Stuttering  also called stammering or childhood-onset fluency disorder — is a speech disorder that involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say, but have difficulty saying it. For example, they may repeat or prolong a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they’ve reached a problematic word or sound.

Sometimes, however, stuttering is a chronic condition that persists into adulthood. This type of stuttering can have an impact on self-esteem and interactions with other people.

Children and adults who stutter may benefit from treatments such as speech therapy, using electronic devices to improve speech fluency or cognitive behavioral therapy.

Symptoms

Stuttering signs and symptoms may include:

• Difficulty starting a word, phrase or sentence
• Prolonging a word or sounds within a word
• Repetition of a sound, syllable or word
• Brief silence for certain syllables or words, or pauses within a word (broken word)
• Addition of extra words such as “um” if difficulty moving to the next word is anticipated
• Excess tension, tightness, or movement of the face or upper body to produce a word
• Anxiety about talking
• Limited ability to effectively communicate

The speech difficulties of stuttering may be accompanied by:

• Rapid eye blinks
• Tremors of the lips or jaw
• Facial tics
• Head jerks
• Clenching fists

Stuttering may be worse when the person is excited, tired or under stress, or when feeling self-conscious, hurried or pressured. Situations such as speaking in front of a group or talking on the phone can be particularly difficult for people who stutter.

However, most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak in unison with someone else.

When to see a doctor or speech-language pathologist

It’s common for children between the ages of 2 and 5 years to go through periods when they may stutter. For most children, this is part of learning to speak, and it gets better on its own. However, stuttering that persists may require treatment to improve speech fluency.

Call your doctor for a referral or contact a speech-language pathologist directly for an appointment if stuttering:

• Lasts more than six months
• Occurs with other speech or language problems
• Becomes more frequent or continues as the child grows older
• Occurs with muscle tightening or visibly struggling to speak
• Affects the ability to effectively communicate at school, at work or in social interactions
• Causes anxiety or emotional problems, such as fear or avoidance of situations where speaking is required
• Begins as an adult

Causes

Researchers continue to study the underlying causes of developmental stuttering. A combination of factors may be involved. Possible causes of developmental stuttering include:

• Abnormalities in speech motor control. Some evidence indicates that abnormalities in speech motor control, such as timing, sensory and motor coordination, may be involved.
• Genetics. Stuttering tends to run in families. It appears that stuttering can result from inherited (genetic) abnormalities.

Stuttering resulting from other causes

Speech fluency can be disrupted from causes other than developmental stuttering. A stroke, traumatic brain injury, or other brain disorders can cause speech that is slow or has pauses or repeated sounds (neurogenic stuttering).

Speech fluency can also be disrupted in the context of emotional distress. Speakers who do not stutter may experience dysfluency when they are nervous or feeling pressured. These situations may also cause speakers who stutter to be less fluent.

Speech difficulties that appear after an emotional trauma (psychogenic stuttering) are uncommon and not the same as developmental stuttering.

Risk factors

Males are much more likely to stutter than females are. Factors that increase the risk of stuttering include:

• Delayed childhood development. Children who have developmental delays or other speech problems may be more likely to stutter.
• Having relatives who stutter. Stuttering tends to run in families.
• Stress. Stress in the family, high parental expectations or other types of pressure can worsen existing stuttering.

Complications

Stuttering can lead to:

• Problems communicating with others
• Being anxious about speaking
• Not speaking or avoiding situations that require speaking
• Loss of social, school, or work participation and success
• Being bullied or teased
• Low self-esteem

Treatments:

After a comprehensive evaluation by a speech-language pathologist, a decision about the best treatment approach can be made. Several different approaches are available to treat children and adults who stutter. Because of varying individual issues and needs, a method — or combination of methods — that’s helpful for one person may not be as effective for another.

