II. Definitions

  1. Stuttering
    1. Involuntary dysfluency in verbal expression
  2. Persistent Stuttering
    1. Stuttering that lasts beyond age 7 years

III. Epidemiology

  1. Genetic component (from twin studies)
  2. Prevalence
    1. Childhood-Onset Fluency Disorder: 5-10% of preschoolers
    2. Children under age 10 years: 1.4% (66% are boys)
    3. Adults: <1% (80% are men)

IV. Pathophysiology

  1. Fluent speech requires CNS complex coordination of respiratory, laryngeal and articulatory muscles
  2. Preschool children normally display speech disfluency as they are learning to speak
  3. Those with Childhood-Onset Fluency Disorder display CNS imaging changes affecting speech related pathways
    1. Requires concious monitoring by those who Stutter, in contrast to unconscious fluent speech

V. Signs

  1. Involuntary dysfluency
    1. Repeated sounds, syllables or words
    2. Speech blocks
    3. Prolonged pauses between words
  2. Associated compensatory behaviors
    1. Eye blinking
    2. Jaw jerking
  3. Provocative Factors
    1. Stressful circumstances
    2. Public speaking

VI. Types

  1. Developmental Stuttering (80% of cases)
    1. Stuttering occurs at begining of words
    2. Prominent secondary behaviors
    3. Onset at age 3-8 years and resolves within 4 years in 75% of cases
  2. Neurogenic Stuttering
    1. Acquired Stuttering due to neurologic Trauma (e.g. Cerebrovascular Accident, Head Trauma)
  3. Psychogenic Stuttering (rare)

VII. Differential Diagnosis

  1. Stutter-like Dysfluency
    1. Dysthymic phonation
      1. Blocks (unable to articulate)
      2. Broken words ("I am sp.....eaking")
      3. Prolonged sounds ("ssssssugar")
    2. Partial word repetition ("my ddddd dad is here.")
    3. Single word repetitions ("I think I think..." or "she she she")
  2. Interjections (e.g. "um")
  3. Incomplete phrase ("He is - oh where is he")

VIII. Grading

  1. Normal Stuttering
    1. Onset age 1.5 to 3 years old
    2. Repeated syllables and sounds at the begining of sentences
    3. Children have no awareness of their Stuttering
  2. Mild Stuttering
    1. Onset age 3 to 5 years old
    2. Similar to normal Stuttering but more frequent, associated with secondary behaviors
  3. Severe Stuttering
    1. Onset age 1-7 years
    2. Stuttering occurs in most phrases and sentences

IX. Management

  1. Refer Mild and Severe Stuttering to Speech Pathology
    1. Early interventions are most effective (plastic brain) and less likely to develop complications (see below)
    2. Stutter-like Dysfluency (see differential diagnosis above)
    3. Parental concerns regarding child's speech
    4. Persistent dysfluency >12 months
    5. Worsening dysfluency
  2. Best therapies focus on reducing, not eliminating Stuttering
    1. Decrease Stuttering to less than half the prior events (and ideally to where the child and others do not notice)
    2. Decrease secondary behaviors and mannerisms (e.g. facial expressions, word avoidance)
    3. Speech pathology sessions are typically with both parent and child
      1. Parent learns interventions to practice with their child
  3. Medications are ineffective in Stuttering
    1. Bothe (2006) Am J Speech Lang Pathol 15(4): 342-52 [PubMed]
  4. Devices (Contremporary Stuttering devices, Fluency-shaping mechanisms)
    1. Example: Delayed auditory feedback device (slows speaking rate)
  5. Behavioral Techniques
    1. Provide relaxed environment that allows child enough time to speak without hurrying
    2. Parents and teachers praise fluent speech
    3. Ocasionally acknowledge and correct Stuttering in a gentle non-judgemental way
      1. Examples of feedback: Noting either bumpy or fluid speech

X. Complications

  1. Decreased self esteem and negative perception by others
  2. Word avoidance and mannerisms (e.g. facial expressions during Stuttering)
  3. Social withdrawal
  4. School difficulties and difficulty completing education
  5. Unemployment or impeded career advancement
  6. Anxiety Disorder (including social anxiety)

