Fearful anticipation of the problem may develop. The speaker may attempt to avoid dys- fluencies by linguistic mechanisms (e.g., altering the rate of speech, avoiding certain words or sounds) or by avoiding certain speech situations, such as telephoning or public speaking. In addition to being features of the condition, stress and anxiety have been shown to exacerbate dysﬂuency.
(e.g., eye blinks, tics, tremors of the lips or face, jerking of the head, breathing movements, fist clenching). Children with ﬂuency disorder show a range of language abilities, and the relationship between ﬂuency disorder and language abilities is unclear.
Childhood-onset ﬂuency disorder, or developmental stuttering, occurs by age 6 for 80%— 90% of affected individuals, with age at onset ranging from 2 to 7 years. The onset can be insidious or more sudden. Typically, dysﬂuencies start gradually, with repetition of initial consonants, first words of a phrase, or long words. The child may not be aware of dysﬂu- encies. As the disorder progresses, the dysﬂuencies become more frequent and interfering, occurring on the most meaningful words or phrases in the utterance. As the child becomes aware of the speech difficulty, he or she may develop mechanisms for avoiding the dys- ﬂuencies and emotional responses, including avoidance of public speaking and use of short and simple utterances. Longitudinal research shows that 65%—85% of children re- cover from the dysﬂuency, with severity of ﬂuency disorder at age 8 years predicting re- covery or persistence into adolescence and beyond.
Genetic and physiological. The risk of stuttering among first-degree biological rela- tives of individuals with childhood-onset ﬂuency disorder is more than three times the risk in the general population.
In addition to being features of the condition, stress and anxiety can exacerbate dysﬂu- ency. Impairment of social functioning may result from this anxiety.
Sensory deficits. Dysﬂuencies of speech may be associated with a hearing impairment or other sensory deficit or a speech-motor deficit. When the speech dysﬂuencies are in ex- cess of those usually associated with these problems, a diagnosis of childhood-onset ﬂu- ency disorder may be made.
Normal speech dysfluencies. The disorder must be distinguished from normal dysﬂu- encies that occur frequently in young children, which include whole-word or phrase rep- etitions (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 childhood-onset ﬂuency disorder is appropriate.
Medication side effects. Stuttering may occur as a side effect of medication and may be detected by a temporal relationship with exposure to the medication.
Adult-onset dysfluencies. If onset of dysﬂuencies is during or after adolescence, it is an ”adult-onset dysﬂuency” rather than a neurodevelopmental disorder. Adult-onset dysﬂu- encies are associated with specific neurological insults and a variety of medical conditions and mental disorders and may be specified with them, but they are not a DSM-S diagnosis.
Tourette's disorder. Vocal tics and repetitive vocalizations of Tourette’s disorder should be distinguishable from the repetitive sounds of childhood-onset ﬂuency disorder by their nature and timing.
Diagnostic Criteria 315.39 (F80.89)
A. Persistent difficulties in the social use of verbal and nonverbal communication as man- ifested by all of the following: 1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.