Understanding, Recognizing, and Managing Functional Speech Disorders: Current Thinking Illustrated With a Case Series

Purpose: Functional speech disorders (FSDs), a subtype of functional neurological disorders, are distinguishable from neurogenic motor speech disorders based on their clinical features, clinical course, and response to treatment. However, their differential diagnosis and management can be challenging. FSDs are not well understood, but growing evidence suggests a biopsychosocial basis distinct from structural lesions that cause neurogenic motor speech disorders. Method and Results: Following an overview of FSDs, four patients are described to illustrate the range of clinical manifestations, biopsychosocial con-texts, and responses to treatment of FSDs. The path to differential diagnosis is discussed, with particular attention to positive features that led to the FSD diag-nosis. Approaches to education, counseling, and management are discussed. Conclusions: This case series demonstrates that FSDs can present with a vari-ety of manifestations including dysfluencies, articulation errors, dysphonia, rate and prosodic abnormalities, and combinations of disruptions in speech subsys-tems. FSDs may present in the context of known recent or remote physical or psychosocial trauma or, as in many cases, in the absence of an identifiable trig-gering event. FSDs are recognizable by positive clinical features and should not be considered a diagnosis of exclusion. With appropriate identification, counsel-ing, and treatment, FSDs may resolve, sometimes rapidly; in some cases, treatment may be prolonged or ineffective.