Childhood-Onset Fluency Disorder
Childhood-onset fluency disorder is a communication disorder characterized by a disturbance in the flow and timing of speech that is inappropriate for an individual’s age. Also referred to as stuttering, this condition includes the repetition or prolongation of speech sounds, hesitations before and during speaking, long pauses in speech, effortful speech, and/or monosyllabic whole-word repetitions. This condition is typically accompanied by anxiety about speaking and can place limitations on how comfortable a child feels participating in social or academic environments.
Symptoms of childhood-onset fluency disorder develop between the ages of 2 and 7, with 80 to 90 percent of cases developing by age 6. While mild stuttering is common in children who are learning to speak, this behavior becomes a fluency disorder when it persists over time and causes distress in the child. Stuttering is more commonly found among males than females.
- Repetition of syllables, sounds, or monosyllabic words (i.e., "I-I-I see them")
- Prolonging the vocalization of consonants and vowels
- Broken words (e.g., pauses within a word)
- Filled or unfilled pauses in speech
- Word substitution to avoid problematic words
- Words produced with an excess of physical tension (e.g., head jerking, fist clenching)
- Frustration or embarrassment related to speech
According to the DSM-5, symptoms may come and go depending on the task at hand. For example, symptoms may be absent during oral reading or singing but present in casual conversation with another person. Symptoms can be exacerbated by stress, anxiety, or feeling self-conscious. Symptoms may also be accompanied by motor movements, such as eye blinks, tics, and shaking of the lips or face.
Childhood-onset fluency disorder affects 5 to 10 percent of preschoolers, research suggests. However, many children outgrow the condition and it affects just 1 percent of adults.
Dysfluencies typically begin gradually and progress into a more noticeable disorder, although occasionally they emerge suddenly. Early signs of the disorder include repeating initial consonants, first words of a phrase, and long words. As dysfluencies become more frequent, children may begin to avoid public speaking or speak more simply.
Stuttering is complex: Researchers propose that the onset and development of dysfluencies are driven by a set of interactions between linguistic, motor, emotional, and neural factors, such as abnormalities in particular regions of the brain. Research also shows that stuttering and other communication difficulties tend to run in families. Stuttering can also appear or worsen in situations that cause distress, such as feeling nervous or pressured.
It’s important to distinguish dysfluencies that result from childhood-onset fluency disorder and dysfluencies that result from other causes. For example, speech problems can arise from a stroke or brain injury, Tourette’s disorder, and certain medications. Clinicians generally rule out other causes before diagnosing a patient with childhood-onset fluency disorder.
Those who stutter seem to be at greater risk for anxiety disorders. Between 22 and 60 percent of adults who stutter also meet the criteria for social anxiety disorder, and 24 percent of children who stutter meet the criteria for social anxiety disorder, research suggests. However, stuttering should not be perceived as a sign of anxiety.
Tourette’s disorder is a tic disorder that involves motor and vocal tics—sudden, rapid, recurrent, nonrhythmic movements or vocalizations. Vocal tics may sometimes be confused for stuttering, but the two are distinct. (Although research suggests they may function similarly in the brain.)
Diagnosis of childhood-onset fluency disorder is made by a trained health-care professional, such as a speech-language pathologist. Treatment is multi-faceted and focuses on decreasing or eliminating fluency problems as well as developing effective communication skills and promoting participation in school, work, and social environments.
Speech therapy may be used to teach the individual to speak slowly and effectively. Some small electronic devices can also help improve speech fluency, such as a delayed auditory feedback tool that requires the user to slow their speech. Cognitive-behavioral therapy may be used to identify thoughts patterns that make stuttering worse and to help cope with or resolve stress or anxiety related to stuttering. Another effective form of treatment is to improve the communication style between children with the condition and their parents, in order to facilitate treatment strategies and help the child cope with their stuttering.
A majority of children who develop symptoms of childhood-onset fluency disorder will recover from the condition. The severity of symptoms at age 8 will often predict the potential for recovery, as well as the persistence of symptoms into adolescence and adulthood.
Between 65 and 85 percent of children recover from childhood dysfluency, according to the DSM-5. The severity of the problem at age 8 can often predict whether the disorder will abate or persist into adulthood.
Although treatment is available for children and adults who want to address a stutter, not everyone chooses to do so. Some people believe that stuttering is not a disorder to be treated but a difference to be accepted. They may seek to release the pressure of trying to change and instead focus on cultivating a community of acceptance and solidarity.