Transient Tic Disorder and Stuttering

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Thanks for your interesting question. From what I hear you reporting, it would appear that the behaviors described may likely be considered as "transient tic disorder" which is not uncommon in children, (5-24% of school-age children at some stage during this period have had tics) especially boys. The tics themselves are often triggered by organic or psychogenic causes and, therefore, your report that anxiety provoked the tics appears consistent with what we know. The tics typically wax and wane for a time, but are usually present for at least 4 weeks consecutively and not consistently present for longer than 12 consecutive months. Perhaps that the anxiety that provoked the onset of the tic behavior was sufficient enough to "precipitate" stutter-like behaviors that you may not have noticed previously. Quite possibly, a significant shift of neurological resources used to manage the extreme level of emotionality associated with school may have left other areas (speech and language/motor coordination) deficient. Tic behavior and other involuntary movements do co-occur in certain subgroups of people who stutter. So, the presence of both behaviors is not unusual.

As far as treating the stuttering, there are a number of questions that would need to be answered, such as the length of time your son has demonstrated the stutter-like behaviors overall, whether the behaviors have worsened or lessened in degree, and how he has reacted. It appears that your son is highly sensitive and as a result, he may also have subsequently reacted with greater negative awareness to his previously normal developmental disfluencies thus exacerbating them.

A thorough case history would also be critical. As variable as stuttering is, it would be interesting to know what other factors may possibly exacerbate or decrease the behavior. I would also be interested in knowing about his language skills and what other developmental and/or academic skills he has either recently acquired or has been developing. At this point, my own inclination would be to consult with your pediatrician regarding the tic behavior and a fluency specialist in your area who could do a comprehensive evaluation of the stuttering. Those sources should help you answer many of the questions more fully before embarking on any specific treatment program.

Irv Wollman is a Clinical Coordinator in the Department of Speech Pathology at Cincinnati Children's Hospital and a Board Recognized Fluency Specialist. He is an Adjunct Assistant Professor in the Department of Communication Sciences and Disorders at the University of Cincinnati and a member of Children's Hospital's fluency team. Irv can be reached at irving.wollman@cchmc.org