5. DifferentialDx Fall24

Differential Diagnosis of Fluency Disorders

Topics Covered

  • Childhood onset stuttering

  • Cluttering

  • Acquired stuttering (neurogenic, psychogenic)

  • Illustrated in Guitar (2014), Chapter 15

Key Components

  1. Definition

  2. Time of Onset

  3. Etiology

  4. Symptomatology

  5. Treatment

Definition

Childhood Onset Stuttering

  • Definition: Stuttering features interruptions in the flow of speech characterized by specific disfluencies.

    • Types of disfluencies:

      • Repetitions of sounds, syllables, and monosyllabic words

      • Prolongations of sounds (not for emphasis)

      • Blocks (inability to produce sounds)

  • Effects: Disfluencies can affect the rate and rhythm of speech, causing negative reactions, avoidance behaviors, escape behaviors, and increased physical tension.

  • Psychological Consequences: People who stutter may experience social anxiety, loss of control, and negative self-perception regarding communication.

Cluttering

  • Definition: A fluency disorder where conversation segments are perceived as too fast or irregular.

    • Must include one or more:

      • Excessive normal disfluencies

      • Excessive collapsing or deletion of syllables

      • Abnormal pauses, syllable stress, or speech rhythm.

Acquired Stuttering

  • Definition: Dysfluent speech that begins in adulthood without prior history of developmental stuttering.

  • Types include:

    • Neurogenic (after brain injury, stroke, etc.)

    • Psychogenic (linked to psychological conditions).

Time of Onset

Childhood Onset Stuttering

  • Typically occurs between 2 and 4 years of age.

  • Most children who will stutter show signs by age 3.5. (Yairi & Ambrose, 2005)

Cluttering

  • Generally diagnosed during preschool years but may go unnoticed until academic performance is affected.

Acquired Stuttering

  • Late onset, often seen in late teens or older.

  • Can be neurogenic post-event or psychogenic related to psychological distress.

Etiology

Childhood Onset Stuttering

  • Factors:

    • Genetics

    • Neurophysiological elements.

Cluttering

  • Considered potentially neurological but involves learning and expression difficulties.

Acquired Stuttering

  • Neurogenic: Following CVA (Stroke), TBI (Traumatic Brain Injury), brain tumors, and degenerative diseases.

  • Psychogenic: Can include conversion disorders and adverse psychological factors.

Symptomatology

Childhood Onset Stuttering

  • Overt Characteristics: Primary and secondary features, including disfluencies.

  • Covert Characteristics: Emotional and psychological responses such as attitudes and feelings.

  • Common Stuttering Occurrences: More frequent on:

    • Consonants than vowels

    • Sounds in word-initial positions

    • Connected speech over isolated words

    • Content words than function words

    • Longer words compared to shorter ones

  • Phenomena:

    • Spontaneous recovery

    • Adaptation effect

    • Fluency-enhancing conditions observed.

Cluttering

  • Overt Characteristics:

    • Excessive repetitions of words/phrases

    • Rapid speech

    • Lack of clarity

    • Syllable omission/slurring

    • Presence of mazes (false starts, hesitations).

  • Covert Characteristics: None reported.

  • Additional Issues: Language difficulties, reading problems, learning disabilities, and hyperactivity.

Neurogenic Stuttering

  • Overt Characteristics:

    • Dominantly primary disfluencies

  • Characteristics of Stuttering:

    • Less reliance on initial syllables

    • Function words more affected than content words.

  • Effects: Spontaneous recovery noted, however, fluency-enhancing conditions do not reduce stuttering frequency.

Psychogenic Stuttering

  • Overt Characteristics: Sudden onset with primarily rapid initial syllable repetition.

  • Effects: Fluency-enhancing conditions do not alleviate the stuttering frequency.

Treatment Approaches

Childhood Onset Stuttering

  • For preschoolers: Target fluent speech.

  • School-age children: Aim for controlled fluency.

  • Adolescents & adults: Focus on modified stuttering technique.

Cluttering

  • Treatment strategies:

    • Reduce speech rate

    • Overarticulation practice

    • Increase speech awareness.

Neurogenic Stuttering

  • Techniques to aid fluency include:

    • Pacing strategies

    • Masking sounds

    • Slower speech rate practices.

Psychogenic Stuttering

  • Often responds dramatically to trial therapy efforts.

Summary of Differential Diagnosis

  • Childhood Onset Stuttering:

    • Onset and behaviors characteristically occur during childhood.

  • Cluttering:

    • Neurological consideration with specific articulatory challenges.

  • Neurogenic Stuttering:

    • Arises post-relevant neurological incidents, affecting fluency differently compared to childhood onset.

  • Psychogenic Stuttering:

    • Linked to specific psychological events and characterized by unique initial dysfluency patterns.