title: Examination of validity in spoken language evaluations: Adult onset stuttering following mild traumatic brain injury.
abstract: BACKGROUND
  Reports of increased incidence of adult onset stuttering in veterans and service members with mild traumatic brain injury (mTBI) from combat operations in Iraq and Afghanistan lead to a reexamination of the neurogenic vs. psychogenic etiology of stuttering.
  
  
  OBJECTIVE
  This article proposes to examine the merit of the dichotomy between neurogenic and psychogenic bases of stuttering, including symptom exaggeration, for the evaluation and treatment of the disorder.
  
  
  METHODS
  Two case studies of adult onset stuttering in service members with mTBI from improvised explosive device blasts are presented in detail. Speech fluency was disrupted by abnormal pauses and speech hesitations, brief blocks, rapid repetitions, and occasional prolongations. There was also wide variability in the frequency of stuttering across topics and conversational situations. Treatment focused on reducing the frequency and severity of dysfluencies and included educational, psychological, environmental, and behavioral interventions.
  
  
  RESULTS
  Stuttering characteristics as well as the absence of objective neurological findings ruled out neurogenic basis of stuttering in these two cases and pointed to psychogenic causes. However, the differential diagnosis had only limited value for developing the plan of care.
  
  
  CONCLUSIONS
  The successful outcomes of the treatment serve to illustrate the complex interaction of neurological, psychological, emotional, and environmental factors of post-concussive symptoms and to underscore the notion that there are many facets to symptom presentation in post-combat health.
authors.affiliation: Speech Pathology Division, Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Carole R
authors.initials: CR
authors.lastname: Roth
authors.affiliation: Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, DC, USA.
authors.forename: Micaela
authors.initials: M
authors.lastname: Cornis-Pop
authors.affiliation: Department of Speech Pathology, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Woodford A
authors.initials: WA
authors.lastname: Beach
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007802:Language; D008297:Male; D013342:Stuttering / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy
keywords: Adult onset stuttering; mild traumatic brain injury; psychogenic disorder; rehabilitation