see him”). The disturbance in fluency interferes with academic or occupational achieve-
ment or with social communication. The extent  of the disturbance varies from situation to
situation and often is more severe when there is special pressure to communicate (e.g., giv-
ing a report at school, interviewing for a job) . Dysfluency is often absent during oral read-
ing, singing, or talking to inanimate objects or to pets.
Associated Features Supporting Diagnosis
Fearful anticipation of the problem may develop. The speaker may attempt to avoid dys-
fluencies by linguistic mechanisms (e.g., al tering the rate of sp eech, avoiding certain
words or sounds) or by avoiding certain speec h situations, such as telephoning or public
speaking. In addition to being features of the condition, stress and anxiety have been
shown to exacerbate dysfluency.
Childhood-onset fluency diso rder may also be accompanied by motor movements
(e.g., eye blinks, tics, tremors of the lips or face, jerking of the head, breathing movements,
fist clenching). Children with fluency disorder  show a range of language abilities, and the
relationship between fluency disorder  and language abilities is unclear.
Development and Course
Childhood-onset fluency disord er, or developmental stutteri ng, occurs by age 6 for 80%–
90% of affected individuals, with age at onset ranging from 2 to 7 years. The onset can be
insidious or more sudden. Typically, dysfluencies  start gradually, with repetition of initial
consonants, first words of a phrase, or long words. The child may not be aware of dysflu-
encies. As the disorder progresses, the dysfluencies become more frequent and interfering,