How Do People Who Stutter Experience Ableist Microaggressions? A Mixed Methods Exploratory Study

Speech production difficulties are apparent in people who stutter (PWS). PWS also have difficulties in speech perception compared to controls. It is unclear whether the speech perception difficulties in PWS are independent of, or related to, their speech production difficulties. To investigate this issue, functional MRI data were collected on 13 PWS and 13 controls whilst the participants performed a speech production task and a speech perception task. PWS performed poorer than controls in the perception task and the poorer performance was associated with a functional activity difference in the left anterior insula (part of the speech motor area) compared to controls. PWS also showed a functional activity difference in this and the surrounding area [left inferior frontal cortex (IFC)/anterior insula] in the production task compared to controls. Conjunction analysis showed that the functional activity differences between PWS and controls in the left IFC/anterior insula coincided across the perception and production tasks. Furthermore, Granger Causality Analysis on the resting-state fMRI data of the participants showed that the causal connection from the left IFC/anterior insula to an area in the left primary auditory cortex (Heschl’s gyrus) differed significantly between PWS and controls. The strength of this connection correlated significantly with performance in the perception task. These results suggest that speech perception difficulties in PWS are associated with anomalous functional activity in the speech motor area, and the altered functional connectivity from this area to the auditory area plays a role in the speech perception difficulties of PWS.

People who stutter (PWS) experience stigma-based health inequalities that can negatively impact their quality of life. Yet, few interventions in the literature are explicitly designed to address these systemic disparities. The Responsible Innovation in Health (RIH) framework offers a promising foundation for developing health innovations that are equitable, sustainable and contextually responsive. This study explores how stakeholders interpret and apply the RIH framework to envision interventions that reduce stigma and promote health equity for PWS. Using a mixed-methods design, namely the Participative Concept Mapping Approach, stakeholders (PWS, clinicians, health innovators) participated in a workshop to generate, sort and rate ideas based on their importance and feasibility. Concept maps were used to analyse and categorize ideas thematically. Stakeholders generated 94 ideas across six clusters as follows: (1) Digital Technology and Video Media, (2) Collective and Professional Approaches, (3) Cost and Accessibility, (4) Inclusive and Sustainable Intervention Design, (5) Engaging Multi-Modal Approaches and (6) Flexibility. The environmental responsibility value of the RIH framework received limited focus. Discrepancies between the importance and feasibility of ideas highlighted challenges in implementing interventions, while ensuring their sustainability. This study demonstrates how stakeholders prioritize values of the RIH framework when envisioning stigma-reducing health innovations for PWS. Findings highlight the need for embedding sustainability within clinical practices and underscore the importance of patient and user feedback to bridge the gap between impactful concepts and practical solutions, ensuring that interventions are meaningful, feasible and grounded in the RIH values. What is already known on this subject Stuttering is associated with stigma-based health inequalities that extend beyond speech, impacting PWS across multiple domains of life. Research has documented the effects of stigma on quality of life, access to care and communicative participation for PWS. However, frameworks to guide the development of interventions that explicitly address these structural inequities remain limited. What this paper adds to existing knowledge This study is the first to explore how the RIH framework can inform the design of stigma-reducing interventions tailored to stuttering. Through participatory concept mapping with PWS, clinicians and health innovators, it identifies how RIH principles, such as inclusion, sustainability and responsiveness, can shape context-specific, equity-oriented innovations that reflect the lived experiences of PWS. What are the potential or actual clinical implications of this work? Applying the RIH framework to stuttering interventions offers a novel approach for promoting health equity in both clinical and community contexts. This study highlights the importance of co-designing interventions with stakeholders, grounding them in the lived experiences and priorities of people who stutter. It sets the stage for developing sustainable, meaningful and inclusive practices that respond to the complex realities of stigma in stuttering.

