Communication is key to how we connect with others and grow personally and professionally. For those with childhood-onset fluency disorders, communicating can be more difficult. Even though these communication disorders affect millions of people, they are often misunderstood.
Fluency disorders include both stuttering and cluttering. The most common type is childhood-onset fluency disorder, also known as developmental stuttering, fluency disorders, or childhood stuttering. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) helps outline the symptoms and criteria for diagnosing childhood-onset fluency disorder.
In this comprehensive guide, we explore childhood-onset fluency disorders, examining their causes and how a speech-language pathologist can help. Whether you are someone with this speech disorder or a concerned loved one, this blog aims to provide much-needed clarity on the topic.
What is Childhood-Onset Fluency Disorder?
Childhood-onset fluency disorders, or developmental stuttering, are complex communication disorders that involve more than what listeners hear. It is characterized by disturbances in the normal fluency and timing of speech. Specifically, there are six major components of stuttering symptoms:
Overt Speech Characteristics of Developmental Stuttering
Interruptions in the normal flow of speech that occur while breathing, making sounds, or forming words. These interruptions may include:
Repetitions (repeated syllables, sounds or words, for example: “f-five”)
Prolongations (drawing out a sound, e.g., “mmmmmy name”)
Blocks, sometimes referred to as broken words (difficulty getting a sound out, e.g., “th—at”)
These are different from what is called typical disfluencies which occur in most children and adults and do not signal a stuttering disorder. Typical disfluencies include:
Repeating a whole word ("cookies cookies and milk")
Adding interjections (inserting "um," "like" into your speech)
Physical Manifestations of Developmental Stuttering
Excess physical tension, especially in the head or neck, may occur during a stuttering event. This tension is not required for a diagnosis but may appear as the individual tries to get through a stuttering moment.
Physiological Activity of Developmental Stuttering
Changes in blood flow, skin reactions, brainwave activities, and other physiological responses during stuttered speech.
Emotional Aspect of Developmental Stuttering
Strong emotional reactions about speaking, such as sadness, frustration, and fear, can lead to avoidance or self-consciousness. For example, a child might stop speaking in class to avoid stuttering, while an adult might avoid applying for jobs that require extensive speaking.
Cognitive Factors of Developmental Stuttering
The processes of selecting, planning, preparing, and executing speech can overwhelm the individual, causing an interruption in normal fluency.
Social Dynamics of Developmental Stuttering
Speech aims to communicate with others. If a listener focuses more on the stutter or becomes judgmental, it can disrupt the speaker's communication intent. This can lead to emotional issues and self-consciousness while speaking, potentially having a significant impact on the speaker.
The Difference between Stuttering and Stammering
There is no difference between stuttering and stammering. "Stuttering" is commonly used by American English speakers, while "stammering" is used by British English speakers. They are both the same communication disorder.
Different Types of Stuttering
There are three different types of stuttering:
Developmental Stuttering, also known as Child Onset Fluency Disorder
Developmental stuttering is the most common type, typically emerging in early childhood, is known as developmental stuttering or childhood stuttering.
Neurogenic Stuttering
Neurogenic stuttering Is an adult-onset fluency disorder resulting from damage or injury to the brain from neurological disorders (e.g., traumatic brain injury).
Psychogenic Stuttering
Psychogenic Stuttering is an uncommon adult-onset fluency disorder caused by extreme trauma or stress.
What Stuttering Isn't
Stuttering is not caused by anxiety, though it can lead to anxiety. Research shows that stuttering is often accompanied by social anxiety disorder. Approximately 22%–60% of adults who stutter meet the criteria for a diagnosis of social anxiety disorder (source).
Stuttering is not linked to intelligence.
Stuttering is not the speaker's fault or a matter of effort.
Stuttering is not a habit; fluency can vary from day to day.
Stuttering is not learned.
Stuttering is not a sign of autism spectrum disorder; however, it is a common speech disorder in individuals with autism.
Can You Be Diagnosed with Childhood-Onset Fluency Disorders As An Adult?
Yes, adults can still have a fluency disorder that started in childhood. The average age of stuttering onset is usually between ages 2 and 5, and some people continue to stutter as they grow older.
If an adult has been stuttering since childhood, they can be diagnosed with a childhood-onset fluency disorder. In contrast, if stuttering starts in adulthood, it's usually due to other factors like a neurological or psychological issue, and it's considered a different type of fluency disorder.