• Improve speech fluency
• Develop effective communication
• Participate fully in school, work and social activities

A few examples of treatment approaches — in no particular order of effectiveness — include:

• Speech therapy. Speech therapy can teach you to slow down your speech and learn to notice when you stutter. You may speak very slowly and deliberately when beginning speech therapy, but over time, you can work up to a more natural speech pattern.
• Electronic devices. Several electronic devices are available to enhance fluency. Delayed auditory feedback requires you to slow your speech or the speech will sound distorted through the machine. Another method mimics your speech so that it sounds as if you’re talking in unison with someone else. Some small electronic devices are worn during daily activities. Ask a speech-language pathologist for guidance on choosing a device.
• Cognitive behavioral therapy. This type of psychotherapy can help you learn to identify and change ways of thinking that might make stuttering worse. It can also help you resolve stress, anxiety or self-esteem problems related to stuttering.
• Parent-child interaction. Parental involvement in practicing techniques at home is a key part of helping a child cope with stuttering, especially with some methods. Follow the guidance of the speech-language pathologist to determine the best approach for your child.

Medication

Although some medications have been tried for stuttering, no drugs have been proved yet to help the problem.

Autism spectrum disorder (ASD) is a developmental disorder that appears in the first 3 years of life. ASD affects the brain’s normal development of social and communication skills.

Causes

Autism spectrum disorder (ASD) is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities are not known. There is likely a combination of factors that lead to ASD. It may run in some families, and research shows that a number of genes may be involved.

Many other possible causes have been suspected, but not proven. Some researchers believe that damage to a specific part of the brain, called the amygdala, may be involved. Other researchers are looking at whether a virus may trigger symptoms.

Some parents have heard that vaccines children receive may cause ASD. Several research studies have found no connection between vaccines and ASD. The American Academy of Pediatrics and the Centers for Disease Control and Prevention report that there is no link between ASD and vaccines.

Some doctors think the increase in the number of children with ASD is due to better diagnosis and newer definitions of ASD. The term autism spectrum disorder now includes conditions that used to be diagnosed separately:

• Autistic disorder
• Asperger syndrome
• Childhood disintegrative disorder
• Pervasive developmental disorder

Symptoms

A number of infectious agents and infection-related conditions can contribute to hair loss.

Surprisingly, ringworm has nothing to do with worms, but is a fungal infection that can occur anywhere on the body. If it develops on the scalp, it can cause patches of hair loss and is known to doctors as “tinea capitis.” Ringworm is the same thing as athlete’s foot, and the same kind of fungal infection that can affect the nails too.

On the scalp, ringworm usually begins as a small pimple that progressively expands in size, leaving scaly patches of temporary baldness. The fungus gets into the hair fibers in the affected area and these hairs become brittle and break off easily, leaving a bald patch of skin. Affected areas are often itchy, red, and inflamed, with scaly patches that may blisterand ooze. The patches are usually redder around the outside with a more normal skin tone in the center. This may create the appearance of a ring — hence the name, ringworm.

The fungus Microsporum gypseum can also sometimes cause tinea capitis. This fungus is common in soil and may be transferred to humans by contact with infected animals. You can also get ringworm from pets that carry the fungus, and cats in particular are common carriers. Ringworm is contagious. It can be passed from one person to the next by direct skin-to-skin contact. You can also catch ringworm through contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces.

Treatment for ringworm varies depending on the particular fungus involved. Some types of ringworm infection will go away spontaneously and no treatment is given. However, most commonly, griseofulvin, an anti-fungal, is used. Griseofulvin is very effective against fungi in hair and skin but it is not so good at treating yeast or bacterial infections. The drug gradually accumulates in the skin and hair. It especially likes to bind with keratin, which is a key component of hair, skin, and nails, and blocks the fungus from infecting the keratin.

More recently, some fungi that cause tinea capitis show some resistance to the drug, which means higher doses and longer courses of treatment. As an alternative to griseofulvin, newer anti-fungal drugs like terbinafine, itraconazole, and fluconazole can be prescribed.

There are several treatments for seborrheic dermatitis. The simplest involves medicated anti-dandruff type shampoos to control the skin proliferation and scaling. Several shampoos might be recommended for alternating use on different days and each with its own particular activity.

Shampoos for seborrheic dermatitis may contain sulfur, selenium sulfide, zinc pyrithione, tar, salicylic acid, or oil of cade. These shampoos have been available for many years. More recently azole-based shampoos (such as ketoconazole [brand name: Nizoral]) have been made available over the counter. All can be effective in treating seborrheic dermatitis.

