Anxiety and stuttering treatment

illustrationSummary of the Research paper: Anxiety of children and adolescents who stutter: A review. By Kylie A. Smith, Lisa Iverach, Susan O’Briand, Elaina Kefalianosa, and Sheena Reilly. Published in the Journal of Fluency Disorders 40 (2014) 22–34.

Approaches to stuttering treatment have undergone changes over the decades. As in any field, practitioners don’t always entirely agree. But one thing all speech pathologists would definitely concur on is the need for more research into the nature of stuttering, its impact and causes, and implications for better treatment methods.

Social Anxiety Disorder

The field of speech therapy has long recognized the high prevalence of social anxiety disorder (also known as “social phobia”) among adults who stutter. The general adult population experiences social anxiety at a rate of 8-13%, whereas adults who stutter rate as high as 60%. It has been recognized that this high anxiety has a negative impact on the success of speech therapy for adults. In many cases the higher likelihood of relapse tends to void gains made towards fluency. It is recommended today that treatment for stuttering address psychological issues, and Cognitive Behaviour Therapy (CBT) is one of the processes now used by many speech therapists as a part of stuttering-reduction treatment.

Early Intervention

anxiety has a negative impact on the success of speech therapyBut there is still an aspect of the problem going unaddressed. Could further research into the nature of anxiety in children who stutter help to inform the high incidence of social phobia in adults? The average age for the onset of social phobia in children is age 11, but could it be younger for stuttering children? Can social anxiety be targeted for treatment at a younger age? The researchers involved in this study used 13 papers (listed at the bottom of this article) for analysis to attempt to answer these questions.

Children who stutter and anxiety

A 2009 Australia study involved 1,619 two-year-old children from the general population. The research found that children who stuttered when they were first learning to talk were not more likely to exhibit traits of anxiousness or nervousness than other children. Other studies, done before and after this one, have corroborated these findings. It has also been found that very young children who stutter do not have lower self-esteem, diminished cognitive skills or a familial history of anxiety or neuroses.  So how do so many adults who stutter end up with anxiety issues? All thirteen of these papers examined the anxiety rates in children of different ages who stutter.

Interpreting results

 children do not begin to stutter because of a predisposition towards anxiety or nervousnessIt is hard to draw conclusions from the 13 research papers. One study found no difference in anxiety levels of children between the ages of 9 and 14 who stutter and to those who don’t. After all, most young people experience increased anxiety at this age. This same study found that these normal anxiety levels among adolescents who stutter were reduced immediately after taking stuttering therapy. The lasting effect of this reduction in anxiety was not studied.

But another study contradicted this finding, showing that a sample of kids who stuttered did have higher anxiety in general compared with non stuttering controls. It should be noted the average age of adolescents in this study was older, possibly a factor in the outcome.

A different study with children 10-16 years of age found that although they did not have higher levels of anxiety overall, they did have “situational anxiety” that emerged in certain situations having to do with speaking, such as using the phone and answering questions in class. This type of anxiety, occurring only in certain situations, is different from “trait anxiety” that affects a person’s overall life activities.

The big picture?

The majority of studies indicated that although children did not start to stutter due to anxiety, they were indeed at risk for greater social anxiety as they got older “due to the negative social consequences of stuttering and negative attitudes towards communication that emerge” from the social deficit presented by stuttering. One researcher found that social consequences were felt by kids who stuttered as early as age 3, at which time they experienced mockery and exclusion because of their speech. Later, during adolescence, stuttering caused lack of romantic opportunities and further hindered social development.

Further research

the question as to the timing of anxiety onset is still unclearIn their analysis, the researchers cite “methodological limitations” for some of the papers that limit their usefulness. Such deficits are usually the result of lack of funding or resources. The question as to the timing of anxiety onset is still unclear.

Recommendations for further research

Implications

 An approach to speech therapy that seeks to correct the physical act of stuttering without addressing psychological aspects is not always effective therapy. Overwhelming feelings of social anxiety can nullify gains made in achieving fluency and to maximize results it is necessary in most cases to address emotional issues. That being said, a substantial number of people who stutter are not affected by social anxiety, and might want therapy with more emphasis on fluency. Ultimately, in order for treatment to be effective, the individual needs of the person who stutters needs to be analyzed and responded to, rather than a one-size-fits-all treatment practice.

The Papers:

  1. Andrews, G., & Harris, M. (1964). The syndrome of stuttering.
  2. Blood, G., & Blood, I. (2007). Preliminary study of self-reported experience of physical aggression and bullying of boys who stutter: Relation to increased anxiety.
  3. Blood, G., Blood, I., Maloney, K., Meyer, C., & Qualls, C. (2007). Anxiety levels in adolescents who stutter.
  4. Blood, G., Blood, I., Tellis, G., & Gabel, R. (2001). Communication apprehension and self-perceived communication competence in adolescents who stutter.
  5. Craig, A., & Hancock, K. (1996). Anxiety in children and young adolescents who stutter.
  6. Craig, A., Hancock, K., Chang, E., McCready, C., Shepley, A., McCaul, A., Costello, D., Harding, S., Kehren, R., Masel, C., et al. (1996).
  7. Davis, S., Shisca, D., & Howell, P. (2007). Anxiety in speakers who persist and recover from stuttering.
  8. Erikson, S., & Block, S. (in press). The social and communication impact of stuttering on adolescents and their families.
  9. Gunn, A., Menzies, R. G., O’Brian, S., Onslow, M., Packman, A., Lowe, R., Block, S. (2013). Axis I anxiety and mental health disorders among stuttering adolescents.
  10. Hancock, K., Craig, A., McCready, C., McCaul, A., Costello, D., Campbell, K., & Gilmore, G. (1998). Two- to six-year controlled-trial stuttering outcomes for children and adolescents.
  11. Mulcahy, K., Hennessey, N., Beilby, J., & Byrnes, M. (2008). Social anxiety and the severity and typography of stuttering in adolescents.
  12. Ortega, A. Y., & Ambrose, N.G. (2011). Developing physiologic stress profiles for school-age children who stutter
  13. van der Merwe, B., Robb, M. P., Lewis, J. G., & Ormond, T. (2011). Anxiety measures and salivary cortisol responses in preschool children who stutter.