Differential Diagnosis

childhood onset stuttering

an interruption in the flow of speech characterized by specific dysfluencies and occurs during childhood

cluttering

fluency disorder characterized by speech perceived as too fast overall, too irregular, or both.

• excessive normal disfluencies

• excessive collapsing or deletion of syllables

• abnormal pauses, syllable stress or speech rhythm.

acquired stuttering

onset of stuttering occurs during adulthood, with no prior childhood history of childhood onset stuttering

onset of childhood onset stuttering

begins during childhood usually between the ages 2 and 4

onset of cluttering

begins in the preschool years and may remain undiagnosed until it starts to interfere with academic performance

acquired stuttering

later onset, late teens or older

neurogenic stuttering

following a neurological event

psychogenic stuttering

associated with a psychological condition

etiology of childhood onset stuttering

genetics and neurophysiological factors

etiology of cluttering

may be neurological. involves aspects of learning, verbal and written expression, and perception

etiology of neurogenic stuttering

stroke, TBI, brain tumor, degenerative neurological diseases

etiology of psychogenic stuttering

conversion disorder (loss or alteration of physical functioning caused by psychological factors)

symptoms of childhood onset stuttering

• overt characteristics (primary and secondary)

• covert characteristics (attitudes and emotions)

• place of stuttering (more likely to occur…)

• phenomena observed

place of stuttering (more likely to occur …)

• on consonants than vowels

• on sounds in word initial position

• in connected speech than on isolated words

• on content words than on function words

• on longer words

• on words in early position in the sentence

• on stressed syllables

cluttering symptoms

overt but no covert characteristics

overt characteristics

• excessive whole word and phrase repetitions

• rapid articulation rate

• lack of intelligibility

• slurring and/or omission of syllables

• mazes (repeated false starts, hesitations, revisions)

additional characteristics

• receptive or expressive language difficulties

• central auditory processing difficulties

• reading problems

• learning disabilities

• limited attention span

• hyperactivity

• lack of awareness of their speech disorder

• symptoms atypical for Childhood onset stuttering

symptoms of neurogenic stuttering

• overt characteristics - primary behaviors only

• covert characteristics - none

• place of stuttering

  • not limited to initial syllables

  • more function than content words

• phenomena observed

  • spontaneous recovery

  • no adaptation effect

  • fluency enhancing/inducing conditions ineffective in reducing stuttering frequency

psychogenic stuttering symptoms

• sudden onset with no previous stuttering history

• overt characteristics - primary dysfluency is rapid initial syllable repetition

• phenomenon observed

  • fluency enhancing/inducing conditions ineffective in reducing stuttering frequency

treatment for childhood onset stuttering

• preschool age - fluent speech

• school age - controlled fluency

• adolescents and adults - modified stuttering

treatment for cluttering

• speech rate reduction

• over-articulation

• increase awareness

treatment for neurogenic stuttering

• techniques that facilitate fluency (pacing, masking, slow rate)

• differentiate fluency, speech, and language components

treatment for psychogenic stuttering

symptoms may dramatically improve with trial therapy