Written by Najwa Bashir

Stuttering

Sometimes called stammering and more generally disfluent speech, stuttering is a speech condition marked by repeating sounds, syllables, or words; sound delay; and speech breaks called blocks (NIDCD, 2017). The childhood-onset fluency disorder is a chronic change in the normal flow and timing of speech that is not proper for the person’s age (American Psychiatric Association, 2013 as cited in SheikhBahaei et al., 2022).

Individuals who stutter know exactly what they want to say but struggle to organize it smoothly. People with trouble speaking may also show signs of stress, like blinking their eyes quickly or trembling their lips. People who stutter may find it hard to talk to others, which can impact their quality of life and ties with others. Stuttering can also make it harder to get a job which can negatively impact your chances of getting hired, and treatment can cost a lot of money. People who stutter can have very different symptoms at different times of the day. Most of the time, stuttering gets worse when someone speaks in front of a group or on the phone. On the other hand, singing, reading, or speaking in unison can briefly make stuttering better (NIDCD, 2017).

Differences in the structure, function, and control of dopamine in the brain have been linked to stuttering. These differences are thought to be genetic. It is important to make sure that the right evaluation or recommendation is made for children because more and more people agree that starting speech therapy early for kids who stutter is very important. For adults, stuttering can be linked to a lot of mental and social problems, like social nervousness and a low quality of life. Recently, pharmacologic treatment has gotten a lot of attention, but there isn’t a lot of clinical evidence to back it up. Speech therapy is still the most common way to help kids and adults (Perez & Stoeckle, 2016). The number of people who have DS depends on their age and the exact meaning of stuttering that is used. The most common number given is a lifetime frequency (chance that a person will ever stutter) of 5%. However, new information suggests that the total frequency is more like 10% (Yairi & Ambrose, 2013), with kids being most affected. Up to 90% of kids who stutter (CWS) will get better on their own as kids. Persistent DS is when an adult did not heal from DS as a kid. This happens to less than 1% of the population (Yairi & Ambrose, 2013). Stuttering that is thought to be caused by mental stress or brain damage is less common, but no one knows how common it is (Theys et al., 2011). According to Yari and Ambrose (2013), men are four times more likely than women to have DS, and men are also more likely to have it last longer than women. Other things that can help you tell if someone will continue with stuttering are a late start age, longer length of stuttering, a family history of persistence, and lower language and nonverbal skills (Yairi et al., 1996). It is very important to diagnose children right away because early treatment has the best results (Weir & Bianchet, 2004).

Diagnostic Criteria for Childhood-Onset Fluency Disorder

According to DSM 5 TR (APA, 2022), the following is the diagnostic criteria for childhood-onset fluency disorder:

A. Disturbances in the regular flow and timing of speech that aren’t acceptable for the person’s age or language skills, last a long time, and are marked by one or more of the following happening often and clearly:

1. Repetition of sounds and syllables.
2. Sound expansions of vowels and consonants.
3. Broken words (e.g., stops within a word).
4. Audible or silence blocking (filled or unfilled breaks in words).
5. Circumlocutions are word changes that get rid of troublesome words.
6. Words that are spoken with too much physical stress.
7. Whole words that repeat on one syllable, like “I-I-I-I see him”

B. The problem makes people nervous about saying out loud or makes it harder for them to communicate, interact with others, or do well in school or at work, either on its own or in combination with other problems.
C. Symptoms start in the early stages of growth. Note: cases that start later are called F98.5 adult-onset speech disorder.
D. It’s not caused by a problem with speech, movement, or senses; it’s not slurred speech from a brain injury (like a stroke, tumor, or trauma); it’s not caused by another medical condition; and it’s not better explained by another mental disease.

Diagnostic Features of Childhood-Onset Fluency Disorder

In the light of DSM 5 TR, the following are the diagnostic features of childhood-fluency disorder:

• A main feature of childhood-onset fluency disorder (stuttering) is a change in the usual flow and timing of speech that isn’t proper for the person’s age.
• This disorder is marked by repeated or prolonged sounds or syllables and different kinds of speech problems, such as broken words (like pauses within a word), audible or silent blocking (like filled or unfilled pauses in speech), circumlocutions (like changing words to avoid problematic ones), words made with too much physical tension, and repeated monosyllabic whole-words (like “I-I-I-I see him”).
• The problem with speech could make it harder to do well in school or at work and to talk to other people.
• Situationally, the level of disturbance changes, and it’s usually worse when there’s extra pressure to talk (like when you have to give a report at school or talk about a job).
• Most of the time, dysfluency doesn’t show up when reading out loud, singing, or talking to pets or inanimate objects.

Associated Features

The associated features are as follows (APA, 2022):

• Individuals may start to fear the problem before it happens.
• Disfluencies can be avoided by changing the rate of speech or ignoring certain words or sounds. The speaker may also try to avoid certain speech situations, like talking on the phone or in public.
• Not only do worry and anxiety make dysfluency worse, they are also symptoms of the disease.
• Motor movements may happen along with a childhood-onset fluency disorder. These can include eye blinks, tics, twitches of the lips or face, jerks of the head, breathing movements, and tightening of the hand.
• There are different levels of speaking skills in kids with speech disorders, and it’s not clear what the link is between the two. Studies have shown that kids who stutter have differences in both the structure and function of their brains. Estimates vary based on age and the possible cause of stuttering, but men are more likely than women to stumble.
• Stuttering has many causes, some of which are genetic and some of which are neurological.

Conclusion

The childhood-onset fluency disorder is a serious concern as it can cause trouble in communication, academics, and overall functioning of the children, either directly or indirectly. Therefore, it is important to take the signs and symptoms of stuttering seriously and seek treatment immediately.

References

• American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (2022). Washington, DC, American Psychiatric Association.
• NIDCD (2017). Stuttering. Available from: https://www.nidcd.nih.gov/health/stuttering#:~:text= Stuttering%20is%20a%20speech%20disorder,a%20normal %20flow%20of%20speech.
• Perez, H. R., & Stoeckle, J. H. (2016). Stuttering: clinical and research update. Canadian family physician, 62(6), 479-484. Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907555/
• SheikhBahaei, S., Millwater, M., & Maguire, G. A. (2023). Stuttering as a spectrum disorder: A hypothesis. Current Research in Neurobiology, 5, 100116. https://doi.org/10.1016/j.crneur.2023.100116
• Theys, C., Van Wieringen, A., Sunaert, S., Thijs, V., & De Nil, L. F. (2011). A one year prospective study of neurogenic stuttering following stroke: incidence and co-occurring disorders. Journal of communication disorders, 44(6), 678-687. https://doi.org/10.1016/j.jcomdis.2011.06.001
• Weir, E., & Bianchet, S. (2004). Developmental dysfluency: early intervention is key. Cmaj, 170(12), 1790-1791. https://doi.org/10.1503/cmaj.1040733
• Yairi, E., & Ambrose, N. (2013). Epidemiology of stuttering: 21st century advances. Journal of fluency disorders, 38(2), 66-87. https://doi.org/10.1016/j.jfludis.2012.11.002
• Yairi, E., Ambrose, N. G., Paden, E. P., & Throneburg, R. N. (1996). Predictive factors of persistence and recovery: Pathways of childhood stuttering. Journal of communication disorders, 29(1), 51-77. https://doi.org/10.1016/0021-9924(95)00051-8