Stuttering and the social model

Assessing Childhood Stuttering Recovery: Incorporating Self-Identification and Caregiver/Clinician Reports Through Adolescence

PURPOSE

Investigating stuttering recovery rates can be challenging, as recovery status can change based on self-report, later recovery, or relapse. In this study, we contacted previous child participants from our longitudinal studies (now older children to young adults) who were originally assigned persistence/recovery status guided by clinician and caregiver reports only. Their stuttering status as adolescents and young adults was re-evaluated based on currently assessed clinician and caregiver reports, observable stuttering severity assessments, and self-reports.

METHOD

Seventy-nine participants were contacted based on their current age and time since their last longitudinal study visit (> 2 years). Of these, 23 participated in this follow-up investigation. Participants and caregivers completed follow-up questionnaires, and participants' speech samples were recorded for offline stuttering disfluency ratings by a speech-language pathologist.

RESULTS

When considering participant and caregiver reports as well as clinician report based on stuttering severity ratings, recovery status changed for nine of the 23 participants (39.13%). All nine self-identified as recovered, although four of the nine were judged to exhibit very mild stuttering. Five of the nine were viewed to be late recovery cases, occurring after the conclusion of the prior longitudinal study. The presence of stuttering behaviors was often reported consistently across clinician and participant/caregiver reports (the basis for "persistence" judgments by the clinician), but in eight cases (34.78%), participants did not self-identify as stutterers despite reported presence of stuttering.

CONCLUSIONS

Our results highlight the importance of assessing stuttering beyond early childhood to examine recovery rates. Furthermore, self-reports on stuttering status reveal that the concept of recovery is nuanced: The presence of overt stuttering does not necessarily correlate with self-identification of stuttering. These findings have implications on how best to define stuttering persistence and recovery for future research and clinical practice.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28654565.

A discussion of topics related to teaching a graduate stuttering course

PURPOSE

To discuss instruction of graduate stuttering courses with a particular focus on contemporary issues such as the pseudostuttering, counting stuttering, and engaging with materials within the classroom and in clinical practice.

METHODS

At a panel discussion at the World Stuttering and Cluttering Organization Congress in May 2024, attendees submitted their questions to a panel of experts in stuttering pedagogy. To document and continue the discussion, each expert responded in turn to the most frequently asked questions.

RESULTS

While the included experts frame key learning activities differently within their respective courses, each takes care to center lived experiences of people who stutter and contextualize learning activities within their clinical purposes.

CONCLUSIONS

The pedagogical insights shared in this discussion offer guidance to instructors of stuttering courses to equip students with tools to assess, treat, and counsel their clients who stutter from a humanistic approach.

CARE Model of Treatment for stuttering: Theory, assumptions, and preliminary findings

The purpose of this article is to present a theory of therapy for stuttering, its related assumptions, and findings from associated empirical studies. Specifically, we propose the Blank Center CARE™ Model of Treatment (CT) for stuttering, which differs from the current, widely employed fluency model of treatment (FT). The CT reflects the authors' belief in the need to move away from fluency-focused or seemingly ableist treatments (i.e., any approach that attempts to correct, cure, or fix a disabling condition) for stuttering. The authors propose a shift toward a theory of treatment that addresses whole-person wellness and considers the treatment of stuttering from outside the framework of fluency shaping and stuttering modification. In support of such considerations, this article provides preliminary findings from both non-clinical and clinical studies of using the CT for children and adults. Although preliminary, these findings appear to lend empirical support to the authors' belief that the treatment of stuttering needs to change. In essence, a change in the zeitgeist regarding the treatment of stuttering may contribute to an associated paradigm shift from FT to CT in the management of stuttering in children and adults.

The Association Between Stuttering Burden and Psychosocial Aspects of Life in Adults

PURPOSE

Stuttering is a speech condition that can have a major impact on a person's quality of life. This descriptive study aimed to identify subgroups of people who stutter (PWS) based on stuttering burden and to investigate differences between these subgroups on psychosocial aspects of life.

METHOD

The study included 618 adult participants who stutter. They completed a detailed survey examining stuttering symptomatology, impact of stuttering on anxiety, education and employment, experience of stuttering, and levels of depression, anxiety, and stress. A two-step cluster analytic procedure was performed to identify subgroups of PWS, based on self-report of stuttering frequency, severity, affect, and anxiety, four measures that together inform about stuttering burden.

