childhood-onset fluency disorder (Stuttering)

Areas of importance you should address, for a patient  with  childhood-onset fluency disorder (Stuttering)but are not limited to, are:

  • Signs and symptoms according to the DSM-5-TR
  • Differential diagnoses
  • Incidence
  • Development and course
  • Prognosis
  • Considerations related to culture, gender, age
  • Pharmacological treatments, including any side effects
  • Nonpharmacological treatments
  • Diagnostics and labs
  • Comorbidities
  • Legal and ethical considerations
  • Pertinent patient education considerations


Childhood-onset fluency disorder

  1. Introduction
  1. Childhood-onset fluency disorder, commonly referred to as stuttering, affects a child’s speech fluency (Ali et al., 2019).
  1. Signs and Symptoms according to Ali et al. (2019)
  1. Sound repetition, blocks in speech, interjections, speech hesitations, and tension when stuttering, such as facial grimaces.
  2. There is anxiety when required to speak due to the limitations of effective communication
  3. Social participation is limited
  4. There may be low academic or occupational performance
  1. Differential diagnoses of Childhood-onset fluency disorder
  1. Cluttering or apraxia of speech
  2. Patients have irregular speaking rates, disorganized speech, and difficulty coordinating articulation
  3. Often co-occurs with stuttering or other speech disorders
  • A speech-language pathologist looks at speech and language evaluations (Deb et al., 2022).
  1. Autism disorder
  2. Affected individuals may have delayed speech development
  3. May have difficulties comprehending language
  • May struggle with social communication
  1. However, not everyone with autism has speech problems (Deb et al., 2022).
  2. Attention-deficit/hyperactive disorder
  3. Characterized by inattention, hyperactivity, and impulsivity
  4. Commonly diagnosed in childhood and can persist into adulthood
  • Childhood-onset fluency disorder can co-occur with other conditions like learning disabilities, anxiety, or depression (Deb et al., 2022).
  1. Speech, motor, or sensory deficit
  2. It is biological and may affect speech (Deb et al., 2022).
  3. Neurological dysfunctions like stroke, tumor, and trauma
  4. Stroke may affect speech
  5. Trauma in the brain may affect speech functions
  • Disease or injuries to the brain can trigger Childhood-onset fluency disorder (Deb et al., 2022).
  1. Incidence
  1. Transient developmental stuttering may be present in 5% of children at some point during their speech.
  2. Persistent stuttering affects 1% of the population
  3. Boys are more likely to develop the disorder than girls (Sommer et al., 2021).
  1. Development and course, according to Ali et al. (2019)
  1. The exact cause is unknown
  2. It may be genetic or environmental
  3. Develops during childhood between 2 and 6 years and persists into adulthood
  4. Transient developmental stuttering is common (Sommer et al., 2021).
  5. Persistent developmental stuttering is uncommon, making it the focus of treatment and diagnosis.
  6. Development and course depend on an individual
  7. For some, it may come and go
  8. For others, it is more persistent and severe even in adulthood (Ali et al., 2019)

Prognosis, according to Ali et al. (2019)

  1. Prognosis also varies
  2. Treatment may improve the disorder for some children
  3. Treatment may not work in other cases
  4. Early interventions result in better outcomes

Considerations related to culture, gender, and age

  1. Culture affects children’s willingness to talk.
  2. Culture affects their perception of stuttering and willingness to seek treatment (Hartung & Lefler, 2019).
  3. There are gender differences in stuttering incidences
  4. Age also affects the course of the disease
  5. Those who start earlier are likely to develop persistent suffering (Ali et al., 2019)
  6. Social stigmatization
  7. It may make them feel depressed and anxious (Ali et al., 2019)

Pharmacological treatments, including side effects

  1. Not recommended
  2. FDA has not approved any treatments for stuttering
  3. Treatments may be to manage associated symptoms
  4. For instance, antidepressants for depression
  5. Medical professionals should monitor the side effects closely (Sommer et al., 2021).

Non-pharmacological treatments

  1. Speech therapy is the gold treatment standard (Ali et al., 2019).
  2. Improves speech fluency, communication skills, and confidence
  3. Requires constant practice
  • May be expensive
  1. Relaxation techniques
  2. Deep breathing and mindfulness
  3. Easy to perform
  • Helps to get rid of anxiety
  1. Available on the internet
  2. Support from electronic devices
  3. Provide auditory feedback
  4. Encourages self-learning
  • Easy to get and use
  1. Providing relaxing environments
  2. For children to feel comfortable speaking (Ali et al., 2019).
  3. Extra tutoring for children at school
  4. Teachers should recognize and assess stutters’ needs separately from the rest (Ali et al., 2019).
  5. Education for family and affected individuals
  6. Raise awareness about the condition
  7. Provide strategies to support affected individuals (Ali et al., 2019).

Diagnostics and labs

  1. Diagnostics and labs are not typically required for diagnosis
  2. Diagnosis is based on specific speech and language behaviors characteristic of stuttering

DSM 5 criteria

  1. Identifies repetitions, broken words, avoiding problematic words, blocks of pauses in speech, words with excess physical tension
  2. The disturbance causes anxiety when speaking
  3. Looks at the onset of the symptoms
  4. Disturbance in speech is unrelated to other health issues (Ali et al., 2019).
  5. Comprehensive assessment to rule out other possible causes of dysfluency (Ali et al., 2019).
  6. Assessment of medical, psychological, and developmental history
  7. Speech and language evaluation and observations of communication behaviors in different contexts (Ali et al., 2019).


  1. Children with a childhood-onset fluency disorder may develop other speech and language disorders.
  2. Also, they are at risk for having ADHD or autism spectrum disorder
  3. Anxiety and depression due to social stigma (Ali et al., 2019)
  4. A thorough evaluation of the overall developmental profile is important to rule out/address any comorbidities (Ali et al., 2019).

Legal and ethical considerations

  1. Children may experience difficulties in school, social, and employment settings due to speech difficulties (Sommer et al., 2021).
  2. Advocacy to ensure appropriate accommodations and support
  3. Healthcare professionals should comply with ethical standards of justice, beneficence, autonomy, and beneficence
  4. They must maintain patient confidentiality
  5. Cultural sensitivity

Pertinent patient education considerations

  1. Education and resources about the disorder, causes, and treatments
  2. Information on the strategies for managing stuttering can be beneficial
  3. Support and encouragement important for child and family members
  4. Educate peers, educators, and others about stuttering and effective communication strategies
  5. Public education to end stigma and discrimination
  6. Support groups or advocacy organizations can provide additional resources and support.



Ali, M., Saad, E., & Kamel, O. (2019). Childhood-onset fluency disorder (stuttering): an interruption in the flow of speaking. International Journal of Psycho-Educational Sciences |, 8(3), 11–13.

Deb, S. S., Roy, M., Bachmann, C., & Bertelli, M. O. (2022). Specific Learning Disorders, Motor Disorders, and Communication Disorders. In Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder (pp. 483-511). Cham: Springer International Publishing.

Hartung, C. M., & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological bulletin145(4), 390.

Sommer, M., Waltersbacher, A., Schlotmann, A., Schröder, H., & Strzelczyk, A. (2021). Prevalence and therapy rates for stuttering, cluttering, and developmental disorders of speech and language: Evaluation of german health insurance data. Frontiers in Human Neuroscience, 15, 1–10.


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