Risk factors and assessment methods for screening childhood-onset fluency disorders: a scoping review

Lima, Mayra Maria Oliveira de; Anjos, Heloísa de Oliveira dos; Dias, Thaíse Sara Costa; Correia, Débora Vasconcelos; Oliveira, Cristiane Moço Canhetti de

doi:10.1590/2317-1782/e20250336pt

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Critical Review or Scoping Review • CoDAS 38 (4) • 2026 • https://doi.org/10.1590/2317-1782/e20250336en linkcopy

Risk factors and assessment methods for screening childhood-onset fluency disorders: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To map the state of the art regarding risk factors and assessment methods employed in the screening of fluency disorders in preschool children.

Research strategies A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. The guiding question was: What are the risk factors and assessment methods used in the screening of fluency disorders (stuttering and cluttering) in preschoolers, as reported in the international literature? The PCC strategy guided the search, using MeSH descriptors and free terms across the Lilacs, PubMed/Medline, Scopus, and ScienceDirect databases, from 2020 to 2025, with no language restrictions.

Selection criteria Original full-text articles addressing at least one research question were included. Exclusion criteria comprised non-scientific or secondary publications, studies without abstracts, those outside the conceptual or population scope, and those involving co-occurring disorders.

Data analysis Data were analyzed descriptively and synthesized narratively.

Results A total of 2,091 publications were identified; after duplicate removal and eligibility screening, 11 articles were included. No studies on risk factors for cluttering were found. For stuttering, 14 predictive risk factors were mapped, related to body functions and structures as well as contextual factors. Only two standardized screening tools were identified, both developed in Brazil: the Developmental Stuttering Risk Protocol and the Developmental Stuttering Screening Instrument.

Conclusion Evidence on risk factors for cluttering in preschoolers is lacking. For stuttering, biological and contextual factors emerged as key predictors. Most available assessment methods are restricted to use by speech-language pathologists, highlighting gaps and opportunities for future research.

Keywords:
Risk Factors; Stuttering; Childhood-Onset Fluency Disorder; Child Development; Child Health; Speech-Language Pathology; Scoping Review

Databases	Search strategies
Lilacs, Pubmed/Medline and ScienceDirect (via Portal CAPES)	((child OR "early childhood" OR preschool) AND (stuttering OR stammering OR cluttering OR "fluency disorder") AND ("risk factor" OR assessment OR screening))
Scopus (via Portal CAPES)	((child OR "early childhood" OR preschool OR children) AND (stuttering OR stammering OR cluttering OR "fluency disorder") AND ("risk factor" OR "predisposing factor" OR "contributing factor") AND (assessment OR screen))

Authors (Year)	Database	Journal	Objective	Level of evidence	Fluency disorder screened	Sample	Age range (years)	Language	Use of any screening instrument?
Authors (Year)	Database	Journal	Objective	Level of evidence	Fluency disorder screened	(if applicable)	Age range (years)	(Country)	Use of any screening instrument?
Lima et al. (2021a)	Lilacs	Cefac	To develop a screening tool for identifying the risk of developmental stuttering in preschool children	Observational, analytical, and cross-sectional	Stuttering	NA	2-5	Portuguese (Brazil)	Yes
Lima et al. (2021a)	Lilacs	Cefac		Level VI	Stuttering	NA	2-5	Portuguese (Brazil)	Yes
Lima et al (2021b)	Lilacs	Cefac			Stuttering	30	2-5	Portuguese (Brazil)	Yes
			To check the sensitivity and accuracy measures of the IRGD	Observational, analytical, and cross-sectional
				Level VI
Pinto et al. (2021)	Lilacs	Audiology Communications Research	To test the variable of familial heredity for GCD as a predictor of direct effect on speech fluency outcome in children		Stuttering	200	2-12	Portuguese (Brazil)	Yes
				Case-control study
				Level IV
Walsh et al. (2021)	Scopus	Journal of Speech, Language and Hearing Research	To investigate how epidemiological and clinical factors collectively predict whether a preschool-aged child who stutters will persist or recover, and to provide guidance on how clinicians can use these factors to assess a child's risk of stuttering and its persistence	Cohort	Stuttering	52	3-5	English (USA)	Yes
Walsh et al. (2021)	Scopus	Journal of Speech, Language and Hearing Research		Level IV	Stuttering	52	3-5	English (USA)	Yes
Ávila et al (2022)	Lilacs	CoDAS	To design a clinical treatment trial – in three modalities – that verifies whether the tested treatments present indicators that allow gathering information for the continuation of their application, establishing an effective and safe benefit-risk ratio.	Non-randomized clinical trial	Stuttering	93	2-12	Portuguese (Brazil)	Yes
Ávila et al (2022)	Lilacs	CoDAS		Level III	Stuttering	93	2-12	Portuguese (Brazil)	Yes
Costa et al. (2022)	Scopus	Int. J. Environ. Res. Public Health	To correlate the speech fluency characteristics of children whose parents reported stuttering behaviors with risk factors for persistent stuttering	Observational and prospective	Stuttering	417	2-11	Portuguese (Brazil)	No
Costa et al. (2022)	Scopus	Int. J. Environ. Res. Public Health		Level VI	Stuttering	417	2-11	Portuguese (Brazil)	No
Singer et al (2022)	Scopus	Journal of Speech, Language, and Hearing Research	To assess whether the presence of an increasing number of predictive factors increases a child's risk of developing persistent stuttering	Documentary and retrospective	Stuttering	67	3-5	English	Yes
Singer et al (2022)	Scopus	Journal of Speech, Language, and Hearing Research		Level VI	Stuttering	67	3-5	(USA)	Yes
			To address all the steps a speech-language pathologist should follow, according to the revised Diretrizes de Gagueira (Stuttering Guidelines) (NVLF, 2020), with a young child who stutters, focusing on the assessment of risk factors and the implementation of monitoring

