Some characteristics of stuttered speech are not as easy for listeners to detect. As a result, diagnosing<unk>  requires the skills of a certified speech–language pathologist (SLP). Diagnosis of<unk>  employs information both from direct observation of the individual and information about the individual's background, through a case history. Information from both sources should consider things such as age, the various times it has occurred, and other impediments. 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. 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<unk>  (TOCS)) and physical concomitants during speech (Riley’s<unk>  Severity Instrument Fourth Edition (SSI-4)). They might also employ a test to evaluate the severity of the<unk>  and predictions for its course. One such test includes the<unk>  prediction instrument for young children (SPI), which analyzes the child's case history, part-word repetitions and prolongations, and<unk>  frequency in order to determine the severity of the disfluency and its prognosis for chronicity for the future.<unk>  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<unk>  (OASES)), behaviors (older adult self-report (OASR)), and mental health (composite international diagnostic interview (CIDI)). The SLP will then attempt to combine the information garnered from the client's case study along with the information acquired from the assessments in order to make a final decision regarding the existence of a fluency disorder and determine the best course of treatment for the client.<unk>  can also be diagnosed per the DSM-5 diagnostic codes by clinical psychologists with adequate expertise. The most recent version of the DSM-5 describes this speech disorder as "Childhood-Onset Fluency Disorder<unk> " for developmental<unk> , 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". Normal disfluency 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"). This type of disfluency is a normal part of speech development and temporarily present in preschool aged children who are learning to speak. These normal disfluencies can present as interjections ("Um"), multisyllabe repetitions ("I want I want to do that") or revised/abandoned utterances ("I want/ hey what's that?"). Normal disfluency should be ruled out before diagnosing<unk> . Classification Developmental<unk>  (also known as childhood onset fluency disorder) is<unk>  that originates when a child is learning to speak and may persist as the child matures into adulthood.<unk>  that persists after the age of seven is classified as persistent<unk> . Other much less common causes of<unk>  include neurogenic<unk> <unk>  that occurs secondary to brain damage, such as after a stroke) and psychogenic<unk> <unk>  related to a psychological condition). Other disorders with symptoms resembling<unk>  include autism, cluttering, Parkinson's disease, essential tremor, palilalia, spasmodic dysphonia, selective mutism, and social anxiety. Developmental<unk>  is typically a developmental disorder beginning in early childhood and continuing into adulthood in at least 20% of affected children. The mean onset of<unk>  is 30 months. Although there is variability, early<unk>  behaviours usually consist of word or syllable repetitions, while secondary behaviours such as tension, avoidance or escape behaviours are absent. Most young children are unaware of the interruptions in their speech. With young stutterers, disfluency may be episodic, and periods of<unk>  are followed by periods of relatively decreased disfluency. Though the rate of early recovery is very high, with time a young person who stutters may transition from easy, relaxed repetition to more tense and effortful<unk> , including blocks and prolongations. Some propose that parental reactions may affect the development of a chronic stutter. Recommendations to "slow down", "take a breath", "say it again", etc., may increase the child's anxiety and fear, leading to more difficulties with speaking and, in the "cycle of<unk> ," to yet more fear, anxiety and expectation of<unk> . With time secondary<unk> , including escape behaviours such as eye blinking and lip movements, may be used, as well as fear and avoidance of sounds, words, people, or speaking situations. Eventually, many become fully aware of their disorder and begin to identify themselves as stutterers. With this may come deeper frustration, embarrassment and shame. Other, rarer patterns of<unk>  development have been described, including sudden onset with the child being unable to speak, despite attempts to do so. The child usually is unable to utter the first sound of a sentence, and shows high levels of awareness and frustration. Another variety also begins suddenly with frequent word and phrase repetition, and does not include the development of secondary<unk>  behaviours. Neurogenic<unk> <unk>  is also believed to be caused by neurophysiology. Neurogenic<unk>  is a type of fluency disorder in which a person has difficulty in producing speech in a normal, smooth fashion. Individuals with fluency disorders may have speech that sounds fragmented or halting, with frequent interruptions and difficulty producing words without effort or struggle. Neurogenic<unk>  typically appears following some sort of injury or disease to the central nervous system. Injuries to the brain and spinal cord, including cortex, subcortex, cerebellar, and even the neural pathway regions. Acquired<unk>  In rare cases,<unk>  may be acquired in adulthood as the result of a neurological event such as a head injury, tumour, stroke, or drug use. The<unk>  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<unk>  behaviors. Techniques such as altered auditory feedback (see below), which may promote decreasing disfluency in those with the developmental condition, are not effective with the acquired type. Psychogenic<unk>  may also arise after a traumatic experience such as a grief, the breakup of a relationship or as the psychological reaction to physical trauma. Its symptoms tend to be homogeneous: the<unk>  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.
Stuttering
Hoarse voice
Drooling
Spasmodic dysphonia
Stilted speech
Facial toning
Kussmaul breathing
Sleepwalking