What Are the Causes of Childhood-Onset Fluency Disorder
Further research is needed, but here is what we know so far:
Genetics
Evidence indicates a genetic component, as individuals with childhood-onset fluency disorders often have a relative who also stutters.
Gender
Males are at a higher risk for stuttering compared to females and are more likely to continue stuttering over time. Additionally, males are twice as likely as females to exhibit stuttering initially.
Developmental Factors
Typically, childhood-onset fluency disorders is diagnosed between ages 2 and 5. The incidence of stuttering decreases after early childhood. While many children outgrow stuttering, some may continue into school-age children, adolescence, and adulthood.
Factors such as language development, motor skills, and overall speech fluency during critical periods of development may influence the persistence of stuttering.
Neurological Factors
Differences in brain structure and function, particularly related to speech production, motor control, and language processing, are found in individuals with childhood-onset fluency disorders.
Consistent research indicates abnormalities in the left hemisphere white matter, including reduced volume, organization, and myelin covering of fibers, as well as right hemisphere hyperactivity and indications of reduced gray matter in subcortical centers (source).
Cognitive impairments
Stuttering is more prevalent in people with intellectual disabilities or impairments.
Language Processing
Difficulties in language processing may contribute to childhood fluency disorders, often emerging during early childhood when language skills are developing.
Psychological Factors
Anxiety, stress, feeling self-conscious, and social pressures can affect childhood fluency disorders, but they usually don’t cause stuttering.
Tourette's Disorder and Stuttering
Stuttering shares some similarities with Tourette’s disorder, which occurs less common.
Both Tourette's and stuttering can involve tic-like movements or tic motions (like eye blinks, facial grimaces, or muscle tension).
They also tend to come and go, with good and bad days.
Anxiety and stress can make Tourette's and stuttering more significant.
Vocal tics are common.
Males are more commonly affected with them.
Tourette's and stuttering both begin in childhood
Both can worsen with dopamine agonists (medications that increase dopamine) and improve with dopamine antagonists (medications that block dopamine). (source)
Both are linked to abnormalities in the basal ganglia.
There may also be a genetic connection between Tourette’s disorder and stuttering
How Childhood-Onset Fluency Disorders are Diagnosed
A speech-language pathologist diagnoses stuttering through a detailed evaluation. The Here’s an overview of the process:
Gathering Information:
First, the SLP gathers a detailed history:
Case History: The SLP collects detailed information about when the disorder started, how it has changed over time, and its current status.
Family History: Knowing if stuttering runs in the family helps determine how likely it is to continue and provides other useful insights.
Medical History: The SLP looks into any medical or neurological conditions to rule out other factors that might contribute to stuttering.
Assessing Speech:
Next, the SLP assesses your speech:
Speech Sample Context: The speech therapist gathers speech samples, including spontaneous conversation, oral reading, group discussions, or phone calls, to analyze disfluencies (for example, they may take note of syllable repetitions, blocks, and other stuttering behaviors).
Formal Assessment: Standardized tools are used to evaluate speech fluency through tasks like reading aloud and conversational speech.
Speech Analysis: The SLP reviews speech patterns to check the frequency, duration, and severity of stuttering. They also observe any secondary behaviors (like facial grimaces or head movements) and emotional reactions to stuttering.
Assessing Beyond Speech
The speech therapist also looks at factors beyond speech:
Attitude Rating Scale: The SLP gathers information about your self-perception, attitudes, feelings about communication, and emotions related to stuttering. This helps guide therapy.
Setting Goals: You and the SLP will work together to set personal goals for your stuttering treatment. These might include reducing disfluencies, building communication confidence, or handling specific speaking situations.
Does Childhood Stuttering Resolve On Its Own?
Most preschool children outgrow stuttering on their own, but some continue to stutter as they get older. Researchers have explored factors that might predict whether a child’s stuttering will persist. While no test can guarantee 100% accuracy, combining several measures can offer better insights.
Key risk factors include family history and the severity of stuttering. Children with mild stuttering and no family history are more likely to recover, whereas those with more severe stuttering and a family history are more likely to continue stuttering. Skills like pronunciation and word repetition can also help predict whether stuttering will persist, especially for children who fall between these extremes.
Children with excess physical tension and those older than age 5 are also less likely to recover from stuttering.
Identifying a Stuttering Disorder and Differentiating it From other Speech Disorders
Identifying developmental stuttering and distinguishing it from other speech disorders can be challenging, but Speech-Language Pathologists (SLPs) consider several key factors during the evaluation process.
