Topic Reference

Stuttering is a speech disorder that affects approximately 5% of all children at some time.   The onset of this disorder typically occurs between the ages of 5 and 7.  Up to 20% of children who stutter will improve without treatment, however, the disorder can persist in adulthood and cause significant problems in overall functioning.   Stuttering is thought to affect up to 3 million, or approximately 1%, of all people in the U.S. (NICD, 2009).  Considered disfluent speech, stuttering involves an interruption of the flow of speech (fluency) that is characterized by sounds,  syllables or words spoken in repetitive, interrupted or prolonged ways.  Consequently, this disorder interferes with effective communication and affects academic, social, emotional and occupational functioning.  Because communication is such an essential part of overall life functioning, stuttering can impact all realms of daily living.  Also known as stammering, stuttering is typically diagnosed by a speech and language specialist who looks for such pervasive life problems related to the speech problem.  Diagnosis is also made by identifying symptoms such as those listed below.  In order to receive the diagnosis of Stuttering, however, speech symptoms must not be age-appropriate.  It is important to remember, when considering whether a child has a stuttering disorder, that the types of speech problems listed here are age and developmentally appropriate in a young child who is just learning speech and language. 
Some of the characteristics of Stuttering are:

• sound and syllable repetitions                                                                                                                         
• prolonged sounds when speaking                                                                                                                     
• interjecting extra sounds into words                                                                                                               
• pauses in words or phrases                                                                                                                                 
• substituting other sounds or words to avoid speech difficulties                                                                                
• physical tension when making sounds or certain words

Additionally, stuttering is often accompanied by obvious behaviors that demonstrate the speaker’s difficulties.  These behaviors can include jerking of the head, facial tremors, closing or blinking the eyes, clenching fists or demonstrating other expressions of frustration (American Psychiatric Association, 2000).  Further, stuttering can become more pronounced when performing certain tasks such as using the telephone, speaking before a group or speaking in a situation that causes some anxiety such as in an oral test or interview. 

There are thought to be three types of stuttering that come from distinct origins and causes.  These are developmental stuttering, psychogenic stuttering and neurogenic stuttering.  Developmental stuttering is the most common and occurs in children who are learning speech and language skills. Neuorogenic stuttering is the result of injury to the brain by head trauma or stroke, for example. The third type of stuttering—psychogenic—is caused by emotional trauma and/or mental or psychological problems.

Other Conditions that Frequently Occur with Stuttering

There are some disorders that should be considered when a child is being evaluated for Stuttering.  These are Phonological Disorder and Expressive Language Disorder.  These disorders appear to occur frequently in children with Stuttering.  Like Stuttering, these disorders also affect the understanding of speech and language as well as spoken expression.  Other co-occurring conditions are learning disabilities, literacy disorders (Blood, Ridenour, Qualls, & Hammer, 2003) and those disorders that involve impulsivity such as ADHD (Blood, Blood, & Maloney, 2007).

The Impact of Stuttering upon Children and Their Families

Children who stutter can be impacted in all realms of functioning.  Social anxiety and withdrawal is common due to embarrassment.  Avoidance of social settings, school activities that involve speech and recreational opportunities with peers can occur.  Feelings of low self-esteem, anxiety, frustration and depression can develop.  Academic achievement can suffer as can occupational planning.  Participation in family life can be impacted due to communication problems and high levels of anxiety and frustration-related behaviors.  Family members and other caregivers must provide assistance and emotional support in everyday living as children who stutter attempt to cope with their disorder in all these areas.  Social stigma is common and children who stutter are often ridiculed and ostracized by peers.

Treatment

• Treatment for Stuttering often requires a variety of approaches to address the many problems related to this disorder.  Below is a brief outline of just some of these treatment interventions; however each child will have unique and specific needs that require an individualized treatment plan.  A physician and a speech and language therapist will be able to recommend and discuss treatment options in much greater detail.   The following list is intended only to suggest the range of available options.

• Speech Therapy and Physical Retraining address the use of speech and vocal muscles through exercises that retrain muscles in order to correct speech.  This is typically conducted by a speech and language therapist, or speech pathologist, in weekly and individual sessions.

• Breath Training teaches breathing techniques that ease the flow of speech and decrease anxiety when speaking.  This can be done individually or in group settings with a therapist.  There are also films and audio recordings available for in-home use.

• Psychological Interventions such as individual therapy and group therapy help with assertiveness skills, socialization and other related emotional and behavioral problems associated with Stuttering.

• Relaxation Training helps decrease anxiety related to Stuttering and can be learned in individual or group sessions as well as from in-home resources such as films and recordings.

Assistive Devices for the ear are electronic aids thought to improve speech fluency.

References
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association.

Blood, G., Blood, I., & Maloney, K. (2007). Exploratory Study of Children Who Stutter and Those Who Do Not Stutter on a Visual Attention Test. Communication Disorders Quarterly 28:3 , 145-153.

Blood, G., Ridenour, V., Qualls, C., & Hammer, C. (2003). Co-occurring disorders in children who stutter. Journal of Communication Disorders , 427-448.
NICD. (2009). Stuttering. Retrieved May 5, 2009, from National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/voice/stutter.htm