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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.

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Research has shown that stuttering and some 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.


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.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Last updated: 02/15/2018