The Association Between Stuttering Burden and Psychosocial Aspects of Life in Adults
Publication: Journal of Speech, Language, and Hearing Research
Volume 67, Number 5
Pages 1385-1399
Abstract
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:
Get full access to this article
View all available purchase options and get full access to this article.
References
Ajdacic-Gross, V., Bechtiger, L., Rodgers, S., Müller, M., Kawohl, W., von Känel, R., Mutsch, M., Rössler, W., Seifritz, E., Castelao, E., Strippoli, M. P. F., Vandeleur, C., Preisig, M., & Howell, P. (2018). Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys. PLOS ONE, 13(8), Article e0198450.
Alm, P. A. (2014). Stuttering in relation to anxiety, temperament, and personality: Review and analysis with focus on causality. Journal of Fluency Disorders, 40, 5–21.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Bernard, R., Hofslundsengen, H., & Norbury, C. F. (2022). Anxiety and depression symptoms in children and adolescents who stutter: A systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research, 65(2), 624–644.
Bleek, B., Reuter, M., Yaruss, J. S., Cook, S., Faber, J., & Montag, C. (2012). Relationships between personality characteristics of people who stutter and the impact of stuttering on everyday life. Journal of Fluency Disorders, 37(4), 325–333.
Blumgart, E., Tran, Y., & Craig, A. (2010). Social anxiety disorder in adults who stutter. Depression and Anxiety, 27(7), 687–692.
Boyce, J. O., Jackson, V. E., van Reyk, O., Parker, R., Vogel, A. P., Eising, E., Horton, S. E., Gillespie, N. A., Scheffer, I. E., Amor, D. J., Hildebrand, M. S., Fisher, S. E., Martin, N. G., Reilly, S., Bahlo, M., & Morgan, A. T. (2022). Self-reported impact of developmental stuttering across the lifespan. Developmental Medicine & Child Neurology, 64(10), 1297–1306.
Boyle, M. P. (2017). Personal perceptions and perceived public opinion about stuttering in the United States: Implications for anti-stigma campaigns. American Journal of Speech-Language Pathology, 26(3), 921–938.
Brocklehurst, P. H., Drake, E., & Corley, M. (2015). Perfectionism and stuttering: Findings of an online survey. Journal of Fluency Disorders, 44, 46–62.
Brutten, G., & Shoemaker, D. (1971). A two factor learning theory of stuttering. In L. E. Travis (Ed.), Handbook of speech pathology and audiology (pp. 1035–1072). Appleton-Century-Crofts.
Brutten, G. J., & Vanryckeghem, M. (2003). Behavior Assessment Battery: A multi-dimensional and evidence-based approach to diagnostic and therapeutic decision making for adults who stutter. Stichting Integratie Gehandicapten & Acco Publishers.
Chu, S. Y., Sakai, N., Lee, J., Harrison, E., Tang, K. P., & Mori, K. (2020). Comparison of social anxiety between Japanese adults who stutter and non-stuttering controls. Journal of Fluency Disorders, 65, Article 105767.
Clatworthy, J., Buick, D., Hankins, M., Weinman, J., & Horne, R. (2005). The use and reporting of cluster analysis in health psychology: A review. British Journal of Health Psychology, 10(3), 329–358.
Connery, A., Galvin, R., & McCurtin, A. (2021). International expert perspectives on the principles and components of effective intervention for adults who stutter. International Journal of Language & Communication Disorders, 56(1), 36–50.
Connery, A., McCurtin, A., & Robinson, K. (2020). The lived experience of stuttering: A synthesis of qualitative studies with implications for rehabilitation. Disability Rehabilitation, 42(16), 2232–2242.
Constantino, C., Campbell, P., & Simpson, S. (2022). Stuttering and the social model. Journal of Communication Disorders, 96, Article 106200.
Craig, A., & Tran, Y. (2006). Fear of speaking: Chronic anxiety and stammering. Advances in Psychiatric Treatment, 12(1), 63–68.
Craig, A., & Tran, Y. (2009). The epidemiology of stuttering: The need for reliable estimates of prevalence and anxiety levels over the lifespan. International Journal of Speech-Language Pathology, 7(1), 41–46.
Craig, A. R., & Hancock, K. (2014). Self-reported factors related to relapse following treatment for stuttering. Australian Journal of Human Communication Disorders, 23(1), 48–60.
de Beurs, E., Van Dyck, R., Marquenie, L. A., Lange, A., & Blonk, R. W. B. (2001). De DASS: Een vragenlijst voor het meten van depressie, angst en stress [The DASS: A questionnaire for the measurement of depression, anxiety, and stress]. Gedragstherapie, 34(1), 35–53. https://psycnet.apa.org/record/2001-14822-001
Douglass, E., & Quarrington, B. (1952). The differentiation of interiorized and exteriorized secondary stuttering. Journal of Speech and Hearing Disorders, 17(4), 377–385.
Ezrati-Vinacour, R., & Levin, I. (2004). The relationship between anxiety and stuttering: A multidimensional approach. Journal of Fluency Disorders, 29(2), 135–148.
