How to help teenagers who stutter (and their families)

Do you remember the joys of being a teenager?

Growth spurts. Hormones amok. Peer-pressured to distraction. Painfully self-conscious:

How do I look?
Should I wear double denim?
Is my hair cut okay?
Will I fit in?
Will they invite me?
Does he/she like me?
I can’t believe I just said/did that!
Look at my moon-pocked skin! I’m a monster!
I hate her!
No-one understands!
I’m an all-knowing god.
I’m a worthless bug.

Random thoughts bouncing about the inside of your head like flubber. Fun times!

Now just think for a moment about what all this does to a teenager who stutters. Even more fun, right?

Well, it’s complicated!

When I ask adults who stutter about their teenage years, many – but certainly not all! – wince, then recount horrible tales of teasing, bullying, social isolation, and rejection. You get the same message from some of the published research (Beilby et al., 2012; Blood et al., 2011, Davis et al., 2002). Research also shows that stuttering as a teen can impact your daily life, your quality of life, your satisfaction with life, your self-esteem, your relationships and your mental health (e.g. Beilby et al., 2012; Blood & Blood, 2004).

But – like many things to do with stuttering – it’s dangerous to make assumptions or to generalise. We’ve written before about the the complex relationship between stuttering and anxiety for young children who stutter.

If anything, the relationships between stuttering severity, psychological functioning and the overall impact of stuttering on a teenager’s life are even more complicated.

To make things more frustrating, at present, we:

don’t have many evidence-based treatment options for teenagers; and
don’t always have a lot of flexibility when administering an evidence-based treatment to incorporate a client’s unique needs (Hearne et al., 2008; Huber et al., 2004).

New research

Luckily, there are greater minds than mine working hard to untangle the complex web of factors affecting teenagers who stutter. One of my favourite researchers, Dr Lisa Iverach and colleagues from the Australian Stuttering Research Centre and the University of Queensland, have recently published a terrific paper looking at the speech and psychological profile of 102 Australian teenagers (86 boys, 16 girls) aged 11-17 who sought treatment for stuttering. This may be the largest number of teenagers studied in one paper; and the findings are fascinating:

Anxiety and depression scores fell within the normal range.
Teens who self-rated themselves as having more severe stuttering tended to have higher anxiety scores and “internalising problems”.
Boys tended to report clinically significant “externalising problems”, e.g. acts of aggression and rule-breaking.
Girls reported “total emotional and behavioural problems” in the borderline clinical range.
As you would expect, higher stuttering severity, anxiety scores and dissatisfaction with speech predicted a more negative overall effect of stuttering.

Clinical significance

This study suggests:

higher stuttering severity predicts higher anxiety levels (which makes sense);
effective stuttering treatment (resulting in lower stuttering severity) may play an important role in stemming the development of later mental health issues;
access to psychological help for teens is important and should be based on the teen’s particular needs and issues; and
teenage boys/men (and their families) may need different kinds of help than teenage girls/women, depending again on individual facts and circumstances.

The study had some important limitations:

All the teenagers in the trial sought stuttering treatment. The findings may not be applicable to teenagers who do not seek treatment and self-manage their stuttering.
It wasn’t clear whether the teens in the study sought treatment off their own bat, or attended therapy because their families wanted them to (which may be relevant to motivation and attitudes to stuttering). For example, we know that some teenagers are reluctant to seek speech treatment (Huber et al., 2014), which is certainly something I’ve observed in clinical practice.
There was no control group, so we can’t tell if there is a statistically significant difference between anxiety levels and other measures in teenagers who stutter compared to teenagers who do not stutter.

Clinical bottom line

Speech pathologists and psychologists working with teenagers who stutter need to consider the whole person – not just the person’s speech impairment or mental health problems. Teenage boys and men may act out more than girls. But each client is different, and access to psychological support may be needed in some cases.

High stuttering severity appears to be related to a higher risk of anxiety. So treatment aimed at reducing stuttering severity is important for both speech fluency and mental health reasons.

Teenagers who stutter should be told about this research and where to seek help if they want or need it.

Related articles:

Principal source: Iverach, L., Lowe, R., Jones, M., O’Brian, S, Menzies, R.G., Packman, A., & Onslow M. (2017). A speech and psychological profile of treatment-seeking adolescents who stutter. Journal of Fluency Disorders, 51, 24-38.

Image: http://tinyurl.com/kqpy6f2

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.