Speech Disfluencies:
Developmental stuttering is often characterized by specific types of disfluencies including repetitions of sounds, syllables, or words, prolongations, and blocks. Other speech disorders typically present with different types of disfluencies.
Age of Onset and Developmental History:
Developmental stuttering usually begins in early childhood, between the ages of 2 and 5 years.
Consistency and Context:
The severity and frequency of developmental stuttering can fluctuate based on factors such as stress, excitement, fatigue, or specific speaking situations. In contrast, other speech disorders are often consistent in terms of severity and frequency.
Secondary Characteristics and Behaviors:
Developmental stuttering often involves secondary behaviors such as head movements, tension, or eye blinking. These characteristics help differentiate stuttering from other speech disorders.
Overall, a comprehensive evaluation by a qualified Speech-Language Pathologist, including observations of speech patterns, developmental history, associated features, and impact on communication, is essential for accurately distinguishing stuttering from other speech disorders and determining appropriate intervention strategies.
Childhood Onset Fluency Disorders Treatment Options
Speech-Language Pathologists (SLPs) utilize various techniques to treat childhood fluency disorders and improve speech fluency, including:
Stuttering Modification for Developmental Stuttering
This approach aims to help individuals become more comfortable with their speech and reduce the negative impact of stuttering on their lives.
Imagine driving a car and hitting a bump in the road. Instead of panicking or trying to avoid bumps entirely, you learn to navigate them smoothly and confidently. Similarly, stuttering modification therapy teaches individuals how to handle stuttering moments with ease and confidence.
Fluency Shaping Therapy for Developmental Stuttering
Designed to enhance speech fluency, this therapy helps individuals who stutter develop new habits and strategies for speaking that promote smoother communication.
Think of a child learning to ride a bike for the first time. Initially, it may feel wobbly or uncertain, but with practice and guidance, they gradually develop smoother, more coordinated movements. Fluency shaping teaches individuals a new way of speaking that is smoother and more fluent.
Avoidance Reduction Therapy for Developmental Stuttering
This therapy addresses the avoidance behaviors that individuals may develop due to stuttering. During therapy, clients discuss and confront situations they typically avoid, aiming to reduce these avoidance behaviors.
Often, these stuttering therapy approaches are customized and combined to meet the unique needs of each client.
Frequently Asked Questions about Fluency Disorders
I think I have fluency problems—how do I know if I stutter?
Fluency problems or challenges with "normal fluency" can arise from various factors. Stuttering is the most common fluency disorder. If you stutter, you might notice the following:
Repetitions: Frequent repetitions in speech.
Blocks: Difficulty getting a sound out.
Prolongations: Stretching out a sound.
Additionally, you might have secondary characteristics of stuttering (sometimes referred to as secondary mannerisms), such as circumlocution (for example, if you anticipate stuttering on the word "pen," you might use "pencil" instead).
If you have a family member who stutters and believe you might stutter as well, you’re likely correct since genetics can play a role in stuttering.
If you suspect you may have a fluency disorder or struggle with normal fluency, it would be beneficial to seek the help of a speech-language pathologist.
What causes developmental stuttering?
While the exact cause of stuttering is unknown, factors such as genetics, gender, cognitive impairments, language processing, developmental issues, neurological, and psychological factors may contribute to stuttering.
Is developmental stuttering genetic?
Yes, some forms of stuttering have a genetic predisposition. In fact, research has identified certain genes that are associated with stuttering.
What coping strategies can I use to manage the anxiety or stress that triggers my stuttering in social situations?
Some coping strategies include:
Start with a Lower Volume: Begin speaking at a lower volume and gradually increase it to reduce pressure on your vocal folds.
Practice Deep Breathing: This can help calm your nervous system and improve voice steadiness.
Reduce Speech Rate and Insert Pauses: Slowing down your speech and inserting pauses can allow your speech muscles to rest and help maintain fluency.
Use Effective Techniques: Work with a speech-language pathologist to discover techniques that suit you best.
How likely will children outgrow stuttering?
Many children outgrow stuttering in early childhood. However, stuttering that persists beyond childhood often has no cure. Nevertheless, a speech-language pathologist can help individuals manage their stuttering more effectively and improve their overall fluency.
Do deficient language skills or language disorders cause stuttering?
Language disorders or reduced language skills do not cause stuttering. However, a study found that articulation challenges (difficulty producing speech sounds) and phonological disorders were common speech problems that co-occurred with stuttering. Fewer children who stutter also had non-speech issues. Among those with other challenges, learning disabilities, literacy issues, and attention deficit disorders (ADD) were the most common.
