Childhood onset fluency disorder (stuttering) is part of a cluster of diagnoses called communication disorders. Communication disorders are a group of psychiatric conditions that include:
A communication disorder is an 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. A child 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.
Approximately 1.6% of children between the ages of 3 and 17 years of age are diagnosed with childhood onset fluency disorder (stuttering). The onset of symptoms typically occurs by age 6 for 80%-90% of affected individuals.
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 academic performance. Children 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 a report at school).
Children who stutter may also experience stress and anxiety in anticipation of their stuttering. This associated fear of speech can elevate to the levels that will affect several aspects of learning, quality of life, and the engagement in everyday activities. Children who stutter are also stigmatized by other children and may experience bullying or be ostracized by their peers. Stuttering children are stereotyped as being nervous, shy, passive, and introverted. There is a promising trajectory for children who stutter. Many preschool age children who stutter naturally recover from their dysfluencies. Approximately 70% of children recover from stuttering during the first 15 months of treatment post-onset.
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.
Childhood onset fluency disorder is treatable. Interventions recommendations for childhood onset fluency disorder are outlined in the American Speech-Language and Hearing Association and Agency for Healthcare Research and Quality.
Clinical research suggests the following treatments are indicated for the treatment of children and adolescents with language disorder:
In addition, research suggests the following interventions are promising:
Clinical research suggests the following treatments are indicated for the treatment of children and adolescents with language disorder:
In addition, research suggests the following interventions are promising: