-
Medical Archives (Sarajevo, Bosnia and... Dec 2021Neurogenic stuttering is a subtype of acquired stuttering, and it is characterized by disfluencies associated with acquired brain damage. (Review)
Review
BACKGROUND
Neurogenic stuttering is a subtype of acquired stuttering, and it is characterized by disfluencies associated with acquired brain damage.
OBJECTIVE
To provide an insight into pathophysiology, symptomatology, differential diagnosis, assessment, and treatment of neurogenic stuttering through a critical review of the literature.
METHODS
Studies published during the past and recent years were searched and analyzed on neurogenic stuttering.
RESULTS
Neurogenic stuttering is a complex disorder. The pathophysiological mechanism of neurogenic stuttering is not yet fully understood. It appears with several neurological diseases and conditions, and the use of some drugs. Differential diagnosis of neurogenic and psychogenic stuttering is a challenge for clinicians. Treatment usually requires a joint effort from speech therapists and doctors, most often neurologists.
CONCLUSION
Although research on neurogenic stuttering can be found in the literature, the complexity of this disorder still requires detailed monitoring and studying to provide the best treatment for patients.
Topics: Brain Injuries; Diagnosis, Differential; Humans; Nervous System Diseases; Stuttering
PubMed: 35169374
DOI: 10.5455/medarh.2021.75.456-461 -
Canadian Family Physician Medecin de... Jun 2016To provide an update on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering. (Review)
Review
OBJECTIVE
To provide an update on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering.
QUALITY OF EVIDENCE
The MEDLINE and Cochrane databases were searched for past and recent studies on the epidemiology, genetics, pathophysiology, diagnosis, and treatment of developmental stuttering. Most recommendations are based on small studies, limited-quality evidence, or consensus.
MAIN MESSAGE
Stuttering is a speech disorder, common in persons of all ages, that affects normal fluency and time patterning of speech. Stuttering has been associated with differences in brain anatomy, functioning, and dopamine regulation thought to be due to genetic causes. Attention to making a correct diagnosis or referral in children is important because there is growing consensus that early intervention with speech therapy for children who stutter is critical. For adults, stuttering can be associated with substantial psychosocial morbidity including social anxiety and low quality of life. Pharmacologic treatment has received attention in recent years, but clinical evidence is limited. The mainstay of treatment for children and adults remains speech therapy.
CONCLUSION
A growing body of research has attempted to uncover the pathophysiology of stuttering. Referral for speech therapy remains the best option for children and adults.
Topics: Adult; Child; Family Practice; Humans; Morbidity; Phobia, Social; Practice Guidelines as Topic; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index; Speech Therapy; Stuttering
PubMed: 27303004
DOI: No ID Found -
American Family Physician Nov 2019Childhood-onset fluency disorder, the most common form of stuttering, is a neurologic disability resulting from an underlying brain abnormality that causes disfluent...
Childhood-onset fluency disorder, the most common form of stuttering, is a neurologic disability resulting from an underlying brain abnormality that causes disfluent speech. Stuttering can lead to significant secondary effects, including negative self-perception and negative perception by others, anxiety, and occasionally depression. Childhood-onset fluency disorder affects 5% to 10% of preschoolers. Early identification of stuttering is important so that therapy can begin while compensatory changes to the brain can still occur and to minimize the chances of the patient developing social anxiety, impaired social skills, maladaptive compensatory behaviors, and negative attitudes toward communication. However, stuttering may be persistent, even with early intervention, and affects about 1% of adults. In patients with persistent stuttering, speech therapy focuses on developing effective compensatory techniques and eliminating ineffective secondary behaviors. The role of family physicians includes facilitating early identification of children who stutter, arranging appropriate speech therapy, and providing support and therapy for patients experiencing psychosocial effects from stuttering. Finally, physicians can serve as advocates by making the clinic setting more comfortable for people who stutter and by educating teachers, coaches, employers, and others in the patient's life about the etiology of stuttering and the specific challenges patients face.