Purpose: The purpose of this study was to explore the following topics. (a) What are the specific stuttering moments that trigger anticipatory completions? (b) How do people who stutter (PWS) perceive anticipatory completions of their turn by people who do not stutter (PWNS)? (c) What are the expectations of PWS from PWNS in a conversation between them? Method: In this qualitative study, the researchers used grounded theory to help analyze the collected data. The data sources were 26 observations, conversations, and interviews. A similar version could be used in the body of the text when the study is described. Results: Five out of six participants experienced anticipatory completions during stuttering moments. Hypothesis 1, “Anticipatory completions by PWNS occur at specific stuttering moments,” was accepted. Hypothesis 2, “PWS have negative perceptions and feelings of anticipatory completions by PWNS,” was not verified during interviews with three participants; therefore, the researchers revised Hypothesis 2 into “PWS do not always have negative perceptions and feelings of anticipatory completions by PWNS.” Five out of six participants expected PWNS to let them finish what they are saying; therefore, the researchers accepted Hypothesis 3, “PWS expect PWNS to let them finish what they are saying.” Conclusion: The main findings of this study include verification that the participants used anticipatory completions at specific stuttering moments and nonstuttering moments in one case, PWS do not always have negative perceptions and feelings about anticipatory completions by PWNS, and PWS expect PWNS to let them finish what they are saying.

This study investigated the speech therapy experiences of people who stutter (PWS) in childhood and adulthood, including the helpfulness and generalizability of specific intervention approaches. PWS (N = 194) completed a mixed-methods survey. Respondents provided quantitative ratings of their overall opinion of speech therapy and of specific speech therapy approaches received during childhood and adulthood. Respondents also provided open-ended responses to questions asking what they found most and least helpful about speech therapy received during each life stage and why. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance; qualitative data were analyzed using reflexive thematic analysis. PWS reported mixed opinions of speech therapy, with speech therapy received during childhood viewed particularly unfavorably and rated significantly more negatively than that received during adulthood. Quantitative and qualitative analyses converged, with PWS generally preferring speech therapy approaches that emphasized the affective, behavioral, cognitive, and social correlates of stuttering over those that emphasized speech fluency. These results have important implications for improving the clinical practice of speech-language pathologists in their provision of speech therapy services to PWS across the lifespan. Through considering the lived experiences and voices of PWS in the development and execution of speech therapy programs, speech-language pathologists can enhance their evidence-based treatment practices for this population by delivering intervention that PWS value.

A number of studies have shown that phonetic peculiarities, especially at the coarticulation level, exist in the disfluent as well as in the perceptively fluent speech of people who stutter (PWS). However, results from fluent speech are very disparate and not easily interpretable. Are the coarticulatory features observed in fluent speech of PWS a manifestation of the disorder, or rather a compensation for the disorder itself? The purpose of the present study is to investigate the coarticulatory behavior in the fluent speech of PWS in the attempt to answer the question on its symptomatic or adaptive nature. In order to achieve this, we have studied the speech of 21 adult PWS (10 French and 11 Italian) compared to that of 20 fluent adults (10 French and 10 Italian). The participants had to repeat simple CV syllables in short carrier sentences, where C = /b, d, g/ and V = /a, i, u/. Crucially, this repetition task was performed in order to compare fluent speech coarticulation of PWS to that of PWNS, and to compare the coarticulation of PWS under a condition with normal auditory feedback (NAF) and under a fluency-enhancing condition due to an altered auditory feedback (AAF). This is the first study, to our knowledge, to investigate the coarticulation behavior under AAF. The degree of coarticulation was measured by means of the Locus Equations (LE). The coarticulation degree observed in fluent PWS speech is lower than that of the PWNS, and, more importantly, in AAF condition, PWS coarticulation appears even weaker than in the NAF condition. The results allow to interpret the lower degree of coarticulation found in fluent speech of PWS under NAF condition as a compensation for the disorder, based on the fact that PWS’s coarticulation is weakening in fluency-enhancing conditions, further away from the degree of coarticulation observed in PWNS. Since a lower degree of coarticulation is associated to a greater separation between the places of articulation of the consonant and the vowel, these results are compatible with the hypothesis that larger articulatory movements could be responsible for the stabilization of the PWS speech motor system, increasing the kinesthetic feedback from the effector system. This interpretation shares with a number of relatively recent proposal the idea that stuttering derives from an impaired feedforward (open-loop) control system, which makes PWS rely more heavily on a feedback-based (closed loop) motor control strategy.

