Stuttering Warning: You are not logged in. Your IP address will be publicly visible if you make any edits. If you log in or create an account, your edits will be attributed to your username, along with other benefits.Anti-spam check. Do not fill this in! == Diagnosis == Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a licensed [[speech–language pathology|speech–language pathologist]] (SLP). Diagnosis of stuttering employs information both from direct observation of the individual and information about the individual's background, through a case history.<ref>{{Cite web|url=https://www.nidcd.nih.gov/health/stuttering|title=Stuttering|date=2015-08-18|website=NIDCD|language=en|access-date=2020-01-29|archive-url=https://web.archive.org/web/20180520055057/https://www.nidcd.nih.gov/health/stuttering|archive-date=2018-05-20|url-status=dead}}</ref> The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents.<ref name="cirrie.buffalo.edu">http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International {{webarchive|url=https://web.archive.org/web/20131110190444/http://cirrie.buffalo.edu/encyclopedia/en/article/158/ |date=2013-11-10 }} Fibiger S. 2009. Stuttering. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation.</ref> The overall goal of assessment for the SLP will be (1) to determine whether a speech disfluency exists, and (2) assess if its severity warrants concern for further treatment. During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech (''Riley's Stuttering Severity Instrument Fourth Edition (SSI-4)'').<ref name="cirrie.buffalo.edu" /> They might also employ a test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future.<ref>[http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International Encyclopedia of Rehabilitation] {{webarchive|url=https://web.archive.org/web/20131110190444/http://cirrie.buffalo.edu/encyclopedia/en/article/158/ |date=2013-11-10 }}</ref> Stuttering is a multifaceted, complex disorder that can impact an individual's life in a variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of the speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)).<ref>{{cite web| url = http://www.latrobe.edu.au/health/downloads/star-stutteringresource.pdfLa| title = Trobe University School of Human Communication Disorders}}</ref> [[Clinical psychology|Clinical psychologists]] with adequate expertise can also diagnose stuttering per the [[DSM-5]] diagnostic codes.<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.</ref> The DSM-5 describes "Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However, the specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms ''fluency'' and ''disfluency''.{{Citation needed|date=February 2024}} ===Normal disfluency=== Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies").<ref name="Sander and Osborne" /> This type of disfluency is a normal part of speech development and temporarily present in preschool-aged children who are learning to speak.<ref name="Sander and Osborne" /><ref>Ambrose, Nicoline Grinager, and Ehud Yairi. "Normative Disfluency Data for Early Childhood Stuttering." ''Journal of Speech, Language, and Hearing Research'' 42, no. 4 (1999): 895–909. https://doi.org/10.1044/jslhr.4204.895 ("Stuttering is shown to be qualitatively as well as quantitatively different from normal disfluency even at the earliest stages of stuttering.")</ref> ===Classification=== Developmental stuttering is stuttering that originates when a child is learning to speak and may persist as the child matures into adulthood. Stuttering that persists after the age of seven is classified as persistent stuttering.<ref name="Sander and Osborne" /> Neurogenic stuttering (stuttering that occurs secondary to brain damage, such as after a stroke) and psychogenic stuttering (stuttering related to a psychological condition) are less common and classified separately from developmental.<ref name="Sander and Osborne" /> ====Developmental==== Stuttering usually begins in early childhood.<ref name="gordon">{{cite journal |author=Gordon, N. |title=Stuttering: incidence and causes |journal=Developmental Medicine & Child Neurology |volume=44 |issue=4 |pages=278–81 |year=2002 |pmid=11995897 |doi = 10.1111/j.1469-8749.2002.tb00806.x }}</ref><ref name="craig2005">{{cite journal|author1= Craig, A.|author2= Tran, Y.|title=The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan|journal= Advances in Speech Language Pathology|volume=7 |issue=1 |pages=41–46 |year=2005 |doi= 10.1080/14417040500055060|s2cid= 71565512}}</ref> The mean onset of stuttering is 30 months.<ref name="fn 30"/> With young stutterers, disfluency may be episodic, and periods of stuttering are followed by periods of relatively decreased disfluency.<ref>{{harvnb|Ward|2006|pp=114–5}}</ref> With time a young person who stutters might transition from easy, relaxed repetition to more tense and effortful stuttering, including blocks and prolongations. Some propose that parental reactions may affect this development. With time, secondary stuttering, including escape behaviours such as eye blinking and lip movements, may be used, as well as fear and avoidance of sounds, words, people, or speaking situations. Eventually, some become fully aware of their disorder and begin to identify themselves as stutterers. Depending on the situation, this may come with deeper frustration, embarrassment and shame.<ref>{{harvnb|Ward|2006|pp= 115–116}}</ref> Other patterns of stuttering development have been described, including sudden onset, with the child being unable to speak, despite attempts to do so. The child usually is unable to utter the first sound of a sentence, and shows high levels of awareness and frustration. Another variety also begins suddenly with frequent word and phrase repetition, and does not include the development of secondary stuttering behaviours. =====Neurogenic stuttering===== Some stuttering is also believed to be caused by neurophysiology. Neurogenic stuttering typically appears following some sort of injury or disease to the central nervous system. Injuries to the brain and spinal cord, including cortex, subcortex, cerebellum, and even the neural pathway regions.<ref name="Carlson, N. 2013 pp. 497-500"/> ====Acquired stuttering==== In some cases, stuttering may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback are not effective with the acquired type.<ref name="gordon"/><ref name="craig2005"/><ref>{{harvnb|Ward|2006|pp= 4, 332–335}}</ref> Additionally, psychogenic stuttering may also arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker.<ref>{{harvnb|Ward|2006|pp= 4, 332, 335–337}}</ref> ===Differential diagnosis=== Other disorders with symptoms resembling stuttering, or associated disorders include [[autism]], [[cluttering]], [[Parkinson's disease]], [[essential tremor]], [[palilalia]], [[spasmodic dysphonia]], and [[selective mutism]]. 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