ICD-10 Code: F98.5
Stuttering (also called onset fluency disorder) is part of a cluster of diagnoses called communication disorders. Communication disorders are a group of psychiatric conditions that include:
A communication disorder is the impairment in the processes of speech, language or communication. Speech is the expressive production of sounds and includes an individual's articulation, fluency, voice and resonance quality. Language includes the form, function, and use of a convention system of symbols (i.e., spoken words, written words, sign language, pictures) in a rule-governed manner for communication. Communication includes any verbal or nonverbal behavior that influences the behavior, ideas, or attitudes of another individual. An adult with a communication problem may exhibit many different symptoms. These may include difficulty following directions, attending to a conversation, pronouncing words, perceiving what was said, expressing oneself, or being understood because of a stutter or a hoarse voice. An assessment of speech, language and communication abilities must take into account the individual's cultural and language context, particularly for individuals growing up in bilingual environments.
The cumulative incidence of stuttering affects approximately 2% of adults between the ages of 21 and 49, and less than 2% of adults ages 50 and over. The disorder is characterized by disturbances in normal fluency and time patterning of speech that are inappropriate for the individual's age and language skills,
persist over time, and are characterized by frequent and marked occurrences of the following symptoms:
These disturbances cause anxiety about speaking or limitations in effective communication, social participation, or occupational performance. Stuttering can occur as a result of a nerve of traumatic brain injury (neurogenic), or begin suddenly after severe emotional trauma or stress (psychogenic). Late or adult onset stuttering occurs when the symptoms are not attributed to a speech-motor or sensory deficit, or dysfluency associated with a neurological insult (e.g., stroke, tumor, trauma).
Adults who stutter may also exhibit secondary, or avoidance, behaviors that may impact their fluent communication. These may include:
The frequency and severity of stuttering may fluctuate from day to day and in relation to the speaking situation. Stuttering is often more severe when there is increased pressure to communicate (e.g., competing for talk time, giving an oral presentation).
Adults who stutter may hold negative self-perceptions of themselves. They avoid many social situations as a consequence of experiencing failure to be fluent, combined with a persistent frustration and embarrassment associated with attempts to communicate verbally. Stuttering adults may also be ostracized or stereotyped by others. Stuttering adults are stereotyped as being shy, self-conscious, anxious individuals who lack confidence. Approximately 25% of adults who seek treatment spontaneously recover from adult-onset stuttering. There is a significant minority of adults who relapse from their treatment. Those who relapse may have a higher risk of developing generalized or social anxiety.
Neuroimaging studies using PET scans or functional MRI to examine adults who stutter have shown different patterns of brain activation when they stutter, with more activation of right hemisphere areas and differing patterns of usage of left hemisphere, subcortical, and cerebellar structures. The risk of stuttering among first-degree biological relatives of individuals who also stutter is more than three times the risk than the normative population. Studies have identified three gene mutations linked to stuttering. Mutations to genes GNPTAB, GNPTG and NAGPA have been found to disrupt the signal that directs enzymes to their target location in the lysosome of the cell. These gene mutations were present in close to 10% of cases of familial stuttering. However, having a genetic predisposition to stuttering does not necessarily mean that someone will develop stuttering.
Stuttering is treatable. Interventions recommendations for stuttering are outlined in the American Speech-Language and Hearing Association and Journal of the American Osteopathic Association.
Clinical research suggests the following treatments are indicated for the treatment of adults with stuttering:
In addition, research suggests the following interventions are promising: