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Stuttering

Repetition of words and phrases is common in children between 18 months and 5 years of age. Almost 90% of children will demonstrate this dysfluency and it persists for 2-3 months. It is believed to originate from the child forming words in their mind quicker than the tongue can produce them. True stuttering involves the repetition of words, syllables, phrases, or sounds. There are often pauses, prolongations, and the absence of smooth speech. Stuttering affects 5% of preschoolers and 1% of the general population. The incidence is 4 times greater in males and higher in upper socioeconomic classes.

1. Genetic- there is a higher incidence in males, brothers of female stutterers and offspring of female stutters
   

-Apparent abnormalities in lysosomal enzyme targeting pathways

-Imaging studies have revealed left-hemisphere white-matter abnormalities

.-Possible association with chromosome 12 mutations

-One hypothesis: inhibited protein trafficking leads to poor maintenance of myelin sheaths which explains mucolipidosis types II and III, mutations in GNPTAB and GNPTAG with severe white matter abnormality documented on MRI and this form of stuttering is thus a “disconnection syndrome”

1. Subtle neurophysiologic dysfunction may be associated
   
2. Attention given to dysfluency when the child is starting to talk. This may lead to anxiety in the child and further aggravate the dysfluency because the child is afraid to talk and will pause and repeat words and phrases.

1. Repetition of words, phrases, and sounds
   
2. Hesitation in speech.
   
3. Tendency to get worse when under pressure or emotionally stressed
   
4. Some characteristics
   
   1. greater than 7% of all words
      
   2. 3 unit repetition i.e. bee, bee, bee, beet
      
   3. greater than 1 second prolongation
      
   4. Use fewer vocabulary words and avoid certain words
      
   5. As progresses, frustration may lead to tension and facial and body movements
      
   6. Often, when singing, reciting from memory, acting, or talking to friends and animals, child won't stutter.

1. Delay in the development of language skills
   
2. Abuse by peers and difficulty in establishing interpersonal relationships is common. There is a poor self esteem. This will often effect school achievement.

1. Observation of the child in the presence of family and alone
   
2. Assessment of development

1. Referral to speech language pathologist if
   
   1. child is older than 4 years old and has been stuttering for longer than 3 months consistently
      
   2. there is tension
      
   3. Child develops tics or unusual bodily movements
      
   4. There is a positive family history
      
   5. The child or parents are overly concerned

1. Prognosis is good if the child is diagnosed early and therapy started.

1. Allow for early dysfluency and do not correct child if they are talking slowly or mispronouncing words.
   
2. Don't say "Think before you speak".
   
3. Don't interrupt speech or ask the child to repeat things.
   
4. Don't praise "good" speech because this will make the child feel that other speech is poor.
   
5. Don't have the child practicing speech or words.

1. Leung, Alexander, and Robson, Wm. Lane. Stuttering Clinical Pediatrics Vol. 29 No.9 September 1990
2. Reilly S et al. Predicting Stutterring Onset by the Age of 3 Years: A Prospective Community Cohort Study.  Pediatrics January 2009
3. Kang C et. al. Mutations in the lysosomal enzyme-targeting pathway and persistent stuttering.  NEJM 2010 Feb 25
4. Buchel C and Watkins KE.  Genetic susuceptibility to ersistent stuttering (Corresondence) NEJM 2010 June 10.
   

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