Topics: Child; Child, Preschool; Curriculum; Education, Medical, Continuing; Female; Humans; Male; Practice Guidelines as Topic; Speech Therapy; Stuttering
PubMed: 31674746
DOI: No ID Found -
American Family Physician May 2008Speech dysfluency (stuttering) is common in children. Although stuttering often resolves before adulthood, it can cause significant anxiety for children and their... (Review)
Review
Speech dysfluency (stuttering) is common in children. Although stuttering often resolves before adulthood, it can cause significant anxiety for children and their families. Stuttering speech patterns are often easily identifiable; when a child is learning to talk, repetition of sounds or words, prolonged pauses, or excessively long sounds in words usually occur. Secondary behaviors (e.g., eye blinking, jaw jerking, involuntary head or other movements) that accompany stuttering can further embarrass the child, leading to a fear of speaking. The etiology of stuttering is controversial, but contributing factors may include cognitive abilities, genetics, sex of the child, and environmental influences. Research has shown that more than 80 percent of stuttering cases are classified as developmental problems, although stuttering can also be classified as a neurologic or, less commonly, psychogenic problem. The initial assessment of patients who stutter addresses the severity of dysfluency; secondary behaviors; and the impact of stuttering, such as patient distress. Further testing is useful in assessing the need for therapy. Pharmacologic therapy has not been shown to improve stuttering. Encouraging patients to talk slowly and the use of fluency-shaping mechanisms such as delayed auditory feedback devices to slow the speech rate can help minimize or eliminate stuttering. For patients with persistent stuttering, controlled fluency or stuttering modification therapy may be effective.
Topics: Child; Humans; Stuttering
PubMed: 18540491
DOI: No ID Found -
American Journal of Speech-language... Jan 2021Purpose It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people...
Purpose It has long been known that stuttering behaviors vary across time and situation. Preliminary evidence suggests that this variability negatively affects people who stutter and that stuttering behaviors are more variable than adverse impact associated with stuttering. More information is needed to determine how variability affects people who stutter and what the clinical and research implications of variability may be. Method Two hundred and four adults who stutter participated in a mixed-methods study exploring (a) how variability of stuttering affects people who stutter in comparison to other aspects of the condition and (b) which aspects of the overall experience of stuttering are variable. Results Analyses indicated that variability is very commonly experienced by people who stutter and that it is among the most frustrating aspects of the condition. Qualitative analyses revealed that variability is experienced in all aspects of the stuttering condition, including the observable behavior other affective, behavioral, and cognitive reactions; and the adverse impact of stuttering. Notable individual differences were found in terms of which specific aspects of the condition were more variable for different respondents. Overall, analyses revealed that the variability of different aspects of stuttering can be viewed in a hierarchy from most variable to least variable: aspects (e.g., frequency, duration), aspects (e.g., covert behaviors, physical tension), and experiences (e.g., negative thoughts, feelings, and self-image). Discussion These findings suggest that variability is a common and burdensome aspect of the experience of stuttering and underscore the importance of considering variability in stuttering behavior, reactions, and impact in research, assessment, and treatment for adults who stutter.
Topics: Adult; Emotions; Humans; Individuality; Research Design; Self Concept; Stuttering
PubMed: 33197323
DOI: 10.1044/2020_AJSLP-20-00112 -
European Neurology 2016Stuttering affects about 1% of the general population and from 8 to 11% of children. The onset of persistent developmental stuttering (PDS) typically occurs between 2... (Review)
Review
Stuttering affects about 1% of the general population and from 8 to 11% of children. The onset of persistent developmental stuttering (PDS) typically occurs between 2 and 4 years of age. The etiology of stuttering is unknown and a unifying hypothesis is lacking. Clues to the pathogenesis of stuttering include the following observations: PDS is associated with adverse perinatal outcomes and birth-associated trauma; stuttering can recur or develop in adulthood following traumatic events such as brain injury and stroke; PDS is associated with structural and functional abnormalities in the brain associated with speech and language; and stuttering resolves spontaneously in a high percentage of affected children. Evidence marshaled from the literature on stuttering and from related sources suggests the hypothesis that stuttering is a neuro-motor disorder resulting from perinatal or later-onset hypoxic-ischemic injury (HII), and that chronic stuttering and its behavioral correlates are manifestations of recurrent transient ischemic episodes affecting speech-motor pathways. The hypothesis could be tested by comparing children who stutter and nonstutterers (controls) in terms of the occurrence of perinatal trauma, based on birth records, and by determining rates of stuttering in children exposed to HII during the perinatal period. Subject to testing, the hypothesis suggests that interventions to increase brain perfusion directly could be effective both in the treatment of stuttering and its prevention at the time of birth or later trauma.
Topics: Brain; Child; Child, Preschool; Female; Humans; Male; Stuttering
PubMed: 27750253
DOI: 10.1159/000452215 -
PloS One 2015Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter.
METHODS
In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude.
RESULTS
Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1-2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant.
CONCLUSIONS
Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term.
TRIAL REGISTRATION
isrctn.org ISRCTN24362190.
