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Content may be subject to copyright.
Bozatlı et al. 71
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Case report / Olgu sunumu
Improvement of stuttering with use of methylphenidate in a child
who was diagnosed with concomitant stuttering and ADHD
Leyla BOZATLI,1 Kıvanç Kudret BERBEROĞLU,1 Cansın CEYLAN,1 Işık GÖRKER1
_____________________________________________________________________________________________________
ABSTRACT
Stuttering is a psychological, neurological and neurophysiological rhythmic disorder in an understandable speech
that is characterized by hesitation in speech flow, standstill with repeating a word or a sound, extension of a sound.
Etiology of stuttering is not exactly known. In this case presentation, it is aimed to discuss the disappearance of
stuttering in an 11 year old child who was diagnosed with stuttering and ADHD after treating with methylphenidate
extended release. (Anatolian Journal of Psychiatry 2016; 17(Suppl.3):71-73)
Keywords: stuttering, stuttering treatment, methylphenidate, ADHD
DEHB ile birlikte kekemeliği olan bir çocukta
metilfenidatla kekemeliğin düzelmesi
ÖZ
Kekemelik, konuşma akışında tutukluk, bir sözcük ya da sesi tekrarlayarak duraklama, sesi uzatma, anlamlı bir
konuşmada psikolojik, nörolojik ve fizyolojik bir ritim bozukluğu olarak tanımlanmaktadır. Kekemeliğin etyolojisi
kesin olarak bilinmemektedir. Bu olgu sunumunda 11 yaşındaki vakamıza Kekemelik ve DEHB tanılarının konması
üzerine başlanan uzun etkili metilfenidat sonrasında ortadan kalkan kekemeliğin tartışılması amaçlanmıştır. (Ana-
dolu Psikiyatri Derg 2016; 17(Ek.3):71-73)
Anahtar sözcükler: Kekemelik, kekemelik tedavisi, metilfenidat, DEHB
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INTRODUCTION
Stuttering is a rhythmic disorder in an under-
standable speech that is characterized by hesi-
tation in speech flow, standstill with repeating a
word or a sound, extension of a sound. It occurs
commonly between ages of 2-7 years old.1 Etio-
logy of stuttering is not exactly known. In the etio-
logy; genetical, neurophsyiological and psycho-
logical factors which lead liability to disturbing
the flow of speech are considered.2
A transient instability in basal ganglia can be
seen due to dysfunction of realizing of dopamine
from substantia nigra to nigrostriatal pathway
during emotional states that occur in stressful
events. In this case, there can be stuttering and
other involuntary movement disorders due to
disinhibition. The all states that trigger stuttering
reinforce and increase stuttering; this condition
is called as feed-forward state.3,4
There have been several studies that demon-
strated hyperdopaminergic states caused stut-
tering. However, the roles of D1-D2 receptors in
the development of stuttering are still unclear.
Beside beneficial effects of methylphenidate in
stuttering, in some cases it worsens the stut-
tering. It has been demonstrated that methyl-
phenidate stimulated D1 receptors and reduced
the D2 receptors in prefrontal cortex by indirect
stimulation.4
In this case presentation, it is aimed to discuss
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1 Department of Child and Adolescent Psychiatry, Trakya University Faculty of Medicine, Edirne
Correspondence address / Yazışma adresi:
Uzm. Dr., Leyla BOZATLI, Department of Child and Adolescent Psychiatry, Trakya University Faculty of Medicine, Edirne, Turkey
E-mail: leylyabozatli@gmail.com
Received: 17.03.2016, Accepted: 11.07.2016, doi: 10.5455/apd.222279
Anadolu Psikiyatri Dergisi 2016; 17(Ek.3):71-73
72 Improvement of stuttering with use of methylphenidate in a child who was diagnosed …
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the disappearance of stuttering in a child who
was diagnosed with stuttering and ADHD after
treating with methylphenidate extended release.
CASE
An 11 year old boy admitted to outpatient clinic
with complaint of hesitation of speech. He had
tonsillectomy and ear tube surgeries when he
was 3 years old, the ear tube was extracted
when he was 4 years old and after this second
surgical intervention, it was reported that hesita-
tion in speech initiated. The family reported that
the hesitation of speech reduced sometimes
however it never disappeared and when he
started to the primary school, the hesitation of
speech worsened. In history, it was reported that
patient was diagnosed with ADHD at the second
and third years of primary school, he was treated
with methylphenidate and imipramine for one
year and he was treated with methylphenidate
extended release after the first year of treatment.
