Childhood-Onset Fluency Disorder (Stuttering)

The signs and symptoms¹ of childhood-onset fluency disorder stammering, or stuttering may vary widely among individuals and fluctuate in intensity over time. They might become more pronounced when a person is stressed, excited, or being pressured. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, an individual must present with just one of several symptoms to be diagnosed with childhood-onset fluency disorder (stuttering). Symptoms often become evident between ages two and five when a child learns to speak. It reflects a marked impairment in speech fluency that is not attributable to stroke or another medical cause.

Key indicators of fluency disorders and stuttering include the following symptoms: 

• Repetition of sounds, syllables, or words. For example, a child might say "c-c-can" instead of "can"
• Prolongation of sounds that may involve stretching out certain sounds, like "ssssnake" for "snake"
• Speech filled with interjections such as "uh" or "like"

Another set of symptoms relates to the physical behaviors associated with the struggle to communicate:

• Rapid eye blinking or lip trembling during speech
• Tense face or upper body when trying to speak
• Visible frustration when trying to communicate
• The avoidance of certain words or social situations due to fear of stuttering
• Difficulty initiating speech, potentially resulting in a pause or block before they begin to speak
• Substitution or omission of problematic words— some children may alter their sentences or choose different words to avoid stuttering
• Frequent use of filler words, such as "um" or "you know," as they try to regain control over their speech

Note that occasional stuttering is relatively common in the early stages of language development and often resolves independently. However, if disfluencies persist, cause a child significant distress,² or impact their ability to communicate effectively, it can be crucial to seek evaluation from a speech-language pathologist.

Beyond the individual impact, childhood-onset fluency disorder (stuttering) can also affect interpersonal dynamics, particularly in social and educational settings. Children may hesitate to participate in classroom discussions or social activities, hindering their academic performance and social development. 

Some children with childhood-onset fluency disorder (stuttering) may also exhibit the following emotional and social symptoms, which are common in children who are experiencing stuttering:

• Fear or anxiety about talking
• Negative self-image due to difficulties in speaking
• Frustration or embarrassment due to speech disfluencies

Some children go through periods of disfluency as they learn to speak, but it doesn't necessarily indicate stuttering. However, if these symptoms persist for more than six months or cause distress in daily communication, it may be a sign of childhood-onset fluency disorder, and it can be vital to seek professional support for stuttering. A speech-language assessment can reveal deficiencies in a child’s speech fluency and identify the presence of a stuttering disorder.

The exact cause of childhood-onset fluency disorder or stuttering remains unclear, but experts believe it may stem from a complex interplay of multiple factors, including the following: 

• Genetic factors: Stuttering tends to run in families, suggesting a genetic component. Children with family members who stutter are at a higher risk of developing the disorder.
• Neurophysiological factors: Differences in brain structure and function have been observed in individuals who stutter. Certain areas of the brain that process language and speech may function differently in people with stuttering.
• Developmental factors: Children with other speech and language problems or developmental delays may be more likely to stutter.

Despite these common factors, emotional or psychological problems do not cause stuttering. Stuttering is not a result of nervousness or a lack of confidence.

Risk factors 

Several risk factors³ can contribute to the persistence or severity of stuttering, such as the following: 

• Gender: Boys are two to three times more likely to stutter than girls and are less likely to outgrow it without intervention.
• Age of onset: Children who begin stuttering at a young age are likely to continue stuttering.
• Family history: Those with a history of persistent stuttering are more likely to continue stuttering.
• Time since onset: Stuttering that persists beyond a year may be more likely to continue.

Recognizing these factors may help providers identify the condition early and ensure quick intervention, which can be crucial for improving the long-term outcomes of individuals with stuttering.

Treatment⁴ for childhood-onset fluency disorder or stuttering primarily aims to improve fluency, enhance communication skills, and boost self-esteem. While there's no “cure” for stuttering, various treatment options can significantly improve speech and manage the disorder's impact on a person's life.

Medication

There are currently no FDA-approved medications specifically for the treatment of stuttering. However, some medicines used to treat other conditions, like certain antidepressants or anti-anxiety medications, may reduce stuttering in some individuals. Stuttering has been shown to respond to dopamine antagonists. Pharmacotherapy for the treatment of stuttering should only be used in combination with other therapy modalities.

Note that these medications can come with side effects, and their efficacy varies from person to person. Any medication use should be under the supervision of a healthcare provider. In addition, consult a doctor before starting, changing, or stopping medication for any condition. 

