Due to the length of this entry, January’s look at Childhood-Onset Fluency Disorder (Stuttering) (Code 315.35; ICD F80.8), will – like December – be presented in two parts.
As with the other disorders within this section, Speech Sound Disorder (Code 315.39; ICD F80.0) typically occurs within early childhood development, and as you may have guessed, the diagnosis must not be attributable to another disorder or medical condition. This disorder is a persistent difficulty with speech sound production that interferes with speech intelligibility. SSD prevents verbal communication of messages that cause limitations in effective communication for satisfying social participation, academic achievement, occupational performance, or a combination thereof.
Chances are good we all know something about stuttering, what it sounds like, and we may even know someone in our lives who experienced this speech pattern at one time or another. With this in mind, we may already realize that such disturbances in fluency and timing of speech patterns are considered abnormal or inappropriate at any age, but must not include a developmental difficulty with new vocabulary or when better attributed to a different disorder, medical condition, impairment. The disturbance causes anxiety about speaking and may limit the individual’s freedom to interact with peers, let alone achieve academic, social or occupational benchmarks. And, adult-onset is a different diagnostic (p. 45-47).
Adult-onset of fluency disorder
Just one or more of the following criteria must be present to be diagnosed with C-OFD: sound or syllable repetitions; prolongation of consonants or vowels; pauses within words; physical tension when producing words; circumlocutions; monosyllabic word repetitions; and or audible or silent word blocking. Many of these descriptions may be fairly obvious while word blocking, circumlocution may not be so clear. Word blocking is described as audible or silent pauses in speech that are filled – which as I write this seems little different from a word pause, but that may be my lack of experience with this disorder made apparent. Circumlocution is the substitution of a word for a different word to avoid problems. A colleague shared with me that “a listener may or may not be aware of the change in word use while the speaker does know the substitution is being made.” Obviously, geo-cultural accents are not to be mistaken for signs of C-OFD.
Differential diagnostics include Turrette’s Syndrome, sensory impairments, selective mutism, as well as Dysarthria – adult onset of fluency disorder.