also been explored as a management alternative. Support groups further focus on the fact that stuttering is not a physical impediment but a psychological one. Psychological approach Cognitive behavior therapy has been used to treat stuttering. Also sociological approaches has been explored regarding how social groups maintain stuttering through social norms. Diaphragmatic breathing Several treatment initiatives, for example the McGuire programme and the Starfish Project, advocate diaphragmatic breathing (or costal breathing) as a means by which stuttering can be controlled. Prognosis Among preschoolers with stuttering, the prognosis for recovery is good. Based on research, about 65% to 87.5% of preschoolers who stutter recover spontaneously by 7 years of age or within the first 2 years of stuttering, and about 74% recover by their early teens. In particular, girls seem to recover well. For others, early intervention is effective in helping the child overcome disfluency. Once stuttering has become established, and the child has developed secondary behaviors, the prognosis is more guarded, and only 18% of children who stutter after five years recover spontaneously. Stuttering that persists after the age of seven is classified as persistent stuttering, and is associated with a much lower chance of recovery. However, with treatment young children may be left with little evidence of stuttering. For adults who stutter, there is no known cure, though they may make partial recovery or even complete recovery with intervention. People who stutter often learn to stutter less severely, though others may make no progress with therapy. Emotional sequelae associated with stuttering primarily relates to state-dependent anxiety related to the speech disorder itself. However, this is typically isolated to social contexts that require speaking, is not a trait anxiety, and this anxiety does not persist if stuttering remits spontaneously. Research attempting to correlate stuttering with generalized or state anxiety, personality profiles, trauma history, or decreased IQ have failed to find adequate empirical support for any of these claims. Epidemiology The lifetime prevalence, or the proportion of individuals expected to stutter at one time in their lives, is about 5%, and overall males are affected two to five times more often than females. However, there is not much information known about the underlying cause for such a skewed sex ratio. Most stuttering begins in early childhood, and studies suggest that 2.5% of children under the age of 5 stutter. As seen in children who have just begun stuttering, there is an