Tonnis, Ormondt (2022)	Scopus	Stem-Spraak-		Narrative and descriptive	Stuttering	NA	< 6	Dutch	No
		En taalpathologie		Level VII
								(Netherlands)
Costa et al. (2023)	PubMed/Medline	CoDAS	To investigate two independent variables considered as possible predictors of cumulative risk for persistent stuttering: family perception of stuttering and the number of speech disruptions	Observational, cross-sectional, and retrospective study	Stuttering	452	3-11	Portuguese (Brazil)	Yes
Costa et al. (2023)	PubMed/Medline	CoDAS		Level VI	Stuttering	452	3-11	Portuguese (Brazil)	Yes
Franken et al. (2024)	Science Direct	Journal of Fluency Disorders	To update and expand the Erasmus clinical model, incorporating recent evidence to explain the onset, development, and possible outcomes of stuttering in children	Theoretical narrative study proposing a clinical model	Stuttering	NA	Preschool	English	No
Franken et al. (2024)	Science Direct	Journal of Fluency Disorders		Level VI	Stuttering	NA	Preschool	(Netherlands)	No
Sakai et al (2025)	Scopus	Folia Phoniatrica et Logopaedica	To investigate the prevalence, cumulative incidence, and risk factors of stuttering in early childhood in Japan	Observational, cross-sectional, and epidemiological	Stuttering	2.055	3
				Level VI				English
								(Japan)	Yes

Authors (Year)	RQ1		RQ2	RQ3	RQ4
Authors (Year)	Risk factors identified	Most predictive risk factors (outcomes)	Evaluation methods	Limitations	Suggestions
	16			Limitations to the instrument development process itself, as it is in the initial phase of the overall validation process. Evidence of content validity is essential, but not sufficient.	The continuation of psychometric analyses through the use of new accuracy measures
Lima et al. (2021a)	(RF 1, RF 2, RF 3, RF 4, RF 7, RF 8, RF 10, RF 11, RF 12, RF 13, RF 14, RF 15, RF 19, RF 20, RF 21, RF 22)	NSA	IRGD

Lima et al. (2021b)	16	4		The reduced sample size was due to the short data collection period attributed to the global health crisis, and there was no "gold standard" assessment in the field for diagnosing children in the at-risk group	(1) increasing the sample size; (2) comparing at-risk children with clinical diagnosis; (3) applying the instrument by more professionals in order to obtain other psychometric validation analyses; (4) comparing the application in digital format.
Lima et al. (2021b)	(RF 1, RF 2, RF 3, RF 4, RF 7, RF 8, RF 10, RF 11, RF 12, RF 13, RF 14, RF 15, RF 19, RF 20, RF 21, RF 22)	(RF 8, RF 10, RF 12, RF 14)	IRGD
	17	3
Pinto et al. (2021)	(RF 1, RF 3, RF 4, RF 7, RF 8, RF 9, RF 10, RF 11, RF 12, RF 13, RF 14, RF 15, RF 16, RF 17, RF 18, RF 23, RF 24)	(RF 2, RF 5, RF 10)	PRGD	It doesn't mention	It doesn't mention

Walsh et al. (2021)

	6	3	Observational methods;	(1) Include a larger sample of children with stuttering at different ages and incorporate additional risk measures	(1) Create an online calculator in which physicians can enter the child's age, relevant epidemiological factors, and other scores collected during an assessment to determine the collective risk of persistent stuttering in each child
	(RF 1, RF 2, RF 3, RF 5, RF 6, RF 9)	(RF 1, RF 2, RF 9)
			Complementary methods: Speech/language assessment
Ávila et al. (2022)				(2) Effect of sample size (non-homogeneous groups regarding the number of participants); absence of randomization; control only of the variable % of stuttered syllables, without evaluating other changes related to stuttering (seasonal variability, speech outside the clinic, interactive skills, emotional and environmental profile, among others); (4) It did not contemplate long-term follow-up of children, preventing the analysis of permanent outcome of the clinical picture.