Some dermatologists may also prescribe antibiotics to control the skin flora and in doing so indirectly reduce the inflammation. The inflammation may be directly treated using a corticosteroid cream or lotion to control the body’s immune response. Seborrheic dermatitis can be very persistent once it starts, so staying with treatment is required and preventative treatment is useful even when the symptoms are gone.

Apraxia is a poorly understood neurological condition. People who have it find it difficult or impossible to make certain motor movements, even though their muscles are normal. Milder forms of apraxia are known as dyspraxia.

Apraxia can occur in a number of different forms. One form is orofacial apraxia. People with orofacial apraxia are unable to voluntarily perform certain movements involving facial muscles. For instance, they may not be able to lick their lips or wink. Another form of apraxia affects a person’s ability to intentionally move arms and legs.

With apraxia of speech a person finds it difficult or impossible to move his or her mouth and tongue to speak. This happens, even though the person has the desire to speak and the mouth and tongue muscles are physically able to form words.

There are two forms of apraxia of speech — acquired apraxia and developmental apraxia. Acquired apraxia can occur in people of all ages. Typically, though, it is found in adults. This condition causes people to lose the speech-making abilities they once possessed.

Developmental apraxia of speech is also known as childhood apraxia of speech. This condition is present from birth, and it affects a child’s ability to form sounds and words. Children with speech apraxia often have far greater abilities to understand speech than to express themselves with spoken words.

The majority of children with developmental apraxia will experience significant improvement, if not complete recovery, with the correct treatment.

Apraxia is sometimes confused with aphasia, another communication disorder. That confusion can be complicated by the fact that the two conditions can occur together.

People with apraxia and aphasia might both have difficulty expressing themselves with words. There are, though, distinct differences between the two. Aphasia describes a problem in a person’s ability to understand or use words in and of themselves. This may make it hard for someone with the condition to speak, read, or write. But apraxia does not describe a problem with language comprehension. Apraxia refers to the difficulty someone has initiating and performing the movements needed to make speech. This difficulty arises despite the fact that there is no weakness in the necessary muscles.

There are a variety of speech-related symptoms that can be associated with apraxia, including:

• Difficulty stringing syllables together in the appropriate order to make words, or inability to do so
• Minimal babbling during infancy
• Difficulty saying long or complex words
• Repeated attempts at pronunciation of words
• Speech inconsistencies, such as being able to say a sound or word properly at certain times but not others
• Incorrect inflections or stresses on certain sounds or words
• Excessive use of nonverbal forms of communication
• Distorting of vowel sounds
• Omitting consonants at the beginnings and ends of words
• Seeming to grope or struggle to make words

Childhood apraxia of speech rarely occurs alone. It is often accompanied by other language or cognitive deficits, which may cause:

• Limited vocabulary
• Grammatical problems
• Problems with coordination and fine motor skills
• Difficulties chewing and swallowing
• Clumsiness

Acquired apraxia results from brain damage to those areas of the brain that control the ability to speak. Conditions that may produce acquired apraxia include head trauma, stroke, or a brain tumor.

Experts do not yet understand what causes childhood apraxia of speech. Some scientists believe that it results from signaling problems between the brain and the muscles used for speaking.

Ongoing research is focusing on whether brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

In some cases of acquired apraxia, the condition resolves spontaneously. This is not the case with developmental apraxia of speech, which does not go away without treatment.

There are various treatment approaches used for apraxia. How effective they are can vary from person to person. For the best results, apraxia treatment must be developed to meet a given individual’s needs. Most children with apraxia of speech benefit from meeting one on one with a speech-language pathologist three to five times a week. They may also need to work with their parents or guardians to practice the skills they are developing.

Therapy for childhood apraxia of speech aims to improve speech coordination. Exercises may include:

• Repeatedly practicing the formation and pronunciation of sounds and words
• Practicing stringing together sounds to make speech
• Working with rhythms or melodies
• Using multisensory approaches, such as watching in a mirror while trying to form words or touching the face while talking

Many therapists believe that sign language is beneficial for children who have difficulty being understood. They often recommend that children attempt to say the words they are signing to practice making the necessary movements with their mouths.

