87 Stuttering (315.31)

DSM-IV-TR criteria

• A. Disturbance in the normal fluency and time patterning of speech (inappropriate for the individual’s age), characterized by frequent occurrences of one or more of the following:
  1. Sound and syllable repetitions
  2. Sound prolongations
  3. Interjections
  4. Broken words (e.g., pauses within a word)
  5. Audible or silent blocking (filled or unfilled pauses in speech)
  6. Circumlocutions (word substitutions to avoid problematic words)
  7. Words produced with an excess of physical tension
  8. Monosyllabic whole word repetitions (e.g., “I-I-I-I see him”)
• B. The disturbance in fluency interferes with academic or occupational achievement and with social communication.
• C. If a speech-motor or sensory deficit is present, the speech difficulties are in excess of those usually associated with these problems.

Associated features

• When stuttering first comes about, the affected individual may not realize there is a problem. After time goes on, most people with stuttering issues will realize there is a problem; some may begin to fear that they will stutter in front of others. To avoid embarrassment, a person with a stuttering problem may try to create ways to avoid stuttering. They might avoid speaking in front of a crowd where they know they would become more anxious and more likely to stutter. They could also change the way they speak. Slowing down the rate of speech would make pauses less noticeable and drawing out certain words wouldn’t be as obvious either if all words were spoken at a slower pace.
• In extreme cases, a person may choose to avoid social contact entirely in order to prevent occurrences where they now some form of stuttering will occur regardless of what precautions they may take.
• Stress makes stuttering more likely to occur. The anxiety about stuttering can lead to several other issues with social functioning. Self-esteem in individuals with a stuttering problem is typically lower than the “normal” population who have less issues with social communication. Nervous twitches may arise in those who stutter such as eye blinks, tics, tremors, and other “twitches” non of which are uncommon.

– Other people may try to hide their unorthodox speech from others by rearranging the words in their sentence
(circumlocution), pretending to forget what they wanted to say, or declining to speak.

Child vs. adult presentation

• The presentation of stuttering in children and adults is very similar; however, the manner in which it affects their lives can be quite different. In children and adults, stuttering can create a major impairment of social functioning.
• In adults, this impairment may also carry over into the work place. Stuttering can limit career options for adults, considering occupations dealing with frequent speaking in front of groups could cause considerable distress or anxiety to an individual who stutters. Stuttering could also limit opportunity for job advancement.
• In children, stuttering causes more of an issue in peer communication.

Gender and cultural differences in presentation

• Stuttering is much more frequently diagnosed in males than in females. According to the DSM, for every female diagnosed with stuttering, there are approximately 3 males diagnosed. Other sources indicate that this ratio may actually be 4:1 (Stuttering).
• While there are no known cultural differences in presentation, it may be possible to avoid being diagnosed with stuttering throughout different cultures due to different languages that may disguise the symptoms of stuttering,

Epidemiology

The prevalence of stuttering in children is approximately 1%. This falls to 0.8% in adolescence. 98% of cases of stuttering occur before age 10. The onset of stuttering typically occurs during the period of greatest language development in which individuals move from simple words and phrases to more complex ones. Later acquisition of the condition may be caused by brain lesions via strokes or other injuries in the speech-governing areas of the brain.

Etiology

• Research has shown many individuals have a predisposition to stuttering. Research with twins have demonstrated that if one twin suffers from stuttering, the other is more likely to suffer from it.
• The exact cause of stuttering is not known, because there are many brain mechanisms that may be involved in the process. Congenital brain damage has been implicated as well. There are also external causes that can contribute to the onset of stuttering.
• Children who have negative experiences with stuttering may develop further problems with speech and communication. If stuttering doesn’t create any social discomfort for the child, they may correct the behavior themselves. Different people have different degrees of stuttering that cause different problems in social situations.
• Some recent studies have shown that genetics play a role in stuttering. Some people inherit traits that put them at a higher risk level for developing a stutter.

Empirically supported treatments

Medicinal treatments for stuttering are not the usual route, since the exact cause of stuttering remains unknown. Instead, behavioral treatments are utilized to try and correct the patient’s stuttering. In these treatments, patients are taught how to control the way, speed, and overall manner in which they communicate (Stuttering). Treatments in speech are limited but can be done if the patient is committed and willing to work with their impairment. A person may also be taught how to control or monitor their breathing as a way of helping as well.