RESULTS

We identified a high- (n = 230) and a low-burden subgroup (n = 372). The high-burden subgroup reported a significantly higher impact of stuttering on education and employment, and higher levels of general depression, anxiety, stress, and overall impact of stuttering. These participants also reported that they trialed more different stuttering therapies than those with lower burden.

CONCLUSIONS

Our results emphasize the need to be attentive to the diverse experiences and needs of PWS, rather than treating them as a homogeneous group. Our findings also stress the importance of personalized therapeutic strategies for individuals with stuttering, considering all aspects that could influence their stuttering burden. People with high-burden stuttering might, for example, have a higher need for psychological therapy to reduce stuttering-related anxiety. People with less emotional reactions but severe speech distortions may also have a moderate to high burden, but they may have a higher need for speech techniques to communicate with more ease. Future research should give more insights into the therapeutic needs of people highly burdened by their stuttering.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25582980.

Designing a Module on Stuttering and Cluttering: A Guide for Speech-Language Pathology Educators

PURPOSE

Due to the scope of practice of speech-language pathology (SLP) expanding considerably in recent times, there is reduced emphasis on certain communication conditions within the curricula of SLP university programs. Stuttering and cluttering are neglected components of such curricula, despite the complex clinical skill set required to work with these client groups. Evaluation of the content and quality of modules on stuttering and cluttering is warranted to ensure that SLP students are graduating with adequate competence and confidence for supporting people with these conditions. This tutorial, based on a review of the literature, aims to provide guidance to educators who are designing or revising such modules.

METHOD

The All Ireland Society for Higher Education (AISHE) model for module design provides a practical and theoretically underpinned guide to educators in higher education on the design of a new module or the review of an existing one. The model's seven key components are discussed, and their application to a module on stuttering and cluttering is outlined.

RESULTS

The AISHE model provides a systematic and user-friendly approach to module design in SLP university programs. It supports educators who are designing a new module or revising a module currently being taught on stuttering and cluttering.

CONCLUSIONS

Educators are encouraged to familiarize themselves with the seven components of the AISHE model and to use it as a tool to design or revise modules on stuttering and cluttering. This will ensure that SLP students are graduating with increased competence and confidence in working with these client groups.

How Inclusive Practice Increases the Educational Relevance of Individualized Education Programs

PURPOSE

Individuals with Disabilities Education Act guidelines for Individualized Education Programs (IEPs) require that students with disabilities should, to the fullest extent appropriate, receive services that promote academic achievement that are delivered within the general educational environment. In this clinical focus article, we will demonstrate how the inclusive practice service delivery model can assist speech-language pathologists (SLPs) with the development of educationally relevant IEPs.

METHOD

Twelve SLPs who saw at least 30% of their students in a general education context shared their perspectives on inclusive practice. Their responses were transcribed and coded using deductive qualitative analysis. Their insights were combined with relevant literature to demonstrate how inclusive practice promotes educationally relevant IEPs.

RESULTS

We provided practical examples of using curriculum-based assessments and academic standards to gauge students' present levels of academic and functional performance. We next described how engaging with the school community and observing students in the educational environment assists with determining the effects of a student's disability on academic achievement and functional performance. We concluded by describing how an inclusive mindset helps to align services to meet students' needs.

CONCLUSION

An inclusive framework can help create IEPs that promote students' access, engagement, and progress in age or grade-level curriculum, instruction, and environments by highlighting the impact of a disability on academic achievement and functional performance.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24354319.

Contemporary clinical conversations about stuttering: Neurodiversity and ableism

PURPOSE

To discuss issues about neurodiversity and ableism, and how they pertain to clinical management of stuttering, with particular reference to early childhood stuttering.

METHODS

During a webinar this year, the issue emerged of how concepts of neurodiversity and ableism apply to early childhood stuttering during the pre-school years. It became apparent that this topic elicited disparate views and would be of particular interest to students of speech-language pathology. Consequently, the leaders of that webinar continued the conversation by written dialogue for the purpose of placing it on record.

RESULTS

The discussants reached agreement on many points, but there was some diversity of viewpoint about how neurodiversity and ableism should apply to clinical practice with children who have recently begun to stutter.

