Assignment: Study Guide Forum NRNP 6665

Childhood-Onset Fluency Disorder, commonly known as stuttering, is a neurodevelopmental disorder that affects speech fluency in children. This disorder can manifest through various disruptions, including the prolongation of speech sounds and the repetition of vowels.
These speech difficulties can significantly hinder effective communication, impacting a child’s social interactions and academic performance.
Early intervention is crucial for improving fluency and overall communication skills. (Craig, 2000).

Overview of Content

Childhood-Onset Fluency Disorder Study Guide ………………….3

DSM-5-TR Criteria for Symptoms and Signs…………………………….3

Differential Diagnoses………………………………………………………..4

Incidence………………………………………………………….4

Development and Course……………………………………………………………….5

Multifactorial Dynamic Pathways Theory……………………………………..5

Prognosis……………………………………………………………………………….5

Considerations Related to Culture, Gender, Age………………………………….5

Pharmacological Treatments and Possible Side Effects……………………….6

Non-Pharmacological Treatments………………………………………7

Diagnostics and Labs………………………………………………………………….7

Comorbidities……………………………………………………………………………..7

Legal and Ethical Considerations…………………………………………………….8

Pertinent Patient Education Considerations……………………………………………………………………8

References…………………………………………………………………………..9

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Study Guide for Childhood Fluency Disorders

Stuttering, identified as a neurodevelopmental disorder, can manifest in children as a disruption in their speech fluency. This disruption can be attributed to various factors, such as prolonged speech sounds and repetition of vowels, which can hinder effective communication (Craig, 2000).

Symptoms and Signs as Outlined by the DSM-5-TR:

The diagnostic criteria encompass fluency and timing issues in speech that are disproportionate to the child’s age and language development. Symptoms of Childhood-Onset Fluency Disorder persist over time and include at least ONE of the following:

1. Repetition of phonemes and syllables.
2. Elongation of both consonants and vowels.
3. The use of pauses within a single word or their absence.
4. Filled or unfilled pauses in speech.
5. Avoidance or substitution of challenging words with “circumlocutions.”
6. Utterance of words with elevated physical tension.

Additionally, it impacts vocational or academic performance due to the anxiety arising from the fear of public speaking, social isolation, or ineffective communication.

Early symptoms typically appear during childhood.

There is no evidence linking this disorder to speech or sensory processing impairments, neurological disorders like stroke or head injuries, or any physical or mental illnesses (American Psychiatric Association, 2015).

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Differential Diagnosis:

Fluency disorders in children can be mistaken for other conditions:

• Sensory Deficit: Some individuals with speech difficulties also have hearing problems or other sensory or speech-motor deficits. When these symptoms are excessive compared to typical issues associated with these conditions, stuttering should be considered as a possible diagnosis.
• Medication Side Effect: Stuttering can be a potential side effect of prolonged medication use.
• Adult-Onset Dysfluency: Onset occurs during or after the teenage years and is characterized by repetitive vocal pauses, which can be distinguished from the tics associated with childhood-onset fluency disorders (American Psychiatric Association, 2015).

Incidence:

• Usually, between 5% and 10% of preschool-aged children experience stuttering, but it often resolves on its own (Craig, 2000).
• Typically, it occurs between the ages of 2 and 5, with the highest incidence at 4 years old and a median occurrence at 33 months (Smith & Weber, 2017).
• Approximately 1% of individuals with this condition experience permanent impairment (Craig, 2000).
• A rise in incidence is observed around puberty (Craig, 2000).

Development and Course:

The Multifactorial Dynamic Pathways Theory suggests that stuttering-like disfluency (SLD) in speech results from unstable signals generated by developing brain networks crucial for speech motor development. Factors such as epigenetics, the environment, and genetics contribute to this (Smith & Weber, 2017).

Prognosis:

• Most individuals can overcome it with or without counseling.
• Approximately 1% of individuals may experience long-lasting symptoms despite early treatment.

