On Oct. 22, people around the world will celebrate International Stuttering Awareness Day, an annual holiday designed to bring awareness to the disorder and support those who stutter.
Ai Leen Choo, College of Education & Human Development assistant professor and director of the college’s Stuttering and Bilingualism Lab, details her research on stuttering, explains some common misconceptions and discusses the importance of this holiday.
Q: How is stuttering defined? Are there any numbers or statistics about stuttering that can give readers a clearer picture of stuttering and its effects?
A: Stuttering is a neurodevelopmental disorder that manifests as excessive levels of speech disruptions or disfluencies.1 These disfluencies can be part-word repetitions (repeating the first sound in a word), single-syllable word repetitions (repeating words that are one syllable in length), prolongations (holding on to a sound, usually the first sound in a word), and blocks (unable to start or vocalize a sound).2
More than 70 million people worldwide stutter, which is about 1 percent of the population.1 Symptoms of the disorder usually become apparent around age three. A majority of children who stutter recover within 2-3 years of onset; however, some (about 30 percent) stutter into adulthood3. Girls are more likely to recover compared to boys,3 which results in a significant sex imbalance, with around four males to every female.
The effects of stuttering can be profound. Over 80 percent of children who stutter are bullied.4 Children who stutter are also 4-7 times more likely to have anxiety or an anxiety disorder compared to children who do not stutter.5 They are also less likely to finish high school or attend college.6
Q: What are some common misconceptions about stuttering?
A: Some of the misconceptions include:
- Speaking multiple languages causes stuttering. There is no evidence that bilingual or multilingual speakers are more likely to stutter.
- Nervousness or stress causes stuttering. Nervousness or stress may make a person who stutters (or even a person who does not stutter) less fluent, but they do not cause stuttering.
- People who stutter are less intelligent. There is no link between stuttering and intelligence.
- Hearing or imitating the speech of a person who stutters causes stuttering. People absolutely cannot “catch” stuttering. However, there is a familial or genetic component – those with a family with a history of stuttering are more likely to stutter.
- It helps to take a deep breath before talking. Taking a deep breath does not help a person stutter less. Asking a person who stutters to take a deep breath before they talk may make them even more self-conscious about their stuttering.
Q: Can you talk about some of your research on stuttering? What have you learned about stuttering from those research projects/studies?
A: My research looks at various aspects of stuttering, from brain development to the experiences of people who stutter in the workplace. The thread that ties these lines of research together is a commitment to improving quality of life for people who stutter.
The main goal of my pediatric research is to improve stuttering diagnosis and treatment. More accurate diagnosis and more effective treatment could reduce relapse and facilitate recovery. This issue is particularly significant for bilingual children, as most research has centered around monolinguals. This means that guidelines for identifying stuttering and treatment are based on monolinguals. Historically, parents have been advised to speak to their children in only one language to prevent stuttering or increase fluency. My research suggests that speaking multiple languages does not increase the risk for stuttering; however, bilingual speech patterns may increase the risk of a misdiagnosis.7,8
Currently, my collaborators and I are working on improving the guidelines for accurately diagnosing stuttering in bilingual children. Accurate and early diagnosis is crucial, as stuttering alters development across multiple domains. My neuroimaging research points to the enlargement of the corpus callosum with long-term stuttering.9,10 The corpus callosum is the white matter structure that connects the right and left sides of the brain. A larger corpus callosum may result in greater interhemispheric interference, or competition between areas of the brain involved in speech-motor control.
Another striking finding from this line of research is that children who stutter show less coordinated skills across multiple domains – including speech, language, motor and cognition – compared to children who do not stutter.11 Lower coordination may mean fewer resources available for processing speech. Currently, my research is focused on understanding the development of specific cognitive components that support fluent speech, including executive function.12,13 Findings from this study could result in novel and more effective treatment targets in children who stutter.
In the adult population, my research seeks to understand how the stigma surrounding stuttering develops in the workplace.14 What we learn from this study will help organizations better support their employees who stutter. The majority of people who stutter in our study report an overwhelming lack of support from their employers and in some cases, job termination and hostile work environments as a result of their stuttering. These experiences highlight the need for greater awareness of stuttering and protection for people who stutter in the workplace.
Q: How can people support their friends, family members and colleagues who stutter?
A: Stuttering can feel isolating. The patience and empathy that you show a person who stutters can go a long way. Here are some dos and don’ts for supporting a person who stutters:
Do: 1.) Be patient. Wait for the person who stutters to finish what they are saying. 2.) Listen. Let them know that you are there for them and that it’s okay to talk to you about their stuttering if they want to. 3.) Be an ally. Stand up for and with people who stutter. Challenge the negative beliefs about stuttering when you see them. Do your research and learn more about stuttering. 4.) Ask. Do ask the person who stutters how you can support them. People who stutter have different experiences and relationships with their stuttering.
