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Stuttering and Neurodiversity

Published in the February 2024 issue of the ISHA Voice.

By Eileen Brann

Eileen is a member of the Evidence-based Practice Committee.

Background: Recently, several colleagues had a conversation about what were the current issues in the field of stuttering. The topic of neurodiversity came up, which led me to think about some of the topics that my current graduate students in my Fluency Disorders course have presented on. The following information is a compilation of their work.

Neurodiversity, a term typically heard in the context of working with individuals with autism, can also be applicable to those who stutter (Shenker, Rodgers, Guitar & Onslow, 2023). Neurodiversity suggests that neurological differences, such as those associated with stuttering, are differences in ways of speaking, rather than disorders that need to be fixed (Siskin, 2022).

How can clinicians apply the term neurodiversity to the field of stuttering?

The Medical Model

There's a current debate that stuttering has been framed as a medical model with MRIs, genetic studies, and intervention goals designed to normalize stuttering and make people who stutter fluent speakers (Siskin, 2022). Neurodiversity, an alternative to the medical model, can be applied to stuttering in this way: neurodiversity is the interaction between the person who stutters and their environment. The environment can be reshaped to reduce the stigma or by changing the PWS. In this model, fluency should not be the goal, rather diverse speakers should be accepted for who they are, namely people who stutter (Siskin. 2022).

Measurement of Stuttering

In assessing stuttering, some of the questionnaires that clinicians have PWS complete may focus on a deficit-based approach (McCashen, 2010). In contrast, a strength-based approach is client-led with a client setting their own goals, identifying their strengths, and linking to environmental resources (Sisken, 2022). In addition, many IEP goals may be unattainable and set unrealistic expectations of fluency for PWS. Sisken (2022) proposes that assessment practices should be stuttering-affirming, which could ultimately help PWS develop a higher quality of life.

Shenker, Rogers, Guitar, and Onslow (2023) discussed how the stuttering community may apply neurodiversity to the field. A summary of this conversation is outlined here:

Early childhood stuttering: Several stuttering researchers feel that since there are evidence-based treatments for early childhood stuttering, young children should still receive this type of therapy (Shenker, Rodgers, Guita, & Onslow, 2023). Shenkar felt that past the preschool age, however, intervention should combine goals of acceptance of stuttering.

Stuttering Intervention with Teens and Adults:  When the conversation turned to school-aged children, adolescents and adults, Guitar (2023) thought that PWS should be free to choose whether they want to work on stuttering in an easier, more relaxed way or to continue their present type of stuttering.

Cognitive Restructuring

One intervention that may address acceptance of stuttering is Acceptance and Commitment Therapy (ACT) (Beily, Bynes, & Yaruss, 2012). ACT is one form of cognitive restructuring that aids or alters the relationship the person who stutters has with their emotions. The core principles of acceptance and commitment therapy are mindfulness, and, with the goal of self-acceptance for the person who stutters.

Another cognitive restructuring intervention is Cognitive Behavior Therapy (CBT), (Scott) which targets the relationship between thoughts and feelings for the person who stutters. One example of this would be if the student is worried about a school presentation, the SLP could use CBT to help them decrease their worry about stuttering in front of the class.

Four ways that the field needs to change to incorporate neurodiversity

  1. As Siskin (2022) recommends, clinicians need to consider stuttering as a communication difference and not a communication disorder.
  2. Another change is our use of the word fluency since it portrays stuttering negatively and creates a stigma (Tichenor, Constantino, & Yaruss, 2021). Use of the term fluency may make it more difficult for some people who stutter to identify with the stuttering condition. It is recommended that researchers and clinicians discontinue referring to stuttering as a “fluency disorder” and simply refer to it as “stuttering”.
  3. A third idea that Siskin proposes is that clinicians examine their assessment and therapy procedures to align with the neurodiversity viewpoint. This entails letting go of dichotomies such as fluent vs. dysfluent speech.
  4. Finally, resources should be allocated to reduce the stigma of stuttering. Many of the anti- bullying programs have been successful and could serve as a model for new programs for stuttering (Sisskin, 2022).

Changing the way our field talks about stuttering will have numerous benefits for people who stutter and the stuttering community.

References:

Beilby, J., Byrnes, M., & Yaruss, J. (2012). Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency. Journal of Fluency Disorders, 37(4), 289-299. https://doi.org/10.1016/j.jfludis.2012.05.003

Scott, L. (2018). Implementing cognitive behavior therapy with school-aged children who stutter. Youtube:https://youtu.be/AITqRsVQCk4.

Shenker, R., Rodgers, N., Guitar, B., & Onslow, M. (2023). Contemporary clinical conversations about stuttering: Neurodiversity and ableism. Journal of Fluency Disorders, 78, 10601 4. https://doi.org/10.1016/j.fludis.2023.106014

Sisskin, V. (2023). Disfluency-affirming therapy for young people who stutter: Unpacking ableism in the therapy room. Language, Speech, and Hearing Services in Schools, 54(1), 114–119. https://doi.org/10.1044/2022_lshss-22-00015.

Tichenor, S., Constantino C, & Yaruss, J.S. (2022). A point of view about fluency. Journal of Speech Language, Hearing Research.65(2), 645-652.

https://doi.org/10.1044/2121_JSLHR-21-00342

Dr. Eileen Brann is in private practice in Oak Park, IL., where her caseload consists of clients of all ages who stutter. She is trained in the Lidcombe program, the Palin Parent-Child Interaction therapy, and the MPI-2 treatment program. In her private practice, she is honored to work with SLPs who specialize in AT, ASD, and early childhood speech-language disorders.