Editing Stuttering (section)

== Diagnosis ==
Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing stuttering requires the skills of a licensed [[speech–language pathology|speech–language pathologist]] (SLP). Diagnosis of stuttering employs information both from direct observation of the individual and information about the individual's background, through a case history.<ref>{{Cite web|url=https://www.nidcd.nih.gov/health/stuttering|title=Stuttering|date=2015-08-18|website=NIDCD|language=en|access-date=2020-01-29|archive-url=https://web.archive.org/web/20180520055057/https://www.nidcd.nih.gov/health/stuttering|archive-date=2018-05-20|url-status=dead}}</ref> The SLP may collect a case history on the individual through a detailed interview or conversation with the parents (if client is a child). They may also observe parent-child interactions and observe the speech patterns of the child's parents.<ref name="cirrie.buffalo.edu">http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International {{webarchive|url=https://web.archive.org/web/20131110190444/http://cirrie.buffalo.edu/encyclopedia/en/article/158/ |date=2013-11-10 }} Fibiger S. 2009. Stuttering. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation.</ref> The overall goal of assessment for the SLP will be (1) to determine whether a speech disfluency exists, and (2) assess if its severity warrants concern for further treatment.

During direct observation of the client, the SLP will observe various aspects of the individual's speech behaviors. In particular, the therapist might test for factors including the types of disfluencies present (using a test such as the Disfluency Type Index (DTI)), their frequency and duration (number of iterations, percentage of syllables stuttered (%SS)), and speaking rate (syllables per minute (SPM), words per minute (WPM)). They may also test for naturalness and fluency in speaking (naturalness rating scale (NAT), test of childhood stuttering (TOCS)) and physical concomitants during speech (''Riley's Stuttering Severity Instrument Fourth Edition (SSI-4)'').<ref name="cirrie.buffalo.edu" /> They might also employ a test to evaluate the severity of the stuttering and predictions for its course. One such test includes the stuttering prediction instrument for young children (SPI), which analyzes the child's case history, and stuttering frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future.<ref>[http://cirrie.buffalo.edu/encyclopedia/en/article/158/#s4International Encyclopedia of Rehabilitation] {{webarchive|url=https://web.archive.org/web/20131110190444/http://cirrie.buffalo.edu/encyclopedia/en/article/158/ |date=2013-11-10 }}</ref>

Stuttering is a multifaceted, complex disorder that can impact an individual's life in a variety of ways. Children and adults are monitored and evaluated for evidence of possible social, psychological or emotional signs of stress related to their disorder. Some common assessments of this type measure factors including: anxiety (Endler multidimensional anxiety scales (EMAS)), attitudes (personal report of communication apprehension (PRCA)), perceptions of self (self-rating of reactions to speech situations (SSRSS)), quality of life (overall assessment of the speaker's experience of stuttering (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)).<ref>{{cite web| url = http://www.latrobe.edu.au/health/downloads/star-stutteringresource.pdfLa| title = Trobe University School of Human Communication Disorders}}</ref>

[[Clinical psychology|Clinical psychologists]] with adequate expertise can also diagnose stuttering per the [[DSM-5]] diagnostic codes.<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.</ref> The DSM-5 describes "Childhood-Onset Fluency Disorder (Stuttering)" for developmental stuttering, and "Adult-onset Fluency Disorder". However, the specific rationale for this change from the DSM-IV is ill-documented in the APA's published literature, and is felt by some to promote confusion between the very different terms ''fluency'' and ''disfluency''.{{Citation needed|date=February 2024}}

===Other disfluencies===
Preschool aged children often have difficulties with speech concerning motor planning and execution; this often manifests as disfluencies related to speech development (referred to as normal dysfluency or "other disfluencies").<ref name="Sander and Osborne" /> This type of disfluency is a normal part of speech development and temporarily present in preschool-aged children who are learning to speak.<ref name="Sander and Osborne" /><ref>{{cite journal |last1=Ambrose |first1=Nicoline Grinager |last2=Yairi |first2=Ehud |title=Normative Disfluency Data for Early Childhood Stuttering |journal=Journal of Speech, Language, and Hearing Research |date=August 1999 |volume=42 |issue=4 |pages=895–909 |doi=10.1044/jslhr.4204.895 |pmid=10450909 |quote=Stuttering is shown to be qualitatively as well as quantitatively different from normal disfluency even at the earliest stages of stuttering. }}</ref>

=== Classification ===
"Developmental stuttering" is stuttering that has its onset in early childhood when a child is learning to speak. "Neurogenic stuttering" (stuttering that occurs secondary to brain damage, such as after a stroke) and "psychogenic stuttering" (stuttering related to a psychological condition) are less common and classified separately from developmental.<ref name="Sander and Osborne" />

====Developmental (and persistent)====
"Developmental stuttering" is a sometimes transient period of stuttering that has its onset in early childhood, i.e. when a child is learning to speak. About 5-7% of children are said to stutter during this period. Despite its name, the onset itself is often sudden. This type of stutter may persist after the age of 7, which is then classified as "persistent stuttering", which is the typical aetiology, pathogenesis, and presentation of adult stuttering.<ref name="gordon">{{cite journal |last1=Gordon |first1=Neil |title=Stuttering: incidence and causes |journal=Developmental Medicine & Child Neurology |date=April 2002 |volume=44 |issue=4 |pages=278–282 |doi=10.1111/j.1469-8749.2002.tb00806.x |pmid=11995897 }}</ref><ref name="craig2005">{{cite journal |last1=Craig |first1=A |last2=Tran |first2=Y |title=The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan |journal=Advances in Speech Language Pathology |date=March 2005 |volume=7 |issue=1 |pages=41–46 |doi=10.1080/14417040500055060 }}</ref><ref name="Sander and Osborne" />

====Neurogenic (or "acquired")====
"Neurogenic stuttering", which may also be called "acquired stuttering", typically appears following some sort of injury or disease to the [[central nervous system]]. Injuries to the brain and spinal cord, including the [[neocortex|cortical]]  and [[subcortex|subcortical]] regions, [[cerebellum]], and even the [[neural pathway]] regions (i.e. the deepest clusters - tracts - of nerves and nerve cells).<ref name="Carlson, N. 2013 pp. 497-500"/> It may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. This stuttering has different characteristics from its developmental equivalent: it tends to be limited to part-word or sound repetitions, and is associated with a relative lack of anxiety and secondary stuttering behaviors. Techniques such as altered auditory feedback are not effective with the acquired type.<ref name="gordon"/><ref name="craig2005"/><ref>{{harvnb|Ward|2006|pp= 4, 332–335}}</ref>

====Psychogenic====
"Psychogenic stuttering", which accounts for less than 1% of all stuttering cases, may arise after a traumatic experience such as a death, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the stuttering is of sudden onset and associated with a significant event, it is constant and uninfluenced by different speaking situations, and there is little awareness or concern shown by the speaker.<ref>{{harvnb|Ward|2006|pp= 4, 332, 335–337}}</ref>

===Differential diagnosis===
Other disorders with symptoms resembling stuttering, or associated disorders include [[autism]], [[cluttering]], [[Parkinson's disease]], [[essential tremor]], [[palilalia]], [[spasmodic dysphonia]], [[selective mutism]], and [[Childhood apraxia of speech|apraxia of speech]].{{fact|date=February 2025}}