Are there support groups for people who stutter?
Your local National Stuttering Association (NSA) often have stuttering support groups. They can be found here.
How Speak with Stephanie Implements Stuttering Therapy Near Skokie, Illinois
Speak with Stephanie LLC is a speech therapy company that specializes in providing high-quality, in-home speech therapy services to individuals in Skokie.
We offer a comprehensive range of services, including consultations, screenings, evaluations, and individualized speech therapy for both children and adults who struggle with stuttering and other speech fluency disorders.
At Speak with Stephanie, we take a holistic approach with each client, working collaboratively to set goals that address their unique needs.
Families and individuals seeking diagnosis or treatment for stuttering disorders or speech fluency challenges benefit greatly from our services. Our speech therapy services are designed for convenience, and we are in-network with Blue Cross Blue Shield PPO and Cigna plans.
During stuttering therapy:
For Preschoolers: I work with preschoolers and their parents to identify and modify situations that may stress the child’s speech and language system. I also work directly with the child to improve speech fluency.
For School-Aged Children, Teenagers, and Adults: I adopt a holistic approach that includes educating clients about stuttering, raising awareness of their stuttering patterns, and teaching techniques to manage stuttering and improve fluency. These techniques are practiced in role-playing scenarios to reduce fear and avoidance and to help generalize skills into everyday life.
Emphasis is placed on addressing the thoughts and feelings associated with stuttering, as these have a direct impact on both the individual and their speech. Principles of Avoidance Reduction Therapy (ART) and Cognitive Behavioral Therapy (CBT) are incorporated to promote successful outcomes.
Speak with Stephanie excels in the following areas of stuttering treatment:
Personalized Treatment Plans: We prioritize individualized care, tailoring each treatment plan to meet the unique needs of our clients rather than adopting a one-size-fits-all approach.
Evidence-Based Practices: Our therapy methods are grounded in proven, research-backed approaches, ensuring that our interventions are both effective and reliable, promoting speech fluency and communicative confidence.
Regular Communication: We value open dialogue and provide consistent, valuable feedback to families, fostering a collaborative and transparent therapeutic journey.
Collaboration with Families and Educators: We actively engage with families, teachers, and other support providers involved in the client’s care, fostering a team approach to support the client's overall well-being.
Community-Centered Therapy: We focus on creating a supportive environment for children who stutter by enhancing awareness and skills within their communication network, including family members, teachers, peers, and coaches. This approach builds a community that supports communication confidence and acceptance for children who stutter, extending beyond individual therapy sessions.
Online Speech Therapy for Stuttering Disorders Throughout Illinois, New York, and New Jersey
In addition to in-person speech therapy, we offer online speech therapy for children and adults with stuttering disorders throughout Illinois, New York, and New Jersey.
Additional Speech Therapy Services Offered at Speak with Stephanie in Illinois, New York, and New Jersey
In addition to our specialized focus on treating persistent stuttering and speech fluency challenges, Speak with Stephanie provides comprehensive care for a wide range of communication disorders. Our services extend to individuals of all ages, ensuring that each client's unique needs are met with the highest level of personalized attention.
For children, we offer targeted interventions to address language difficulties and speech production issues. Whether a child is struggling with expressive language, receptive language, or articulation, our tailored therapy sessions are designed to foster significant improvements in their ability to communicate effectively. We understand the importance of early intervention and work closely with families to create a supportive environment that encourages the child’s progress both in and out of therapy.
For adults, we offer support for a variety of communication challenges, including articulation disorders, language disorders, and cognitive-communication issues. We recognize that communication is a vital aspect of personal and professional life, and our goal is to help adults regain or enhance their communicative abilities. Through evidence-based practices and individualized treatment plans, we empower our adult clients to overcome their challenges and achieve greater fluency, clarity, and confidence in their speech.
About the author:
Stephanie Jeret is a Speech-Language Pathologist and the owner of Speak with Stephanie LLC. She obtained her Bachelor's and Master's degree from the City University of New York. She has practiced speech therapy in a number of settings including outpatient rehabilitation, telepractice, skilled nursing facilities, schools, and a private practice. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including articulation disorders, receptive/expressive language disorders, and fluency disorders. Information is available by emailing her at stephanie@speakwithstephanie.com or by visiting www.speakwithstephanie.com.