Other treatment options for stuttering

Alternative treatments for stuttering can also be considered:

• Electronic devices: Some devices may improve fluency by altering how an individual hears their voice. These devices might delay or change the pitch of the user's voice, promoting slower, more fluent speech.
• Support groups:  Children, adolescents, and adults who stutter can find communities of people experiencing similar challenges through support groups. Joining a stuttering support group can provide emotional support and shared experiences. These groups can be beneficial in coping with the social and emotional aspects of stuttering.

Self-care 

Specific strategies may help individuals manage stuttering on a day-to-day basis:

• Regular practice: Regularly practicing speech techniques at home may improve fluency.
• Relaxation techniques: Activities like yoga, meditation, or deep breathing exercises may help individuals manage the stress and anxiety associated with stuttering.
• Positive self-talk: Encouraging self-acceptance and reducing negative self-talk may improve confidence and decrease anxiety around speech.

Early intervention can be crucial for children who stutter. If you suspect your child may be stuttering, consult a speech-language pathologist or a healthcare provider for evaluation and guidance.

Therapy can be crucial in managing childhood-onset fluency disorder or stuttering by helping individuals improve their speech fluency, manage associated anxiety or embarrassment, and boost self-esteem. With professional guidance, those struggling with stuttering may learn techniques to control and reduce stuttering during communication.

One resource for therapeutic support is online therapy platforms like BetterHelp. Online platforms offer licensed therapists specializing in various areas, including communication disorders like stuttering. These services allow individuals to seek help comfortably from their homes, making them a good option to those who might find it difficult to attend traditional, in-person therapy. Through tailored therapy options like messaging, live chat, phone, or video sessions, individuals can choose the method that best fits their needs. 

Beyond therapy, several organizations and resources can provide valuable support and information, including the following: 

• The Stuttering Foundation: This non-profit organization offers many resources for people who stutter, including free online books, brochures, and educational materials about stuttering. They also maintain a list of specialized speech therapists across the country.
• National Institute on Deafness and Other Communication Disorders (NIDCD): The NIDCD provides extensive, research-based information about stuttering and other communication disorders, including a list of available clinical trials.
• National Stuttering Association (NSA): The NSA offers resources for individuals who stutter and their families and access to local chapters and support groups.

A significant breakthrough in stuttering research comes from a study by the University of Michigan. The researchers identified specific brain cells, or astrocytes, in a brain region called the corpus callosum to be involved in stuttering. These cells, which were earlier thought to merely provide nutrients to neurons, have now been revealed to play a more active role in controlling neurons and possibly contributing to speech disorders.

The study on stuttering, published in the Proceedings of the National Academy of Sciences (PNAS), utilized sophisticated imaging techniques and mice genetically engineered to stutter. The findings suggest that a deficit in astrocytes might disrupt the balance between neurons that stimulate and inhibit activity, thus affecting speech fluency. While more research may be required to understand these findings' implications fully, this study represents a significant step forward in understanding the neurological underpinnings of stuttering.

In another pioneering study conducted by researchers at New York University, a unique brain activity pattern was identified in people who stutter. This specific pattern, found in the thalamus region of the brain, was observed when individuals anticipated moments of stuttering. The thalamus is a crucial part of the brain involved in relaying sensory and motor signals and regulating consciousness and sleep.

The study emphasized the distinctive neural response within the thalamus incited by the anticipation of stuttering, potentially escalating speech disfluency. The researchers used functional magnetic resonance imaging (fMRI) to observe increased activity in the thalamus and decreased activity in speech motor and auditory regions when participants anticipated a stutter. The study's findings suggest that stuttering anticipation might feed into a cycle of speech disfluency, highlighting new potential therapy strategies that could aim to reduce stuttering anticipation and associated fear.

81 million people experience stuttering

Childhood-onset fluency disorder, also known as stuttering, is a common condition, impacting over 81 million people worldwide. ¹

¹American Speech-Language-Hearing Association

Below are more critical statistics on childhood-onset fluency disorder (stuttering):

• The condition tends to run in families, with research suggesting that up to 60% of those who stutter have a family member who also stutters.
• Stuttering is more common in boys than girls. Boys are two to three times more likely to stutter than girls.
• Early intervention can significantly improve outcomes. According to the Stuttering Foundation, over 70% of those who stutter improve with therapy, demonstrating the efficacy of therapeutic intervention.⁵