Topics: Behavior Therapy; Child; Child, Preschool; Early Intervention, Educational; Female; Follow-Up Studies; Humans; Male; Quality of Life; Speech Production Measurement; Speech Therapy; Stuttering; Treatment Outcome
PubMed: 26218228
DOI: 10.1371/journal.pone.0133758 -
Journal of Speech, Language, and... Feb 2022This article presents several potential concerns with the common usage of the term in the study of and people who stutter (or, as many speakers now prefer, ). Our goal...
PURPOSE
This article presents several potential concerns with the common usage of the term in the study of and people who stutter (or, as many speakers now prefer, ). Our goal is to bridge gaps between clinicians, researchers, and stutterers to foster a greater sense of collaboration and understanding regarding the words that are used and meanings that are intended.
METHOD
We begin by reviewing the history of the term . We then explore its usage and current connotations to examine whether the term meaningfully describes constructs that are relevant to the study of the stuttering condition.
RESULTS
By highlighting current research and perspectives of stutterers, we conclude that the term (a) is not fully inclusive, (b) encourages the use of misleading measurement procedures, (c) constrains the subjective experience of stuttering within a false binary categorization, and (d) perpetuates a cycle of stigma that is detrimental to stutterers and to the stuttering community as a whole.
CONCLUSIONS
We recommend that researchers and clinicians cease referring to stuttering as a and simply refer to it as . Furthermore, we recommend that researchers and clinicians distinguish between moments of stuttering (i.e., what stutterers experience when they lose control of their speech or feel stuck) and the overall lived experience of the stuttering condition.
Topics: Emotions; Humans; Motivation; Speech; Speech Production Measurement; Stuttering
PubMed: 34982943
DOI: 10.1044/2021_JSLHR-21-00342 -
CoDAS 2021To analyze and to compare fluency parameters in spontaneous speech and reading and reading comprehension of school-age children who stutter and who do not stutter.
PURPOSE
To analyze and to compare fluency parameters in spontaneous speech and reading and reading comprehension of school-age children who stutter and who do not stutter.
METHODS
Cross-sectional and prospective study approved by the Research Ethics Committee. Sample consisted of 30 scholars aged 8 and 11 years and 11 months divided into two groups: Study Group with 15 school-age children who stutter, Control Group with 15 school-age children who do not stutter. Participants underwent fluency evaluation of spontaneous speech, reading of expository and narrative texts, and reading comprehension evaluation. Inferential statistical analysis was conducted using the Mann-Whitney tests and correlation analysis was conducted using the Spearman's Coefficient test.
RESULTS
The comparison between the fluency parameters indicated that school-age children who stutter showed a greater amount of stuttering-like disfluencies, while school-age children who do not stutter showed longer flows of syllables and words per minute, in spontaneous speech and reading. Regarding reading comprehension, school-age children who stutter had lower performance than school-age children who do not stutter in both texts. There was no association between the frequency of disfluencies and reading comprehension in school-age children who stutter and who do not stutter.
CONCLUSION
School-age children who stutter showed impairments in reading comprehension when compared to fluent, since there was no association between the frequencies of disfluencies with reading comprehension for both groups. It is suggested that reading comprehension be evaluated and, if necessary, improved in order to reduce the consequences of stuttering and provide learning of this school-age children.
Topics: Child; Comprehension; Cross-Sectional Studies; Humans; Prospective Studies; Reading; Speech; Students; Stuttering
PubMed: 34259753
DOI: 10.1590/2317-1782/20202020059 -
American Journal of Speech-language... Aug 2011To identify, integrate, and summarize evidence from empirical studies of the language abilities of children who stutter (CWS) and children who do not stutter (CWNS). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To identify, integrate, and summarize evidence from empirical studies of the language abilities of children who stutter (CWS) and children who do not stutter (CWNS).
METHOD
Candidate studies were identified through electronic databases, the tables of contents of speech-language journals, and reference lists of relevant articles and literature reviews. The 22 included studies met the following criteria: studied both children who did and did not stutter between ages 2;0 (years;months) and 8;0, and reported norm-referenced language measures and/or measures from spontaneous language samples amenable to effect size calculation. Data were extracted using a coding manual and were assessed by application of general and specialized analytical software. Mean difference effect size was estimated using Hedges's g (Hedges, 1982).
RESULTS
Findings indicated that CWS scored significantly lower than CWNS on norm-referenced measures of overall language (Hedges's g = -0.48), receptive (Hedges's g = -0.52) and expressive vocabulary (Hedges's g = -0.41), and mean length of utterance (Hedges's g = -0.23).
CONCLUSIONS
Present findings were taken to suggest that children's language abilities are potentially influential variables associated with childhood stuttering.
Topics: Child Language; Child, Preschool; Humans; Language Development; Stuttering
PubMed: 21478281
DOI: 10.1044/1058-0360(2011/09-0102)