People with more extreme cases of acquired apraxia may also benefit from sign language. Or they may use assistive electronic devices, including computers that can be used to produce words and sentences.

Very few studies have been done to determine the relative effectiveness of various treatment approaches for childhood apraxia of speech. This may be due, in part, to ongoing debate among experts as to which symptoms and characteristics merit a diagnosis of apraxia.

The muscles in your lips, tongue, vocal cords, and diaphragm work together to help you speak clearly. With dysarthria, the part of your brain that controls them doesn’t work well and it’s hard for you to move those muscles the right way. Other people may not be able to understand you very well.

Some people with dysarthria have only minor speech problems. Others have a lot of trouble getting their words out. A speech-language therapist can help.

Dysarthria can make your speech:

• Flat
• Higher or lower pitched than usual
• Jerky
• Mumbled
• Slow or fast
• Slurred
• Soft, like a whisper
• Strained

It also can change the quality of your voice. You might sound hoarse or stuffed up, as if you have a cold.

Because dysarthria can make it harder to move your lips, tongue, and jaw, it can also make it harder for you to chew and swallow. Trouble swallowing can cause you to drool.

Conditions that cause this speech problem include:

• Amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease
• Brain injury
• Brain tumors
• Cerebral palsy
• Huntington’s disease
• Multiple sclerosis
• Parkinson’s disease
• Stroke

If you have trouble speaking, you should see a speech-language pathologist (SLP). She’ll ask about any diseases you have that could affect your speech.

• Stick out your tongue
• Make different sounds
• Read a few sentences
• Count numbers
• Sing
• Blow out a candle

Speech-language therapy is the only treatment for dysarthria. How much your speech may improve depends on the condition that caused it.

Your therapist will teach you:

• Exercises to strengthen the muscles of your mouth and jaw
• Ways to speak more clearly, such as talking more slowly or pausing to catch your breath
• How to control your breath to make your voice louder
• How to use devices like an amplifier to improve the sound of your voice

Your therapist also will give you tips to help you communicate, such as:

• Carry a notebook or smartphone with you. If someone doesn’t understand you, write or type what you want to say.
• Make sure you have the other person’s attention.
• Speak slowly.
• Talk face to face if you can. The other person will be able to understand you better if they can see your mouth move.
• Try not to talk in noisy places, like at a restaurant or party. Turn down music or the TV before you speak, or go outside.
• Use facial expressions or hand gestures to get your point across.
• Use short phrases and words that are easier for you to say.

Alopecia areata is a type of hair loss that occurs when your immune system mistakenly attacks hair follicles, which is where hair growth begins. The damage to the follicle is usually not permanent. Experts do not know why the immune system attacks the follicles. Alopecia areata is most common in people younger than 20, but children and adults of any age may be affected. Women and men are affected equally.

Alopecia areata usually begins when clumps of hair fall out, resulting in totally smooth, round hairless patches on the scalp or other areas of the body. In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs (called “exclamation point” hair). In rare cases, complete loss of scalp hair and body hair occurs. The hair loss often comes and goes-hair will grow back over several months in one area but will fall out in another area.

When alopecia areata results in patches of hair loss, the hair usually grows back in a few months. Although the new hair is usually the same color and texture as the rest of the hair, it sometimes is fine and white.

About 10% of people with this condition may never regrow hair. You are more likely to have permanent hair loss if you:

• Have a family history of the condition.
• Have the condition at a young age (before puberty) or for longer than 1 year.
• Have another autoimmune disease.
• Are prone to allergies (atopy).
• Have extensive hair loss.
• Have abnormal color, shape, texture, or thickness of the fingernails or toenails.

Because hair is an important part of appearance, hair loss can result in feeling unattractive.

In some people with alopecia areata, the fingernails and toenails become pitted-they look as if a pin had made many tiny dents in them. They may also look like sandpaper.

Alopecia areata cannot be “cured” but it can be treated. Most people who have one episode will have more episodes of hair loss.

