Implementing Change within School Districts

In nearly every school district nationwide, children and teens diagnosed with stuttering are being pulled out of their classrooms to participate in treatment. One of the treatment’s primary measurements of eligibility, progress, and readiness for discharge is the frequency of a child’s stuttered speech. Not only is using stuttering frequency in this way invalid, but it also has harmful psychosocial consequences.  

When stuttering frequency is used to determine whether a child needs treatment and whether they have made enough progress to be discharged from it, as soon as they enter the school system, they begin to be taught, either implicitly or explicitly, that the way they talk is not okay. Thus, paradoxically, in a genuine attempt to help these young children to integrate into a fluent world, speech-language pathologists and teachers can negatively impact their psychosocial development.  

For example, to avoid the potential embarrassment or discomfort of stuttering, children are frequently provided accommodations wherein they are “protected” from having to contribute to class discussions, give presentations, and/or be asked direct questions. At the infrequent times when they are called on or expected to contribute, they often feel penalized for stuttering when they speak. As this 12-year-old explains, years of trying to speak without stuttering makes children avoid talking as much as possible.  

Fluency conformity’s immediate and long-term effects during the school-age years are not trivial. Adults lament how different their lives would have been if they had been taught as children that it is truly okay to stutter—and had not been given contradictory suggestions like “but, let’s work to try to do it a little less,” as one adult shares here. Failed efforts to practice or “try hard enough” to speak more fluently in the classroom and at home causes children to engage in unhealthy coping strategies, such as social avoidance, rejection of social networks, and reduced social activity, that may exclude them from protective mechanisms known to improve quality of life: peer and familial interaction and support, as is poignantly conveyed by this mother, reflecting on the failed attempts to try to fix her daughter’s stuttering.   

Furthermore, as these young children grow older, they report higher levels of communication apprehension and social anxiety. As highlighted by one 36-year-old, adults suffer markedly increased isolation, lower levels of self-esteem, limited self-efficacy, and overall poorer quality of life, as well as reduced engagement and attainment in academic and vocational environments.  

These negative consequences are not due to the frequency of their stuttering; they are a result of having been forced to try to speak more fluently when they did talk. In fact, people who stutter, even those perceived by listeners to be among the most fluent speakers, describe being limited to using words they can say without stuttering. They develop tricks such as scripting their speech in advance, whispering, using alternate words, substituting sounds, and even changing their names. And the impact these attempts to hide their stuttering have on their quality of life can be debilitating.  

As this individual, age 27, shares, trying to pass as fluent leads to unbearable shame and self-loathing that can prevent one’s full engagement in life. Notably, this is true not only for people whose overall frequency of stuttering is high but also for those whose stuttering is remarkably low—another reason why using reduced stuttering frequency as a target is so misguided. However, as this adult, age 22, expresses, if the focus is shifted to how effectively someone communicates rather than how fluently they speak, people who stutter can begin to view their speech, and themselves, in a more positive light.   

Yet, many speech-language pathologists, teachers, and caregivers are concerned that if a child doesn’t learn how to stutter less, they will feel less confident when communicating. The prevailing assumption is that the best strategies for treating stuttering are the ones that modify stuttering and/or increase fluency. However, targeting behaviors related to communication competence are strategies that have academic and social benefits and result in long-term psychosocial and vocational gains. For example, this 12-year-old articulates that talking about stuttering with others increases self-confidence and decreases concerns about stuttering while speaking. And this 7-year-old reports that teaching others about stuttering is empowering and provides opportunities to make a difference for others, as is further amplified by children worldwide. 

However, it is much harder to feel confident even sharing about stuttering when you are being taught implicitly and/or explicitly that you should try to, at the very least, do it less. Bullies tend to select victims who appear less confident in their social interactions. Shifting away from fluency as a measure of success is particularly crucial to the mental health and well-being of young children; effective communication has been documented as a protective factor against bullying in general. Furthermore, focusing on stuttering frequency as a positive outcome serves to make children feel inferior regarding their communication, as is noted by this individual, age 19, and thereby increases their vulnerability to bullying. Conversely, when a child is taught that stuttering is simply the way they talk and they do not need to try to speak like their fluent peers, as this 8-year-old boldly shares, they learn that if someone treats them differently because they stutter, that is a reflection of that person, not of them.  

Perhaps the most critical point is that the frequency of stuttering is on a continuum: some people stutter more often than others, and there is variability in any given individual’s daily, monthly, and yearly stuttering frequency. Frequency does not correlate with a person’s experience of stuttering: someone who stutters may perceive stuttering as severely impacting their daily life, even if the frequency is low. In contrast, someone else may stutter on nearly every word but consider the impact on their life to be mild. Yet, all too often, the public media perpetuate what this 28-year-old describes as the “hero’s journey” of stuttering, which falsely suggests that they will no longer stutter if they can gain more confidence.   

The concept of the “hero’s journey” directly contradicts data that indicate that if a child is still stuttering at age 7, they will likely continue to stutter for the rest of their life, no matter how confident they are. Nevertheless, as noted by a physician who is the parent of a 3-year-old, many caregivers and children are taught that eliminating stuttering is a prerequisite for effective communication. As this individual, age 23, eloquently shares, fluency is then achieved at the expense of natural, effective communication. Children, teens, and adults consistently report that trying to speak without stuttering compromises their desire to communicate, as it is unnatural, effortful, and incongruent with their identity.  

Instead of using stuttering frequency as a guideline, we can consider the affective and cognitive experiences of stuttering and engage children in activities designed to enhance their communication skills. In making this critical change, we can spend our limited time with children in the school setting, encouraging them, at the earliest possible age, to never let stuttering stop them from being who they were born to be (see this 5-year-old). We can ensure that they are no longer afraid to engage in even the most challenging speaking situations, as shared by this child, age 9. We can inspire them to encourage others to navigate the same path, as is demonstrated by this 10-year-old. 

Finally, as shared by this individual, age 8, who is now age 20, stutters openly, communicates effectively, and is president of a campus-wide stuttering advocacy organization, they just want to be treated like everyone else. Using stuttering frequency as a measurement of meaningful progress indicates that they will have to change how they talk to be viewed and treated like their peers. Thus, even unintended pressure to become fluent can compromise their quality of life for many years.  

I sincerely hope this letter will inspire all who read it to please consider joining our initiative to change the school district guidelines, so that stuttering frequency is no longer used to determine eligibility for, progress in, or readiness for discharge from treatment. With this one simple, yet important change, we can change the conversations about stuttering in the classroom, the clinical environment, the home, and the public arena.  

Teachers can shift their focus to children’s engagement with others, including their peers, rather than how much they are or are not stuttering. Clinicians can strengthen a child’s overall communication skills rather than using the fluency of their speech as an indicator of how effectively they communicate. Caregivers can reinforce children’s positivity about communication, rather than asking them to try harder to be more fluent. Public discourse can accurately reflect what stuttering is, rather than perpetuate the pervasive misperception that if children are less nervous and more confident, they will speak more fluently. 

With this one change, we can make significant steps toward ending the stigmatization of stuttering, which all too often begins in what should be our safest spaces.  

Together, with this one change, we can impact countless lives.  

To join our efforts to advocate for this change, email stuttering@austin.utexas.edu.