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DYSFLUENCY MAY REFLECT TOURETTE’S SYNDROME, NOT DEVELOPMENTAL STUTTERING
VANCOUVER, BRITISH COLUMBIA—Developmental stuttering is the most common childhood dysfluency, according to Namrata S. Shah, MD. Because of this, “other behavioral disorders may be overlooked or disregarded as potential causes of the dysfluency,” he said. A recent study by Dr. Shah and colleagues in the Division of Pediatric Neurology and the Division of Speech and Hearing, Childrens Hospital, Los Angeles, attempted to demonstrate features resembling Tourette’s syndrome in stutterers.
The Tourette Syndrome Study Group examined eight males, ages 6 to 9. The participants exhibited multiple motor and at least one vocal tic, not necessarily concurrently. The tics evolved in a progressive manner and followed a waxing and waning course. “Symptoms had been present for at least one year, and in all cases there was an absence of precipitating illness or medication,” Dr. Shah noted.
Subjects were initially assessed for severe stuttering by a speech and language pathologist, and video recordings of at least one hour were made of these sessions. Speech evaluation documented the presence of the primary characteristics of stuttering—part-word repetitions, prolongation of sounds, tense pauses, and broken words—as well as secondary stuttering behaviors, including additional facial and body movements observed during assessment.
A subsequent neurologic evaluation, conducted independently by two pediatric neurologists, was obtained through reviews of the speech assessment videos. “Special attention was given to facial and body movements during silent play, as well as when the children were engaged in conversation with the speech pathologist,” Dr. Shah added. The results of the study were presented at the 30th Annual Meeting of the Child Neurology Society.
Based on the evaluations, six of the eight children studied exhibited multiple motor tics such as eye blinking, grimacing, twitching of eyebrows and nose, shoulder shrugging, throat clearing, and sniffing. These children had frequent whole-body restless movements and could not stay seated. Tics were observed to be more frequent at times of perceived stress, when children were actively engaged in conversation, and during periods of dysfluency. However, tics were also observed when the children were engrossed in silent play and appeared more relaxed.
The results led Dr. Shah and colleagues to conclude that Tourette’s syndrome may be overlooked in children with developmental stuttering, and may be mistakenly dismissed as a behavior rather than recognized as an underlying pathology. “It is important to look for improvement in dysfluent speech in response to tic suppressants,” Dr. Shah said. “This may improve quality of life for these patients by providing them with more fluent speech.”
NR
—C. Justin Romano
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