Because hair usually grows back within a year, you may decide not to treat alopecia areata.

If you choose not to treat the condition and wait for your hair to grow back, you may wish to:

• Wear hairpieces. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. But hair weaving, which involves sewing or braiding pieces of longer hair into existing hair, is not recommended because it may cause permanent hair loss.
• Use certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. But continual use of perms or dyes may result in more hair loss.

The most common treatment for patchy hair loss is many injections of corticosteroids into the scalp or skin, about 1 cm (0.4 in.) apart, every 4 to 6 weeks.

Children and some adults may be treated with topical corticosteroids that are applied to the affected skin.

Minoxidil (Rogaine) may be used along with topical corticosteroids.

Anthralin is an ointment that may help hair grow again. It looks and feels like tar, and it can irritate and stain the skin. So anthralin is applied to bare patches on the scalp only for a short time and then is washed off. It may take 2 months or more for new hair to grow.

Contact immunotherapy triggers an allergic reaction on the scalp that may help hair to grow. A medicine is “painted” on the scalp once a week. This irritates the skin and makes it red and scaly. Hair growth may appear within 3 months of beginning treatment. Side effects of contact immunotherapy include a severe rash (contact dermatitis) and swollen lymph nodes, especially in the neck.

Alopecia areata does not affect you as another condition might: it is not painful, it does not make you feel sick, and it does not result in serious health problems. You cannot spread it to other people, and it should not interfere with school, work, or recreation.

But if hair loss is making you feel unattractive, it is important to talk to someone about it. A counselor can help, as can talking to other people with the same condition.

Urticaria, also known as hives, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly  either as a result of the body’s reaction to certain allergens, or for unknown reasons.

Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to one day before fading.

Angioedema is similar to hives, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours.

Rarely, angioedema of the throat, tongue, or lungs can block the airways, causing difficulty breathing. This may become life threatening.

Symptoms:

If hives or angioedema occur with any of the following symptoms, contact your doctor right away:

• Dizziness
• Wheezing
• Difficulty breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

Allergic hives and angioedema form when, in response to histamine, bloodplasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin’s blood vessels.

Allergic reactions, chemicals in certain foods, insect stings, sunlight exposure, or medications can all cause histamine release. It’s often impossible to find out exactly why hives have formed.

There are several different types of hives, including:

Acute urticaria: Hives lasting less than six weeks. The most common causes are certain foods, medications, or infections. Insect bites and internal disease may also be responsible.

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.

Drugs that can cause hives and angioedema include aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen, high blood pressure drugs (ACE inhibitors), or painkillers such as codeine.

Chronic urticaria and angioedema: Hives lasting more than six weeks. The cause of this type of hives is usually more difficult to identify than those causing acute urticaria. For most people with chronic urticaria, the cause is impossible to determine. In some cases, though, the cause may be thyroiddisease, hepatitis, infection, or cancer.

Chronic urticaria and angioedema can affect other internal organs such as the lungs, muscles, and gastrointestinal tract. Symptoms include muscle soreness, shortness of breath, vomiting, and diarrhea.

Physical urticaria: Hives caused by direct physical stimulation of the skin — for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear elsewhere. Most of the hives appear within one hour after exposure.

Dermatographism: This is a common form of physical urticaria where hives form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.

Your doctor will need to ask many questions in an attempt to find the possible cause of hives or angiodema. Since there are no specific tests for hives or the associated swelling of angioedema — testing will depend on your medical history and a thorough exam by your primary care doctor or dermatologist.

Skin tests may be performed to determine the substance to which you are allergic. Routine blood tests are done to determine if a system-wide illness is present.

Hypertrichosis, also known as werewolf syndrome, is a condition characterized by excessive hair growth anywhere on a person’s body. It can affect both women and men, but it’s extremely rare. The abnormal hair growth may cover the face and body or occur in small patches. Hypertrichosis can appear at birth or develop over time.

Types of hypertrichosis

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What Are the Different Types of Brain Disorders?

What Are the Risk Factors for Brain Disorders?

How Are Brain Disorders Diagnosed?