Don’t: 1.) Don’t interrupt or speak over them when they are talking or when they are stuttering. Often, we try to help by finishing what the person is trying to say. However, to the person who stutters this may feel like you are rushing them and comes across as impatience; feeling rushed could make their stuttering worse. 2.) Don’t laugh at, make fun of or imitate their stuttering. This is hurtful and disrespectful. 3.) Don’t try to give advice on how to be more fluent. Telling a person who stutters to take a deep breath or think about what they want to say is not helpful. People who stutter know what they want to say but have a difficult time with the delivery.
Q: Why is International Stuttering Awareness Day so important?
A: An awareness of stuttering is the first step toward making our spaces more inclusive, accommodating and welcoming to people who stutter. There is a pervasive stigma toward people who stutter that is exacerbated by how stuttering is depicted in the media. Stuttering is often caricatured, and used as a prop for humor, to convey mental or social flaws, weakness, deception or nervousness (e.g., Porky Pig, Ken in A Fish called Wanda, Lennie Small in Of Mice and Men, Billy Bibbit in One Flew Over the Cuckoo’s Nest). Unfortunately, the stigma and negative depictions have real-life consequences for those who stutter. Children who stutter experience high rates of victimization in school. Adults who stutter face discrimination in the workplace, and higher rates of unemployment or underemployment compared to those who do not stutter.15
The lack of awareness could also have devastating effects beyond the classroom or workplace. For example, U.S. Customs and Border Patrol at the Atlanta Hartsfield-Jackson Airport detained a woman who stutters because the agent accused her of lying.16 Unfortunately, these experiences are not uncommon for people who stutter.
Q: Anything else you’d like to add?
A: Some famous people who stutter include Emily Blunt, Winston Churchill, Charles Darwin, Samuel L. Jackson, Kendrick Lamar, Ed Sheeran, Alan Turing and Dr. Leana Wen.
Women who stutter are a minority within a minority. Often, women who stutter report not knowing another woman who stutters. Consequently, I started and co-lead a support group for women who stutter. The aim of the group is to empower and provide a safe, welcoming space for all women who stutter. https://westutter.org/event/women-connect-oct22/
References
1 Bloodstein, O., Ratner, N. B. & Brundage, S. B. A handbook on stuttering. (Plural Publishing, 2021).
2 Ambrose, N. G. & Yairi, E. Normative disfluency data for early childhood stuttering. Journal of Speech, Language, and Hearing Research 42, 895-909 (1999).
3 Yairi, E. & Ambrose, N. G. Early Childhood Stuttering I: Persistency and Recovery Rates. Journal of Speech, Language, and Hearing Research 42, 1097-1112 (1999).
4 Hugh-Jones, S. & Smith, P. K. Self‐reports of short‐ and long‐term effects of bullying on children who stammer. British Journal of Educational Psychology 69, 141-158, doi:doi:10.1348/000709999157626 (1999).
5 Iverach, L. et al. Prevalence of anxiety disorders among children who stutter. Journal of Fluency Disorders 49, 13-28 (2016).
6 Rees, D. I. & Sabia, J. J. The kid's speech: The effect of stuttering on human capital acquisition. Economics of Education Review 38, 76-88 (2014).
7 Choo, A. L. & Smith, S. A. Bilingual children who stutter: Convergence, gaps and directions for research. Journal of Fluency Disorders 63, 105741 (2020).
8 Smith, S. A., Choo, A. L. & Seitz, S. R. Disfluencies in English Speech Produced by Spanish-English Bilinguals. Folia Phoniatrica et Logopaedica 74, 122-130 (2022).
9 Choo, A. L. et al. Corpus callosum differences associated with persistent stuttering in adults. Journal of Communication Disorders 44, 470-477 (2011).
10 Choo, A. L., Chang, S.-E., Zengin-Bolatkale, H., Ambrose, N. G. & Loucks, T. M. Corpus callosum morphology in children who stutter. Journal of communication disorders 45, 279-289 (2012).
11 Choo, A. L., Burnham, E., Hicks, K. & Chang, S. E. (2016). Dissociations among linguistic, cognitive, and auditory-motor neuroanatomical domains in children who stutter. Journal of Communication Disorders 61, 29-47 (2016).
12 Choo, A. L., Smith, S. A. & Li, H. Associations between stuttering, comorbid conditions and executive function in children: a population-based study. BMC Psychology 8, 113, doi:10.1186/s40359-020-00481-7 (2020).
13 Choo, A. L., Smith, S. & Li, H. Prevalence, severity and risk factors for speech disorders in US children: the National Survey of Children’s Health. Journal of Monolingual and Bilingual Speech 4, 109-126, doi:doi.org/10.1558/jmbs.20879 (2022).
14 Seitz, S. R. & Choo, A. L. Stuttering: Stigma and perspectives of (dis)ability in organizational communication. Human Resource Management Review 32, 100875, doi:https://doi.org/10.1016/j.hrmr.2021.100875 (2022).
15 Gerlach, H., Totty, E., Subramanian, A. & Zebrowski, P. Stuttering and Labor Market Outcomes in the United States. Journal of Speech, Language, and Hearing Research 61, 1649-1663 (2018).
16 Simmons, K. in HuffPost (2016).