Franken, M., Boyes, L., & Peters, H. F. M. (1997). Evaluation of Dutch precision fluency-shaping program. International Fluency Association, Second World Congress on Fluency Disorders, 22(2), 149–307.
Gerlach-Houck, H., Kubart, K., & Cage, E. (2023). Concealing stuttering at school: “When you can't fix It … the only alternative is to hide it.” Language, Speech, and Hearing Services in Schools, 54(1), 96–113.
Gunn, A., Menzies, R. G., O'Brian, S., Onslow, M., Packman, A., Lowe, R., Iverach, L., Heard, R., & Block, S. (2014). Axis I anxiety and mental health disorders among stuttering adolescents. Journal of Fluency Disorders, 40, 58–68.
Guntupalli, V. K., Kalinowski, J., & Saltuklaroglu, T. (2006). The need for self-report data in the assessment of stuttering therapy efficacy: Repetitions and prolongations of speech. The stuttering syndrome. International Journal of Language & Communication Disorders, 41(1), 1–18.
Horton, S., Jackson, V., Boyce, J., Franken, M. C., Siemers, S., John, M. S., Hearps, S., van Reyk, O., Braden, R., Parker, R., Vogel, A. P., Eising, E., Amor, D. J., Irvine, J., Fisher, S. E., Martin, N. G., Reilly, S., Bahlo, M., Scheffer, I., & Morgan, A. (2023). Self-reported stuttering severity is accurate: Informing methods for large-scale data collection in stuttering. Journal of Speech, Language, and Hearing Research, Advance online publication.
Iverach, L., Jones, M., Lowe, R., O'Brian, S., Menzies, R. G., Packman, A., & Onslow, M. (2018). Comparison of adults who stutter with and without social anxiety disorder. Journal of Fluency Disorders, 56, 55–68.
Iverach, L., Jones, M., Lowe, R., O'Brian, S., Menzies, R. G., Packman, A., & Onslow, M. (2019). Characteristics of adults who stutter by treatments sought. Logopedics, Phoniatrics, Vocology, 44(3), 134–142.
Iverach, L., Jones, M., O'Brian, S., Block, S., Lincoln, M., Harrison, E., Hewat, S., Cream, A., Menzies, R. G., Packman, A., & Onslow, M. (2009). The relationship between mental health disorders and treatment outcomes among adults who stutter. Journal of Fluency Disorders, 34(1), 29–43.
Iverach, L., O'Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., Hewat, S., Menzies, R. G., Packman, A., & Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 23(7), 928–934.
Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69–82.
Kefalianos, E., Onslow, M., Ukoumunne, O. C., Block, S., & Reilly, S. (2014). Stuttering, temperament, and anxiety: Data from a community cohort ages 2–4 years. Journal of Speech, Language, and Hearing Research, 57(4), 1314–1322.
Kefalianos, E., Onslow, M., Ukoumunne, O. C., Block, S., & Reilly, S. (2017). Temperament and early stuttering development: Cross-sectional findings from a community cohort. Journal of Speech, Language, and Hearing Research, 60(4), 772–784.
Koedoot, C., Bouwmans, C., Franken, M. C., & Stolk, E. (2011). Quality of life in adults who stutter. Journal of Communication Disorders, 44(4), 429–443.
Koedoot, C., Versteegh, M., & Yaruss, J. S. (2011). Psychometric evaluation of the Dutch translation of the Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A-D). Journal of Fluency Disorders, 36(3), 222–230.
Koenraads, S. P. C., Jansen, P. W., de Jong, R. J. B., van der Schroeff, M. P., & Franken, M. C. (2021). Bidirectional associations of childhood stuttering with behavior and temperament. Journal of Speech, Language, and Hearing Research, 64(12), 4563–4579.
Kraaimaat, F. W., Vanryckeghem, M., & Van Dam-Baggen, R. (2002). Stuttering and social anxiety. Journal of Fluency Disorders, 27(4), 319–331.
Langevin, M., Huinck, W. J., Kully, D., Peters, H. F. M., Lomheim, H., & Tellers, M. (2006). A cross-cultural, long-term outcome evaluation of the ISTAR Comprehensive Stuttering Program across Dutch and Canadian adults who stutter. Journal of Fluency Disorders, 31(4), 229–256.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation of Australia.
Lowe, R., Menzies, R., Onslow, M., Packman, A., & O'Brian, S. (2021). Speech and anxiety management with persistent stuttering: current status and essential research. Journal of Speech, Language, and Hearing Research, 64(1), 59–74.
Messenger, M., Onslow, M., Packman, A., & Menzies, R. (2004). Social anxiety in stuttering: Measuring negative social expectancies. Journal of Fluency Disorders, 29(3), 201–212.
Miller, S., & Watson, B. C. (1992). The relationship between communication attitude, anxiety, and depression in stutterers and nonstutterers. Journal of Speech and Hearing Research, 35(4), 789–798.