Considerations Related to Culture, Gender, and Age:

• Males are more commonly affected than females (Ehud, 2005).
• The male-to-female ratio increases to around 4:1 or higher in older children and adults (Ehud, 2005).
• Chronic stuttering is more prevalent in boys (Ehud, 2005).
• Girls have a better chance of full recovery without medical intervention than boys (Ehud, 2005).
• Stuttering has historically carried cultural stigma (Constantino et al., 2022).
• Prejudice and discrimination are faced by those with the disorder due to a lack of understanding (Constantino et al., 2022).
• Educators have exhibited bias against learners who stutter (Constantino et al., 2022).

Pharmacological Treatments and Possible Side Effects:

• There are no FDA-approved drugs for addressing stuttering in children or adults. However, dopamine-blocking drugs have shown effectiveness (Maguire et al., 2020).
• Haloperidol, a first-generation dopamine-blocking antipsychotic, may enhance speech fluency but can lead to side effects like fatigue, anxiety, chapped lips, digestive issues, headache, restlessness, sleep disturbances, and acne (Maguire et al., 2020).
• Levetiracetam, an anti-seizure medication, has been effective in treating stuttering in children but may cause side effects like infection, drowsiness, stress, headaches, restlessness, worry, and exhaustion (Davidow, 2013).

Non-Pharmacological Treatments:

• Non-pharmacological treatments for stuttering include fluency shaping techniques, such as speaking slowly, adjusting breathing, and progressing from simple words to longer utterances, which can help reduce stuttering.
• Stuttering modification involves educating patients about the condition and teaching coping strategies for related stress and difficulties.
• Electronic devices, similar to hearing aids, can alter or delay speech and may benefit those who stutter.
• Parent training equips parents with methods to assist their children’s language skills progression, such as the Lidcombe Program and the Demands and Capabilities Model.
• Behavioral therapy and speech therapy can also be effective.
• Generalization activities play a role (Davidow, 2013).

Diagnostics and Labs:

• Diagnosis is primarily based on the DSM-V criteria and a detailed client/family history.
• Speech-language pathologists consider the patient’s history, behavior of dysfluency, language comprehension, and the patient’s ability to speak and understand language when making a diagnosis.
• Diagnostic instruments such as the Test of Childhood Stuttering can be used to confirm the presence of dysfluency (Thapar et al., 2018).

Comorbidities:

Children with childhood-onset fluency disorder are 5.5 times more likely to have one or more of the following conditions:

• Autism and Asperger’s syndrome
• Intellectual or learning disabilities
• Pervasive developmental disorder
• ADHD (Briley & Ellis, 2018).

Legal and Ethical Considerations:

• Clinicians must rule out other potential causes of stuttering in children, such as head trauma or medication side effects, before diagnosing this disorder (Smith & Weber, 2017).
• Obtaining consent is crucial before administering any medication.

Pertinent Patient Education Considerations:

• Education should be provided to the patient and their family about the disorder and its various treatment options, including pharmaceutical and non-pharmaceutical approaches.
• Patients should be instructed on how to respond to adverse drug reactions, particularly those that could be life-threatening.
• Individualized therapy plans should consider the client’s family dynamics, cultural background, and values.

References

American Psychiatric Association. (2015). DSM-5: Diagnostic and statistical manual of mental disorders, 5th edition. Generic.

Briley, P. M., & Ellis, C. (2018). The coexistence of disabling conditions in children who stutter: Evidence from the national health interview survey. Journal of Speech, Language, and Hearing Research, 61(12), 2895–2905. https://doi.org/10.1044/2018_jslhr-s-17-0378

Constantino, C., Campbell, P., & Simpson, S. (2022). Stuttering and the social model. Journal of Communication Disorders, 96, 106200. https://doi.org/10.1016/j.jcomdis.2022.106200

Craig, A. (2000). Journal of Developmental and Physical Disabilities, 12(3), 173–186. https://doi.org/10.1023/a:1009463703647

Davidow, J. H. (2013). Modifying phonation interval stuttering treatment program. In The science and practice of stuttering treatment (pp. 1–14). John Wiley & Sons, Ltd,. https://doi.org/10.1002/9781118702796.ch1

