Differential Diagnosis

Normal developmental disfluency and early signs of stuttering are often difficult to differentiate. Thus, diagnosis of a stuttering problem is made tentatively. It is based upon both direct observation of the child and information from parents about the child’s speech in different situations and at different times. The following sections will help the physician distinguish between normal disfluency, mild stuttering, and severe stuttering, so that appropriate referral can be made.

Questions That Might Be Asked of Parents

Note: These questions are listed in order of the seriousness of the problem. If a parent answers “yes” to any question other than number 1, it suggests the possibility of stuttering rather than normal disfluency.

1.) Does the child repeat parts of words rather than whole words or entire phrases? (For example, “a-a-a-a-apple”)
2.) Does the child repeat a sound more than once every 8 to 10 sentences?
3.) Does the child have more than two repetitions? (“a-a-a-a-apple” instead of “-a-a-apple”)
4.) Does the child seem frustrated or embarrassed when he has trouble with a word?
5.) Has the child been stuttering more than a year?
6.) Does the child raise the pitch of his voice, blink his eyes, look to the side, or show physical tension in his face when he stutters?
7.) Does the child use extra words or sounds like “uh” or “um” or “well” to get a word started?
8.) Does the child sometimes get stuck so badly that no sound at all comes out for several seconds when he’s trying to talk?
9.) Does the child sometimes use extra body movements, like tapping his finger, to get sound out?
10.) Does the child avoid talking or use substitute words or quit talking in the middle of a sentence because he might stutter?

Download the "Physicians Checklist for Referral" from the link below:
http://lillianagresta.com/docs/PhysiciansReferralChecklist.doc

Source: The Child Who Stutters:
To the Pediatrician 3rd edition, Stuttering Foundation of America Publication no. 0023, 2004.

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