XI. Prognosis

  1. Most Stuttering (65-87%) resolves by age 7 years with or without treatment

XII. Resources

  1. American Board of Fluency and Fluency Disorders
    1. https://www.stutteringspecialists.org/
  2. American Speech-Language-Hearing Association (ASHA)
    1. https://www.asha.org/
  3. National Stuttering Association
    1. https://westutter.org/
  4. Stuttering Foundation of America
    1. http://www.stutteringhelp.org

XIII. References

  1. Moore and Jefferson (2004) Handbook Psychiatry , 2nd ed, Chap. 20
  2. Simms in Kliegman (2007) Nelson Pediatrics, 18th ed., Chap. 32
  3. Prasse (2008) Am Fam Physician 77(9): 1271-8 [PubMed]
  4. Sander(2019) Am Fam Physician 100(9): 556-60 [PubMed]
  5. Costa (2000) CMAJ 162(13):1849-55 [PubMed]

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Related Studies

Ontology: Stuttering (C0038506)

Definition (MEDLINEPLUS)

Stuttering is a problem that affects the flow of your speech. If you stutter, you may

  • Make certain words sound longer than they should be
  • Find it hard to start a new word
  • Repeat words or parts of words
  • Get tense when you try to speak. You may blink your eyes rapidly, or your lips and jaw may tremble as you struggle to get the words out.

Stuttering can affect anyone. It is most common in young children who are still learning to speak. Boys are three times more likely to stutter than girls. Most children stop stuttering as they grow older. Less than 1 percent of adults stutter.

Scientists don't fully understand why some people stutter. The problem seems to run in families. There is no cure, but treatments can help. They include stuttering therapy, electronic devices, and self-help groups. Starting stuttering therapy early for young children can keep it from becoming a lifelong problem.

NIH: National Institute on Deafness and Other Communication Disorders

Definition (NCI) A speech disorder characterized by frequent sound or syllable repetitions, sound prolongations, or other dysfluencies that are inappropriate for the individual's age.
Definition (MSH) A disturbance in the normal fluency and time patterning of speech that is inappropriate for the individual's age. This disturbance is characterized by frequent repetitions or prolongations of sounds or syllables. Various other types of speech dysfluencies may also be involved including interjections, broken words, audible or silent blocking, circumlocutions, words produced with an excess of physical tension, and monosyllabic whole word repetitions. Stuttering may occur as a developmental condition in childhood or as an acquired disorder which may be associated with BRAIN INFARCTIONS and other BRAIN DISEASES. (From DSM-IV, 1994)
Definition (CSP) disorder in which speech is involuntarily interrupted by hesitations, repetitions, and spasms of the muscles involved in breathing or vocalization.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D013342
ICD10 F80.81
SnomedCT 29916003, 39423001, 416163003
DSM4 307.0
English STUTTERING, Stuttering (finding), Stammering (finding), stuttering (symptom), speech fluency stuttering, stuttering (diagnosis), speech fluency stuttering (physical finding), stuttering, Stuttering [Disease/Finding], stutter, stuttered, stutters, Stuttering NOS, Stuttering, Stammering, Non-fluent speech, Stammer, Stutter, dysphemia
German STOTTERN, Balbuties, Dysphemie, Psellismus, Stottern
Dutch stotteren, gestotter, Stotteren
Portuguese Gago, Gaguez, GAGUEZ, Paralalia Literal, Pselismo, Gagueira
Spanish Tartamudez, Tartajear, BALBUCEO, disfemia, tartamudeo, tartamudeo (hallazgo), Pselismo, Paralalia Literal, tartamudez, tartamudez (hallazgo), Tartamudeo
Swedish Stamning
Japanese キツオン, ドモリ, どもり, 吃音, , 吃り
Czech balbuties, koktavost, Zajíkání
Finnish Änkytys
Russian ZAIKANIE, ЗАИКАНИЕ
French BREDOUILLEMENT, Bégaiement
Croatian MUCANJE
Polish Jąkanie się
Hungarian Dadog, Dadogás
Norwegian Stamming
Italian Balbuzie

Ontology: Childhood onset fluency disorder (C2921028)

Concepts Disease or Syndrome (T047)
ICD9 315.35
ICD10 F80.81
SnomedCT 288271000119103
English Chldhd onset flncy disor, childhood onset fluency disorder (diagnosis), Childhood onset fluency disorder (disorder), Childhood onset fluency disorder
Spanish trastorno de la fluidez, de inicio en la infancia, trastorno de la fluidez, de inicio en la infancia (trastorno)