Understanding the Diagnosis, Treatment of Stuttering Disorder

178967449Childhood-onset fluency disorder is a newly created condition included in DSM 5, the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. It belongs to a group of conditions called communication disorders and replaces a disorder—included in the previous edition of the Diagnostic and Statistical Manual (DSM IV)—called stuttering. Stuttering typically first appears in childhood, and some affected individuals stop stuttering before they reach adulthood. However, some people continue to stutter for their entire lives and experience significant life impairment as a result of their condition.

Stuttering Basics

Stuttering is the general medical term for disruptions in the normal, fluid production of speech. Virtually everyone stutters occasionally, regardless of overall language production skills. However, some people develop unusually severe stutters that affect their ability to communicate effectively or make themselves easily understood. Specific problems that can appear in people who develop prominent stuttering include the repeated pronunciation of sounds or entire words, unusual drawing out of words or sounds, a temporary inability to produce sound when attempting to speak, and the adoption of unusually tense facial postures while speaking. In addition, some people who stutter intentionally add pauses, repetitions or prolongations to their speaking patterns when attempting to pronounce words that regularly give them difficulty.

As a rule, affected individuals start stuttering during childhood. Generally speaking, young children have increased risks for continuing to stutter throughout childhood if they have stuttering symptoms for at least half a year, have other people in their bloodline who stutter, have other communication-related problems, develop a personal dread about the presence of a stutter, or are exposed to the stuttering-related dread of their parents or other family members. The Mayo Clinic lists relatively common potential stuttering causes that include hereditary problems with speech production and a temporary period of imbalance between language skills and verbal intentions during childhood. Relatively uncommon causes of stuttering include traumatic brain injuries, disruptions in the brain’s normal blood supply (i.e., strokes) and brain dysfunction caused by some form of mental illness.

Childhood-Onset Fluency Disorder

The American Psychiatric Association created childhood-onset fluency disorder as a replacement for stuttering in DSM 5 in an attempt to avoid the negative connotations that have accumulated around stuttering diagnoses over time. However, the actual criteria used to diagnose childhood-onset fluency disorder in DSM 5 remain the same as the criteria listed for stuttering in the now-outdated DSM IV.

In order to qualify for a mental health diagnosis, an affected individual must have some indication of a significant disruption in his or her ability to speak fluently in an age-appropriate manner. Symptoms of such a disruption essentially mirror the symptoms used to define stuttering in strictly physical terms. They include unusually prolonged vocal sounds, repetitive production of words or word sounds, the insertion of unusual sounds into spoken words, habitual attempts to avoid using words that are difficult to pronounce, unusual gaps or pauses during word pronunciation, unusual gaps or pauses between words, and unusual facial straining during word production. In addition, a person with childhood-onset fluency disorder must first develop his or her fluency problems during childhood, and must also experience meaningful impairments in his or her school life, work life, or social interactions with others. While people with the disorder may have actual mechanical difficulty with speech production, they must have speaking problems above and beyond their purely physical limitations.

Treatment Considerations

Potential options for addressing childhood-onset fluency disorder in children include a form of speech therapy called controlled fluency, use of devices that provide electronic feedback, and a form of psychotherapy called cognitive behavioral therapy. During controlled fluency sessions, patients learn how to speak more slowly and gradually pick up on the language patterns that lead to stuttering. Electronic feedback devices can do such things as help monitor the speed of speech production or help monitor the pronunciation of words. Cognitive behavioral therapy helps patients identify and react differently to situations in which stuttering is likely to occur. Children also benefit greatly from well-informed assistance provided by their parents.

In some cases, adults with childhood-onset fluency disorder need additional help to overcome established stuttering patterns. Potential options here include weekly visits to an anti-stuttering program maintained by a clinic or hospital, and more immersive programs designed to provide large amounts of speech therapy over just a few weeks of time. Immersive programs and clinic and hospital programs all typically use a number of different approaches to deal with various aspects of childhood-onset fluency problems.

Posted on September 12th, 2014

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