	19	NA	PRGD		It doesn't mention
	(RF 1, RF 2, RF 3, RF 4, RF 5, RF 6, RF 7, RF 8, RF 9, RF 11, RF 12, RF 13, RF 14, RF 15, RF 16, RF 17, RF 18, RF 23, RF 24)		Observational methods;

			Complementary methods: SSI-3
	7	4	Self-report methods;	(1) Children without stuttering behaviors (NCSC) did not have a family history of stuttering. Perhaps for this reason the study did not identify the variable "family history" as a predictor for stuttering;	Authors suggest including different age ranges in order to analyze the risk factor for late onset of stuttering behaviors.
Costa et al. (2022)	(RF 1, RF 3, RF 4, RF 5, RF 6, RF 7, RF 8)	(RF 3, RF 7, RF 8, RF 10)		(2) Most of the children in this study were younger (the average age was 6.5 years in both groups). Perhaps for this reason it was not possible to verify whether the risk factors "complaint of stuttering for more than 12 months" and "complaint of stuttering before the age of 5" would be predictors for stuttering;
			Observation methods;	(3) The results of this study were derived from a single institution;
				(4) The speech analysis was based exclusively on the first 200 fluent syllables and did not use other speech samples, such as oral reading, naming of isolated words, and longer speech samples.
Singer et al. (2022)					(1) Include data on the child's temperament and reaction to stuttering to explore the negative consequences related to stuttering (beyond persistence) more comprehensively;
			Self-report based methods;	(1) Data availability; it did not include the temperament/emotion domain;	(2) Include weighted DTGs;
	10	5			(3) Include performance on a pseudoword repetition task;
	(RF 1, RF 2, RF 3, RF 5, RF 6, RF 9, RF 16, RF 18, RF 25)	(RF 3, RF 5, RF 9, RF 16, RF 25)	Observational methods;	(2) The measures used were not identical in all cases.	(4) Include the child's self-report of whether or not they are still stuttering;

			Complementary methods: TOCS, SSI-3
Tonnis and Ormondt (2022)	9	4	NSA	It doesn't mention	It doesn't mention
Tonnis and Ormondt (2022)	(RF 1, RF 3, RF 4, RF 5, RF 6, RF 9, RF 16, RF 17, RF 26)	(RF 1, RF 3, RF 5, RF 6).	NSA	It doesn't mention	It doesn't mention
				(1) Analysis of the participants' family history;
				(2) Differences in the percentages and profiles of breakups in groups of boys and girls;
Costa et al. (2023)	2	2	Self-report based methods;	3) Time of onset of symptoms and considerations about family attitudes.	It mentions that the limitations will be addressed in future studies
	(RF 2, RF 10)	(RF 2, RF 10)
			Observation methods.

Franken et al.	5	NA	NA	(1) The model is based on theoretical synthesis and narrative literature review, therefore it has no direct empirical validation.	Empirical validation of the model and improvement of the severity and impact scales for stuttering
-2024	(RF 1, RF 4, RF 8, RF 9, RF 27)			(2) It depends on the integration of multiple risk factors (genetic, neurological, linguistic, emotional, social), but the causal relationship between these factors is not yet fully proven;
				(3) The model is more useful as a clinical and communication tool with families and patients than as high-level scientific evidence.
			Self-report methods;	(1) Overestimation of incidence and prevalence	It doesn't mention
Sakai et al. (2025)	7	3	Observation methods;	(2) Reduction of estimated incidence and prevalence due to some parents' avoidance of confirming their children's stuttering because of the strong social stigma associated with the questionnaire
	(RF 1, RF 2, RF 5, RF 6, RF 7, RF 10, RF 17)	(RF 1, RF 10, RF 17)		(3) Based on parental reports, without direct clinical confirmation
				(4) Possibility of recall bias in parents' responses
				(5) As children over four years old are not included in the sample of this research, it is not possible to capture all cases of early-onset stuttering in childhood.

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[1] Source: Prepared by the authors, 2025