Fluency Disorders: Stuttering

Introduction
Fluency refers to continuity, smoothness, rate, and effort in speech production. All speakers are
disfluent at times. They may hesitate when speaking, use fillers (“like” or “uh”), or repeat a word or
phrase. These are called typical disfluencies or nonfluencies.
A fluency disorder is an interruption in the flow of speaking characterized by atypical rate, rhythm,
and disfluencies (e.g., repetitions of sounds, syllables, words, and phrases; sound prolongations; and
blocks), which may also be accompanied by excessive tension, speaking avoidance, struggle
behaviors, and secondary mannerisms (American Speech-Language-Hearing Association [ASHA],
1993). People with fluency disorders also frequently experience psychological, emotional, social,
and functional impacts as a result of their communication disorder.
1- Definition of Stuttering
Stuttering, the most common fluency disorder, is an interruption in the flow of speaking
characterized by specific types of disfluencies, including
 repetitions of sounds, syllables, and monosyllabic words (e.g., “Look at the b-b-baby,”
“Let’s go out-out-out”);
 prolongations of consonants when it isn’t for emphasis (e.g., “Ssssssssometimes we stay
home”); and
 blocks (i.e., inaudible or silent fixation or inability to initiate sounds).
These disfluencies can affect the rate and rhythm of speech and may be accompanied by
 negative reactions to speaking;
 avoidance behaviors (i.e., avoidance of sounds, words, people, or situations that involve
speaking);
 escape behaviors, such as secondary mannerisms (e.g., eye blinking and head nodding or
other movements of the extremities, body, or face); and
 physical tension.
Children and adults who stutter also frequently experience psychological, emotional, social, and
functional consequences from their stuttering, including social anxiety, a sense of loss of control,
and negative thoughts or feelings about themselves or about communication.
Stuttering typically has its origins in childhood. Approximately 95% of children who stutter start to
do so before the age of 4 years, and the average age of onset is approximately 33 months. Onset
may be progressive or sudden. Some children go through a disfluent period of speaking. It is also
not unusual for disfluencies to be apparent and then seem to go away for a period of weeks or
months only to return again. Approximately 88%–91% of these children will recover spontaneously
with or without intervention.
Stuttering can co-occur with other disorders (Briley & Ellis, 2018), such as
 attention-deficit/hyperactivity disorder,
 autism spectrum disorder,
 intellectual disability,
 language or learning disability,
 seizure disorders,
 social anxiety disorder,
 speech sound disorders,
 other developmental disorders.
2- Incidence and Prevalence
Overall, the lifetime prevalence of stuttering was estimated to be 0.72%. Cumulative incidence
estimates of stuttering in children range from 5% to 8%. Higher incidence rates of stuttering have
been reported in preschool-aged children (11.2%), with prevalence estimates reported as 2.2%–
5.6%.
A recent U.S. study estimated that approximately 2% of children ages 3–17 years stutter. The
lowest prevalence rates of stuttering were reported in adults aged 21–50 years (0.78%) and adults
aged 51 years or older (0.37%). “Recovery” rates were estimated to be approximately 88%–91%.
Increased incidence of stuttering has been noted among those with a first-degree relative (e.g.,
parent, sibling) who stutters and an even greater likelihood if that relative is an identical twin.
Children with a family history of stuttering were estimated to be 1.89 times more likely to persist in
stuttering. Estimates have reported the male-to-female ratio of individuals who stutter to be as large
as 4:1; however, more recent studies in preschool children suggest that a younger age of onset has
smaller ratios in gender differences. Males were reported to be 1.48 times more likely to persist in
stuttering than females.
The prevalence rate of stuttering in African American children (2–5 years of age) was estimated to
be 2.52%, but was not reported to not be significantly different from that reported for European
American children in the same age group between 2- to 5-year-old African American children and
European American children. Non–English-speaking countries reported prevalence rates similar to
those reported in English-speaking countries. Depending on the country and methodology used,
rates were estimated to range from 1.03% to 1.38%, but could be as high as 8.4%.
“The presence of at least 1 disabling developmental condition was 5.5 times higher in CWS
[children who stutter] when compared to children who do not stutter” (Briley & Ellis, 2018,
p.2895). For example, individuals with attention-deficit/hyperactivity disorder, autism spectrum
disorder, intellectual disability, learning disability, or seizures have higher odds of stuttering.
Estimates report that 1.5% of school-age children who are hard of hearing also stutter, which is
similar to the estimates of older elementary students who stutter.