Author: Helen Okoye, MD, MBA, MS-Epi













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Childhood-Onset Fluency Disorder (Stuttering) DSM-5 315.35 (F80.81)

DSM-5 Category: Communication Disorders

Introduction

Childhood-onset fluency disorder, also known as stuttering or stammering is a common disorder. A multifactorial speech disorder, it is normally seen with recurrent prolongations, reverberations, or blocks of sounds, syllables, phrases or words (Maguire, Yeh, & Ito, 2012). During these unintentional breaks in speech, the individual is not able to make sounds. The main issue of individuals with Childhood-onset fluency disorder is that of repetition. Some of the coping mechanisms are blocks and prolongations, which are used to mask repetition. Other characteristics of this disorder are word substitutions, or unwarranted physical tension while trying to formulate speech (Maguire, Yeh, & Ito, 2012). Other simultaneous symptoms can include facial grimacing, tremors of muscles used in speech, and eye blinks in addition to the evasion of words or circumstances which aggravate stuttering episodes (Maguire, Yeh, & Ito, 2012).

Childhood-onset fluency disorder remains the most frequent type of stuttering. A reported five percent of children are affected by this disorder, and approximately an overall eighty to ninety percent of stuttering starts by about age six years of age (Maguire, Yeh, & Ito, 2012). About seventy five percent of these individuals ultimately recover (Maguire, Yeh, & Ito, 2012). This is normally seen by about age sixteen years of age. Nevertheless in many cases, many cases continue on into adulthood. Early diagnosis and treatment of Childhood-onset fluency disorder is the key to early intervention.

With DSM-5, while the criteria for diagnosis remain largely the same as the previous DSM, there are some notable changes, such as the change of the terminology from stuttering to childhood-onset fluency disorder. Additionally, there are no longer any requirements for the use of speech interjections, such as “you know”, or “um”, which are also normally used for others without this disorder. Furthermore, there is the addition of anxiety and avoidance to the criteria for diagnosis, as this has been noted to be a big problem for many (Cohen, 2014).

Symptoms of Childhood-Onset Fluency Disorder

According to DSM-5, there are certain criteria that must be met in order for the diagnosis of childhood-onset fluency disorder (American Psychiatric Association, 2013).

A. Interruptions in normal fluency and time patterning of speech (unsuitable for the individual’s age), exemplified by repeated occurrences of 1 or more of the following:

Sound and syllable repetitions

Sound prolongations

Interjections

Broken words (such as breaks within a word)

Audible or silent blocking (filled or unfilled gaps in speech)

Circumlocutions (word substitutions to evade challenging words)

Words formed with an overload of physical tension

Monosyllabic whole-word repetitions

B. The interruptions in fluency gets in the way with academic or occupational accomplishments or with social communications

C. If a speech-motor or sensory deficit is evident, the speech challenges are in excess of those typically connected with these problems:

Deficits in intellectual functions, like reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, established through the use of both clinical assessment and individualized, standardized intelligence testing.

Deficits in adaptive functioning that end up in failure to achieve developmental and sociocultural standards for personal autonomy and social responsibility. Lacking continuing support, the adaptive deficits hinder functioning in one or more activities of daily life, including communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.

Start of intellectual and adaptive deficits throughout the developmental period.

Childhood-onset fluency disorder usually consists of reiterations of words or sections of words, in addition to prolongations of speech sounds. While this is seen in the general population, it is more common in those who stutter. A few individuals who stutter may appear to be experiencing shortness of breath while talking. In some cases, even when the mouth appears to be in the process of formulating a sound, nothing may come forth for some seconds. The individual may require some effort in other finish up the word.

Treatment of Childhood-Onset Fluency Disorder

It is important for children with childhood-onset fluency disorder to get diagnosed early, so as to get an early intervention. This is because it can affect communication development and hinder social skills.

Quite a few different methods can be used in treating children and adults that stutter (Maguire, Yeh, & Ito, 2012). It is necessary to look at individual problems and wants, in order to create the most effective treatment method for the individual.

A widely known effective form of treatment is cognitive behavioral therapy (Koc, 2010). This form of psychological counseling helps the therapist in identifying and changing possible methods of thinking that can worsen the individual’s stuttering. It can also assist the individual in determining how to figure out any underlying stress, anxiety, issues with confidence and self-esteem that may be associated with stuttering.

In addition, parental support and involvement are essential to assisting a child deal with stuttering, especially with the assistance of the speech-language pathologist and possible tools (Yaruss, Coleman, & Quesal, 2012).

Another possible form of treatment is that of controlled fluency. With this form of speech therapy, the individual is taught to decrease the rate of talking, so as to pay attention when stuttering occurs. By doing so, the individual can learn to prevent stuttering, gradually increasing the speech pattern to a more natural flow.

The use of some electronic devices can be helpful in treating this disorder. There are various electronic equipments that exist. One method known as delayed auditory feedback involves either slowing the rate of the individual’s speech or distorting the speech. Another one imitates the individual’s speech so it appears that the speech is in parallel with another person.

The options for treatment can be done either at home, with the use of a speech-language pathologist, or through the assistance of a rigorous program. Currently no medications have been scientifically proven to assist with this disorder; although there are some that have been tried (Maguire, Yeh, & Ito, 2012). The most hopeful have been antidopaminergic agents, though none have been officially approved by the United States Food and Drug Administration (FDA).

Living with Childhood-Onset Fluency Disorder

For someone who stutters, living with this communication disorder can have a tremendous effect emotionally and on the individual’s daily life. Such an individual may experience fear speaking certain words, speaking in public in front of an unknown crowd in a work setting, holding leadership positions, and socializing. Children may particularly experience bullying by their peers, for this manner of speaking (Yaruss, Coleman, & Quesal, 2012). Without a positive coping mechanism, individuals may be affected in their choice of careers, or position in the community. Individuals should be encouraged to also figure out ways to decrease anxiety and stress load, as this can exacerbate stuttering.

Children or adults who stutter may appear not to be as outgoing and withdrawn, as a result of the fear of being mocked by others (Yaruss, Coleman, & Quesal, 2012). They may be prone to aggression, as a result of being unable to express anger openly (Yaruss, Coleman, & Quesal, 2012). Many with childhood-onset fluency disorder appear prone to depression, which can have devastating effects if not addressed quickly and appropriately. Children as a result may perform poorly in school because of being unable to express themselves in class, work well in groups and do all that may be expected academically. Adults may have a challenging time holding management and leadership positions that involve being the voice of the organization. Furthermore adults may experience hardships not only in public settings, but even in the home front, with family relationships, such as in marriage.

Individuals who stutter should be encouraged to engage in cognitive therapy especially to decrease self doubts, and to raise self confidence. Ultimately this can help provide individuals with childhood-onset fluency disorder, both children and adults, can express themselves well verbally and live much fulfilled lives.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Cohen, J. (2014, July/Aug). A new name for stuttering in DSM-5. Monitor on Psychology, 45(7), 51.

Koc, M. (2010, April). The Effect of Cognitive-Behavioral Therapy on Stuttering. Social Behavior and Personality: an international journal, 38(3), 301-309.

Maguire, G., Yeh, C., & Ito, B. (2012). Overview of the Diagnosis and Treatment of Stuttering. Journal of Experimental and Clinical Medicine, 4(2), 92-97.

Yaruss, J., Coleman, C., & Quesal, R. (2012, October). Stuttering in School-Age Children: A Comprehensive Approach to Treatment. Language, Speech and Hearing Services in Schools, 43, 536-548.

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