Self-perceived outcomes of informative and apologetic self-disclosure: A mixed methods study

PURPOSE

Self-disclosure statements that are informative, rather than apologetic, have been demonstrated to improve listener perceptions of adults who stutter (Byrd et al., 2017). The purpose of the present study is to investigate the benefits of self-disclosure from the perspective of the speaker and to determine whether self-disclosure statement type is associated with self-perceived outcomes of use.

METHOD

A total of 156 adults who stutter completed a survey adapted from a previous study investigating affective, behavioral, and cognitive outcomes of voluntary stuttering. Survey responses were analyzed using descriptive and inferential statistics to determine if there was a significant relationship between self-disclosure statement type and self-reported outcomes. Additionally, responses to two open-ended questions relating to timing of self-disclosure and self-disclosure experiences in general were analyzed using reflexive thematic analysis.

RESULTS

Self-disclosure was perceived as beneficial in at least one context by 96.8 % of respondents. Respondents who used an informative self-disclosure statement were more likely to agree that self-disclosure increased confidence and were less likely to report attempting to conceal or avoid stuttering than respondents who used an apologetic self-disclosure statement. Themes relating to additional aspects of self-disclosure experiences included personalized use, social connection, acceptance of stuttering, challenging cognitive distortions, communication is easier, self-empowerment, humor, voluntary stuttering, and vulnerability to prejudice.

CONCLUSION

Similar to studies investigating the influence of self-disclosure on listener perceptions, informative self-disclosure is associated with greater self-perceived benefits than apologetic self-disclosure for adults who stutter.

Ableism to Empowerment: Navigating School Structures When Working With Students Who Stutter

PURPOSE

School-based speech-language pathologists (SLPs) face uniquely complex webs of guidelines and criteria that can undermine their ability to move toward disability-affirming practices. The purpose of this clinical focus article is to present a contrast between ableist and disability-affirming practices in school-based stuttering therapy while highlighting the critical perspectives of students who stutter. Practical examples of disability-affirming stuttering therapy in public school settings are provided.

CONCLUSIONS

This clinical focus article outlines practical guidelines and specific examples of affirming collaboration, eligibility decisions, goal choice, and accommodations for students who stutter. These discussions demonstrate how SLPs can adopt updated assessment therapy planning and institutional practices to affirm students who stutter while informing school cultures and society about the dignity and value of stuttered voices.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21818028.

Communicative Fluency and the Experience of Stuttering: A Viewpoint

PURPOSE

Despite ambiguity in meaning and usage, "fluency" has played a central role in the understanding and treatment of developmental stuttering. The appropriateness of the term fluency in association with so-called fluency disorders, such as stuttering, has recently been questioned. The purpose of this article is to propose that fluency is best conceptualized as the efficiency of goal-directed action through cybernetic function. Spoken utterances are examples of sequences of action for the fulfillment of a hierarchy of nested and increasingly abstract social goals, including behaviors (e.g., introducing oneself) and values (e.g., being a sociable person). In contrast, some moments of speech disfluency, such as stuttering disfluencies, are inefficiencies in goal-directed action that may or may not hinder the fulfillment of higher level communicative behaviors and values, described here as communicative fluency.

CONCLUSIONS

The concept of communicative fluency refers to the continual, reliable, and upward fulfillment of increasingly abstract social goals in the form of communicative actions, behaviors, and values. This expanded conceptualization of fluency beyond simply speech production has the potential to be a useful indicator of psychosocial well-being for individuals who stutter.

The disabling nature of hope in discovering a biological explanation of stuttering

Discovering developmental stuttering's biological explanation has been an enduring concern. Novel advances in genomics and neuroscience are making it possible to isolate and pinpoint genetic and brain differences implicated in stuttering. This is giving rise to a hope that, in the future, dysfluency could be better managed if stuttering's biological basis could be better understood. Concurrent to this, there is another hope rising: a hope of a future where differing fluencies would not be viewed through a reductive lens of biology and associated pathologies. The central aim of this paper is to edge out ethical implications of novel research into stuttering's biological explanation. In doing so, the paper proposes to look beyond the bifurcation sketched by the medical and social model of disability. The paper demonstrates how the scientific hope of discovering stuttering's biological explanation acts as an accessory of disablement due to the language of 'lack' and 'deficit' employed in reporting scientific findings and proposes participatory research with people who stutter as an antidote to manage this disablement.