AKHILA PRASAD

A70420721081- PSYBSCA2124

BSC CLINICAL PSYCHOLOGY- SECTION A

CHILDHOOD-ONSET FLUENCY DISORDER

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

The symptoms of Childhood-Onset Fluency Disorder (Stuttering) include disturbances in the

normal fluency and time patterning of speech, characterized by frequent and marked occurrences
of various speech dysfluencies.

Diagnostic Criteria

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.

The DSM-5 diagnostic criteria for Childhood-Onset Fluency Disorder (Stuttering) include
disturbances in the normal fluency and time patterning of speech, such as sound and syllable
repetitions, sound prolongations, broken words, audible or silent blocking, circumlocutions,
words pronounced with an excess of physical tension, and monosyllabic whole-word repetitions.
Additionally, the disturbance in speech fluency must cause anxiety about speaking or limitations
in effective communication, social participation, and academic or occupational performance.

The DSM-5 criteria for Childhood-Onset Fluency Disorder no longer require the use of speech
interjections, such as "you know" or "um", as a requirement for diagnosis

Furthermore, the DSM-5 includes anxiety and avoidance as part of the diagnostic criteria,
recognizing the significant impact these factors can have on an individual's functioning. Early
diagnosis and treatment of Childhood-Onset Fluency Disorder is crucial for improving outcomes
and reducing the risk of long-term negative impacts on communication and social participation.
Speech therapy and cognitive behavioral therapy can be used to encourage the individual to
speak more slowly and effectively, and to identify thoughts and processes that worsen stuttering,
and to identify coping strategies related to stress from stuttering
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.

Prevalence

The prevalence of Childhood-Onset Fluency Disorder (Stuttering) is around 5% in children, with

80% to 90% of cases developing by the age of 6 years. The disorder is characterized by frequent
repetitions or prolongations of sounds or syllables, single words broken up, audible or silent
blocks, circumlocutions, words produced with excess physical tension, and monosyllabic whole-
word repetitions. The risk of stuttering in first-degree biological relatives of individuals with the
disorder is three times higher than in the general population.

The disorder can cause anxiety about speaking or limitations in effective communication, social
participation, or academic or occupational performance. The disturbance is not attributable to a
speech-motor or sensory deficit, neurological insult, or another medical condition and is not
better explained by another mental disorder.

The onset of symptoms is in the early developmental period, and the disorder can persist into
adulthood, although around 65 to 85% of children with stuttering do recover. The disorder can
co-occur with other disorders, such as Cluttering, another fluency disorder characterized by a
perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors, pragmatic issues,
decreased awareness of fluency problems or moments of disruption, excessive disfluencies,
collapsing or omitting syllables, and language formulation issues

Functional Consequences
Childhood-Onset Fluency Disorder (COFD), also known as stuttering, can have significant
functional consequences that impact an individual's quality of life. These consequences can
include:

 Low self-esteem: Children with COFD may experience low self-esteem due to their
difficulty with speaking fluently, which can lead to negative self-perception and self-
doubt.
 Bullying: Children with COFD may be bullied by their peers due to their speech
difficulties, which can lead to social isolation and anxiety.
 Problems with schoolwork: COFD can affect a child's academic performance, as they
may struggle to communicate effectively in the classroom or during presentations.
 Impairment of social relationships: COFD can impact a child's ability to form and
maintain social relationships, as they may feel self-conscious about their speech and
avoid social situations.
 Anxiety: Children with COFD may experience anxiety related to speaking, which can
lead to avoidance of social situations and difficulty with public speaking.
 Negative perception by others: COFD can lead to negative perceptions by others,
including teachers, coaches, and employers, which can impact a child's opportunities and
self-esteem.

Associated Features

Associated features of Childhood-Onset Fluency Disorder (Stuttering) include various

characteristics and symptoms that can accompany the primary speech dysfluencies. These
associated features can include:

 Coping mechanisms: Individuals with Childhood-Onset Fluency Disorder may use blocks
and prolongations to mask repetitions in speech.
 Word substitutions: People with the disorder may substitute words to avoid problematic
ones.
  Physical tension: Speech may be accompanied by unwarranted physical tension while
trying to formulate words.
 Facial grimacing: Some individuals may exhibit facial grimacing during speech.
 Muscle tremors: Tremors of muscles used in speech can be present.
 Eye blinks: Excessive eye blinking may occur during speech.
 Evasion of words or circumstances: Individuals may avoid certain words or situations
that exacerbate stuttering episodes.

Differential Diagnosis

The differential diagnosis for childhood-onset fluency disorder includes sensory deficits, normal
speech dysfluencies, medication side effects, and adult-onset dysfluencies. Sensory deficits, such
as hearing impairment or a speech-motor deficit, can cause dysfluencies of speech, but only
when the speech dysfluencies are in excess of what is expected should a diagnosis of childhood-
onset fluency disorder be made. Normal dysfluencies occur frequently in young children and
may include whole-word or phrase repetitions, incomplete phrases, interjections, unfilled pauses,
and parenthetical remarks. If these difficulties continue to increase in frequency or complexity
with age, then childhood-onset fluency disorder is more likely. Medication side effects can also
cause stuttering, and this should be correlated with a temporal history of exposure to the
medication. Adult-onset dysfluencies are usually due to a neurological insult, medical conditions,
or mental disorders and are not considered a DSM-5 diagnosis.

Comorbidity

According to a study in the Journal of Neurodevelopmental Disorders, neurodevelopmental

differences in syntactic processing can distinguish between children who recover from stuttering
and those who persist in their disorder. A comparative investigation of the speech-associated
attitude of preschool and kindergarten children who do and do not stutter found that children
who stutter had significantly more negative attitudes towards speech than their non-stuttering
peers.
A study in the Journal of Fluency Disorders found that speech disruptions in relation to language
growth in children who stutter can affect their language development, and that these disruptions
can persist into adulthood. A study in the Journal of Speech, Language, and Hearing Research
found that disfluency characteristics of 4- and 5-year-old children who stutter can predict
stuttering persistence and recovery.

A study in the Journal of Speech, Language, and Hearing Research found that children who
stutter had a higher incidence of developmental delay and emotional problems, allergies, and
deafness from among 16 pre-selected conditions compared to children who do not stutter. A
study in the Journal of Fluency Disorders found that children who stutter had a higher incidence
of developmental delay and emotional problems, allergies, and deafness from among 16 pre-
selected conditions compared to children who do not stutter.

Risk Factors and Prognosis

The risk factors for stuttering include having a childhood developmental condition, a family
history of stuttering, and being male. The prognosis for recovery from stuttering is favorable,
with 75%-80% of children recovering within 15 months of onset. However, a positive family
history of stuttering, poorer performance on a standardized articulation/phonological assessment,
higher frequency of stuttering-like disfluencies during spontaneous speech, and lower accuracy
on a nonword repetition task are all significantly associated with an increased probability of
stuttering persistence. Additionally, increased effort to speak, negative family attitude towards
the child’s speech, and complaints of stuttering for more than 12 months are associated with a
higher risk of stuttering in children.

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

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. Cohen, J. (2014, July/Aug). A new name for stuttering in DSM-5. Monitor on
Psychology, 45(7), 51.

3. Koc, M. (2010, April). The Effect of Cognitive-Behavioral Therapy on Stuttering. Social

Behavior and Personality: an international journal, 38(3), 301-309.

4. 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.

5. 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.