Ehud, Y. (2005). On the Gender Factor in Stuttering. The Stuttering Foundation. https://www.stutteringhelp.org/gender-factor-stuttering

Maguire, G. A., Nguyen, D. L., Simonson, K. C., & Kurz, T. L. (2020). The pharmacologic treatment of stuttering and its neuropharmacologic basis. Frontiers in Neuroscience, 14. https://doi.org/10.3389/fnins.2020.00158

Maguire, G. A., Yu, B. P., Franklin, D. L., & Riley, G. D. (2004). Alleviating stuttering with pharmacological interventions. Expert Opinion on Pharmacotherapy, 5(7), 1565–1571. https://doi.org/10.1517/14656566.5.7.1565

Smith, A., & Weber, C. (2017). How stuttering develops: The multifactorial dynamic pathways theory. Journal of Speech, Language, and Hearing Research, 60(9), 2483–2505. https://doi.org/10.1044/2017_jslhr-s-16-0343

Stuttering: Understanding and treating a common disability. (2019). American Family Physician, 100(9), 556–550. https://doi.org/https://search.ebscohost.com/login.aspx?

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2018). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

Assignment: Study Guide Forum NRNP 6665

Assignment: Study Guide Forum NRNP 6665

Assignment: Study Guide Forum

Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or non-pharmacological, while other disorders are chronic and need to be managed throughout the lifespan. For this assignment, you will develop a study guide for an assigned neurodevelopmental disorder from the DSM-5 and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.

Photo Credit: Getty Images/iStockphoto

To Prepare

• Your instructor will assign you to a specific neurodevelopmental disorder from the DSM-5.
• Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.

The Assignment

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.

Areas of Importance to Address

• Signs and symptoms according to the DSM-5
• Differential diagnoses
• Incidence of neurodevelopmental disorders
• Development and course
• Prognosis
• Considerations related to culture, gender, and age
• Pharmacological treatments, including any side effects
• Non-pharmacological treatments for neurodevelopmental disorders
• Diagnostics and labs
• Comorbidities associated with neurodevelopmental disorders
• Legal and ethical considerations
• Pertinent patient education considerations

By Day 7 of Week 8, submit your assignment to the forum as an attachment. Although no responses are required, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.

Submission and Grading Information

Grading Criteria

To access your rubric: Week 8 Assignment Rubric

Post by Day 7 of Week 8

To Participate in this Assignment:

Week 8 Assignment

What’s Coming Up in Week 9?

In Week 9, you will analyze clinical, ethical, and legal issues related to diagnosing and treating dissociative disorders.

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next Week

To go to the next week: Week 9

Learning Resources

Required Readings (click to expand/reduce)

• Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
  • Chapter 12, “Developmental Milestones”
• Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
  • Chapter 51, “Autism Spectrum Disorder”
  • Chapter 55, “ADHD and Hyperkinetic Disorder”
• Utah State University. (n.d.). Creating study guides. https://www.usu.edu/academic-support/test/creating_study_guides
• Walden University. (2020). Success strategies: Self-paced interactive tutorials. https://academicguides.waldenu.edu/academic-skills-center/skills/tutorials/success-strategies
• Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
  • Chapter 13, “Child/Adolescent Neurodevelopmental Disorders”

Required Media (click to expand/reduce)

• Dillon, K. (2019, March 23). DSM-5 neurodevelopmental disorders. [Video]. YouTube. https://www.youtube.com/watch?v=Ydr9s_UwACo
• The National Center for Learning Disabilities. (2013, February 20). What is ADHD? [Video].YouTube.
• Osmosis. (2017, October 17). Autism – causes, symptoms, diagnosis, treatment, pathology. [Video]. YouTube. https://youtu.be/x2hWVgZ8J4A

Medication Review

Irritability in Autism:

• aripiprazole
• risperidone

Attention-Deficit/Hyperactivity Disorder:

• amphetamine IR, XR, and ER
• dextroamphetamine
• atomoxetine
• clonidine hydrochloride ER
• Dexmethylphenidate IR and XR
• guanfacine hydrochloride ER
• lisdexamfetamine
• methylphenidate
• methylphenidate hydrochloride IR and ER, transdermal