The family reported that patient benefited parti-
ally from treatment and stopped treatment. It was
considered that there have been hesitations in
speech during the clinical examination and it was
noted this hesitation commonly appeared at
initiating of speech and it was also noted that
frequency of hesitations were at the beginnings
of every 2-3 words. After taking information from
family and teacher and clinical examination,
case was diagnosed as ADHD according to DSM
5. At the second assessment, patient was
started on methylphenidate treatment and he
was referred to speech therapist. When patient
came to outpatient control, it was considered that
the hesitations in speech disappeared. The
family reported that hesitations in speech disap-
peared after 2-3 week of methylphenidate ex-
tended release treatment and they did not admit
to speech therapist.
DISCUSSION
There is not a specific drug treatment for stut-
tering according to literature data. Because there
are movement symptoms concomitant with stut-
tering, there are similarities between tic disor-
ders and stuttering, and there is worsening of
stuttering during stressful events, the dopamine
type 2 (D2) receptor antagonists were tried in the
treatment of stuttering. In this aspect, haloperidol
and risperidone were reported to be effective in
the treatment of stuttering in the case of ac-
companying movement disorders. While avoid-
ant behaviors and anxiety are intensive, patients
are reported to be benefited from serotonin re-
uptake inhibitors (SSRIs).2
In our case, it was noted that stuttering ameli-
orated after starting on methylphenidate ex-
tended release for treatment of ADHD. Re-
garding this case, it was found that there have
been studies that investigated the role of D-
amphetamine, non-selective beta blocker oxpre-
nolol, methylphenidate and methylphenidate ex-
tended release in the treatment of stuttering and
there has been also placebo controlled studies
that mentioned this issue in literature.
Ginn and Hohman were the first authors who
were aware of the beneficial effects of ampheta-
mine in stuttering; they also reported 4 cases
with stuttering who were treated with ampheta-
mine for behavior disorder and in 2 cases stut-
tering were improved after treatment.5 In a
double blind placebo controlled study, there was
a significant improvement in D-amphetamine
group compared with placebo group in terms of
stuttering; however there was not any improve-
ment in other speech disorders.6,7 In another
study that compared methylphenidate and pla-
cebo in patients with stuttering, the patients were
assessed in terms of reading and speech; there
have been statistically significant decrease in
hesitation in methylphenidate group compared
with placebo group4
Although D-amphetamine demonstrated signifi-
cant effects in the treatment of stuttering, they
were not used in clinical practice due to their side
effects. Methylphenidate which is an analogous
of D-amphetamine is known to have no side
effects like D-amphetamine, further randomized
controlled studies are needed for providing the
use of methylphenidate in the treatment of stut-
tering.7
There have been another agents that were in-
vestigated in the treatment of stuttering. Olanza-
pine was reported to have superiority to placebo
in terms of ameliorating the stuttering; however
only a few study confirmed this effect due to
possible intolerable side effects of olanzapine8
Pimozide has been reported to have a significant
role in providing the flow of speech. However,
when considering the dopamine antagonists in
the treatment of stuttering, potential side effects
should be mentioned.9 In a randomized study,
risperidone was reported to be effective in the
treatment of developmental stuttering and also
reported to be tolerable.10
SSRIs such as citalopram, escitalopram, tricyclic
antidepressants such as clomipramine and
benzodiazepines such as alprazolam were in-
Anatolian Journal of Psychiatry 2016; 17(Suppl.3):71-73
Bozatlı et al. 73
_____________________________________________________________________________________________________
vestigated in the treatment of stuttering and beneficial effects were reported.11,12 In our literature
research, we considered that the agents that were investigated in the treatment of stuttering are limited
to studies which were not confirmed or case reports. Regarding the amelioration of stuttering with
methylphenidate in our case, it is emphasized that further studies are needed to clarify the place of
methylphenidate extended release in the treatment of stuttering.
Authors’ contributions: L.B.: Konuyu bulma, planlama, literatür, makaleyi yazma; K.K.B.: Konuyu bulma, literatür;
C.C.: Literatür; I.G.: Literatür.
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