Naz, H., & Kausar, R. (2022). Stuttering related and psychosocial predictors of impact of stuttering. The Journal of the Pakistan Medical Association, 72(9), 1704–1707.
Ntourou, K., Conture, E. G., & Walden, T. A. (2013). Emotional reactivity and regulation in preschool-age children who stutter. Journal of Fluency Disorders, 38(3), 260–274.
O'Brian, S., Jones, M., Packman, A., Onslow, M., Menzies, R., Lowe, R., Cream, A., Hearne, A., Hewat, S., Harrison, E., Block, S., & Briem, A. (2022). The complexity of stuttering behavior in adults and adolescents: Relationship to age, severity, mental health, impact of stuttering, and behavioral treatment outcome. Journal of Speech, Language, and Hearing Research, 65(7), 2446–2458.
Reilly, S., Onslow, M., Packman, A., Cini, E., Conway, L., Ukoumunne, O. C., Bavin, E. L., Prior, M., Eadie, P., Block, S., & Wake, M. (2013). Natural history of stuttering to 4 years of age: A prospective community-based study. Pediatrics, 132(3), 460–467.
Reilly, S., Onslow, M., Packman, A., Wake, M. Bavin, E. L., Prior, M., Eadie, P., Cini, E., Bolzonello, C., & Ukoumunne, O. C. (2009). Predicting stuttering onset by the age of 3 years: A prospective, community cohort study. Pediatrics, 123(1). 270–277.
Riley, G. D. (2009). Stuttering Severity Instrument–Fourth Edition (SSI-4). Pro-Ed.
Singer, C. M., Hessling, A., Kelly, E. M., Singer, L., & Jones, R. M. (2020). Clinical characteristics associated with stuttering persistence: A meta-analysis. Journal of Speech, Language, and Hearing Research, 63(9), 2995–3018.
Sisskin, V., & Goldstein, B. (2022). Avoidance reduction therapy for school-age children who stutter. Seminars in Speech and Language, 43(02), 147–160.
Sizer, E., & Sizer, B. (2023). The effect of stuttering on symptoms of depression and social anxiety in adolescents. European Review for Medical and Pharmacological Sciences, 27(8), 3288–3293.
Smith, K. A., Iverach, L., O'Brian, S., Kefalianos, E., & Reilly, S. (2014). Anxiety of children and adolescents who stutter: A review. Journal of Fluency Disorders, 40, 22–34.
Sønsterud, H., Howells, K., & Ward, D. (2022). Covert and overt stuttering: Concepts and comparative findings. Journal of Communication Disorders, 99, Article 106246.
Teesson, K., Packman, A., & Onslow, M. (2003). The Lidcombe Behavioral Data Language of Stuttering. Journal of Speech, Language, and Hearing Research, 46(4), 1009–1015.
Tichenor, S., & Yaruss, J. S. (2020). Repetitive negative thinking, temperament, and adverse impact in adults who stutter. American Journal of Speech-Language Pathology, 29(1), 201–215.
Tichenor, S. E., & Yaruss, J. S. (2019a). Group experiences and individual differences in stuttering. Journal of Speech, Language, and Hearing Research, 62(12), 4335–4350.
Tichenor, S. E., & Yaruss, J. S. (2019b). Stuttering as defined by adults who stutter. Journal of Speech, Language, and Hearing Research, 62(12), 4356–4369.
Tichenor, S. E., & Yaruss, J. S. (2021). Variability of stuttering: Behavior and impact. American Journal of Speech-Language Pathology, 30(1), 75–88.
Vanryckeghem, M., Matthews, M., & Xu, P. (2017). Speech Situation Checklist–Revised: Investigation with adults who do not stutter and treatment-seeking adults who stutter. American Journal of Speech-Language Pathology, 26(4), 1129–1140.
Williams, A. L., McLeod, S., & McCauley, R. J. (2010). Interventions for speech sound disorders in children. Brookes.
Yairi, E. (2007). Subtyping stuttering I: A review. Journal of Fluency Disorders, 32(3), 165–196.
Yairi, E., & Ambrose, N. (2013). Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders, 38(2), 66–87.
Yairi, E., & Seery, C. H. (2015). Stuttering: Foundations and clinical applications (2nd ed.). Pearson.
Yaruss, J. S., & Quesal, R. W. (2006). Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Fluency Disorders, 31(2), 90–115.
Information & Authors
Information
Published In
Journal of Speech, Language, and Hearing Research
Volume 67 • Number 5 • 7 May 2024
Pages: 1385-1399
PubMed: 38625147
Copyright
Copyright © 2024 American Speech-Language-Hearing Association.
History
- Received: Sep 13, 2023
- Revised: Dec 18, 2023
- Accepted: Feb 13, 2024
- Published online: Apr 16, 2024
- Published in issue: May 7, 2024
Authors
Metrics & Citations
Metrics
Article Metrics
View all metricsCitations
Download article citation data for:
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
View Options
Sign In Options
ASHA member? If so, log in with your ASHA website credentials for full access.
Member Login