Close message

Stuttering

BlankSend to a friend

307.0 Stuttering

Diagnostic Features

The essential feature of Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for the individual's age (Criterion A). This disturbance is characterized by frequent repetitions or prolongations of sounds or syllables (Criteria A1 and A2). Various other types of speech dysfluencies may also be involved, including interjections (Criterion A3), broken words (e.g., pauses within a word) (Criterion A4), audible or silent blocking (filled or unfilled pauses in speech) (Criterion A5), circumlocutions (i.e., word substitutions to avoid problematic words) (Criterion A6), words produced with an excess of physical tension (Criterion A7), and monosyllabic whole-word repetitions (e.g., "I-I-I-I see him") (Criterion A8). The disturbance in fluency interferes with academic or occupational achievement or with social communication (Criterion B). If a speech-motor or sensory deficit is present, the speech difficulties are in excess of those usually associated with these problems (Criterion C). If a speech-motor or sensory deficit or a neurological disorder is present, this condition should also be coded on Axis III. The extent of the disturbance varies from situation to situation and often is more severe when there is special pressure to communicate (e.g., giving a report at school, interviewing for a job). Stuttering is often absent during oral reading, singing, or talking to inanimate objects or to pets.

Associated Features and Disorders

At the onset of Stuttering, the speaker may not be aware of the problem, although awareness and even fearful anticipation of the problem may develop later. The speaker may attempt to avoid stuttering by linguistic mechanisms (e.g., altering the rate of speech, avoiding certain speech situations such as telephoning or public speaking, or avoiding certain words or sounds). Stuttering may be accompanied by motor movements (e.g., eye blinks, tics, tremors of the lips or face, jerking of the head, breathing movements, or fist clenching). Stress or anxiety have been shown to exacerbate Stuttering. Impairment of social functioning may result from associated anxiety, frustration, or low self-esteem. In adults, Stuttering may limit occupational choice or advancement. Phonological Disorder and Expressive Language Disorder occur at a higher frequency in individuals with Stuttering than in the general population.

Prevalence

The prevalence of Stuttering in prepubertal children is 1% and drops to 0.8% in adolescence. The male-to-female ratio is approximately 3:1.

Course

Retrospective studies of individuals with Stuttering report onset typically between ages 2 and 7 years (with peak onset at around age 5 years). Onset occurs before age 10 years in 98% of cases. The onset is usually insidious, covering many months during which episodic, unnoticed speech dysfluencies become a chronic problem. Typically, the disturbance starts gradually, with repetition of initial consonants, words that are usually the first words of a phrase, or long words. The child is generally not aware of Stuttering. As the disorder progresses, there is a waxing and waning course. The dysfluencies become more frequent, and the Stuttering occurs on the most meaningful words or phrases in the utterance. As the child becomes aware of the speech difficulty, mechanisms for avoiding the dysfluencies and emotional responses may occur. Research suggests that some proportion recover; estimates range from 20% to 80%. Some individuals with Stuttering recover spontaneously, typically before age 16 years.

Familial Pattern

Family and twin studies provide strong evidence of a genetic factor in the etiology of Stuttering. The presence of a Phonological Disorder or the developmental type of Expressive Language Disorder, or a family history of these, increases the likelihood of Stuttering. The risk of Stuttering among first-degree biological relatives is more than three times the risk in the general population. For men with a history of Stuttering, about 10% of their daughters and 20% of their sons will stutter.

Differential Diagnosis

Speech difficulties may be associated with a hearing impairment or other sensory deficit or a speech-motor deficit. In instances where the speech difficulties are in excess of those usually associated with these problems, a concurrent diagnosis of Stuttering may be made. Stuttering must be distinguished from normal dysfluencies that occur frequently in young children, which include whole-word or phrase repetitions (e.g., "I want, I want ice cream"), incomplete phrases, interjections, unfilled pauses, and parenthetical remarks. If these difficulties increase in frequency or complexity as the child grows older, a diagnosis of Stuttering becomes more likely.

Diagnostic criteria for 307.0 Stuttering

  1. Disturbance in the normal fluency and time patterning of speech (inappropriate for the individual's age), characterized by frequent occurrences of one or more of the following:
    1. sound and syllable repetitions
    2. sound prolongations
    3. interjections
    4. broken words (e.g., pauses within a word)
    5. audible or silent blocking (filled or unfilled pauses in speech)
    6. circumlocutions (word substitutions to avoid problematic words)
    7. words produced with an excess of physical tension
    8. monosyllabic whole-word repetitions (e.g., "I-I-I-I see him")
  2. The disturbance in fluency interferes with academic or occupational achievement or with social communication.
  3. If a speech-motor or sensory deficit is present, the speech difficulties are in excess of those usually associated with these problems.

Coding note: If a speech-motor or sensory deficit or a neurological condition is present, code the condition on Axis III.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text RevisionTM. Copyright 2000 American Psychiatric Association. All Rights Reserved.