Purpose: The primary purpose of this study was to evaluate correlations between stuttering severity and satisfaction with life (SWL), self-acceptance (SA), self-compassion (SC), and avoidance among people who stutter (PWS) and did seek support or did not seek support from family, friends, and the National Stuttering Association (NSA). Method: This study surveyed 47 self-identified PWS from a larger study in order to obtain information on background, avoidance, SA, SWL, and SC. Correlation analyses were used to examine concurrent associations. Results: Stuttering severity was significantly correlated with lower SA and higher avoidance among PWS who did not seek support from friends. Stuttering severity was not significantly correlated with lower SA, lower SC, or higher avoidance among PWS who sought support from friends or family. However, correlations between stuttering severity and lower SWL were similarly strong and significant among PWS who did and did not seek support from friends and from family. Stuttering severity was significantly correlated with lower SA and lower SWL among PWS who sought support from the NSA, but not correlated with these variables among PWS who did not seek support from the NSA. Conclusions: Correlations between greater stuttering severity and lowered SWL, SA, SC, and increased avoidance were not reduced with presence of formal support (i.e., NSA) but were nonsignificant with support from friends in some cases. Additional research is needed to address why a person is more or less likely to seek support and the impact support has on the life of the person. The clinical implications involve determining help-seeking behavior and the potential barriers to help-seeking.

Differences in sensorimotor integration mechanisms have been observed between people who stutter (PWS) and controls who do not. Delayed auditory feedback (DAF) introduces timing discrepancies between perception and action, disrupting sequence production in verbal and non-verbal domains. While DAF consistently enhances speech fluency in PWS, its impact on non-verbal sensorimotor synchronization abilities remains unexplored. A total of 11 PWS and 13 matched controls completed five tasks: (1) unpaced tapping; (2) synchronization-continuation task (SCT) without auditory feedback; (3) SCT with DAF, with instruction either to align the sound in time with the metronome; or (4) to ignore the sound and align their physical tap to the metronome. Additionally, we measured participants' sensitivity to detecting delayed feedback using a (5) delay discrimination task. Results showed that DAF significantly affected performance in controls as a function of delay duration, despite being irrelevant to the task. Conversely, PWS performance remained stable across delays. When auditory feedback was absent, no differences were found between PWS and controls. Moreover, PWS were less able to detect delays in speech and tapping tasks. These findings show subtle differences in non-verbal sensorimotor performance between PWS and controls, specifically when action-perception loops are disrupted by delays, contributing to models of sensorimotor integration in stuttering.

Introduction: Stuttering is a fluency disorder that involves problems with fluency and the flow of speech. In previous research, results have emerged where the types of disfluency in bilingual people who stutter (PWS) and monolingual PWS were different. There has, however, been no research into the language characteristics and psychological characteristics of Japanese-speaking bilingual PWS. The purpose of this study was to investigate the characteristics of disfluency and psychology in Japanese-speaking bilingual PWS. Methods: Five bilingual PWS and have lived in Japan participated in this study. The tasks consisted of 50 phrases of oral reading tasks, 200 phrases of conversational speech samples, and an Overall Assessment of the Speaker’s Experience of Stuttering (OASES) translated into Japanese. Results: All of the participants stuttered in every language they spoke, and most of them answered that their stutter varied from one language to another. The disfluency in conversational speech samples showed that there were high frequencies of interjection among the participants. The OASES result showed that most participants had high impact scores in Section 2 (Reactions to stuttering). Discussions: The fact that all participants had stuttering symptoms in all the languages they spoke was consistent with previous research. Interjection was the most frequent disfluency, differing from previous research on Japanese monolingual PWS. This may have some relationship with bilingual PWS having difficulty in the proficiency of the language and in finding the correct words. There were no significant differences in the OASES scores from previous research for monolingual PWS and as such, further research will be needed.

Objectives: People who stutter (PWS) are suggested to stutter due to insufficient speech motor abilities. Speech motor abilities can be measured by reaction time, characteristics of fluent speech, and non-speech motor control. However there are some studies which have reported inconsistent results. Therefore the primary purpose of the current study is to provide a comprehensive perspective on whether there are differences in speech motor abilities between PWS and people who do not stutter (PWNS) by using meta-analysis. Moreover we tried to determine whether there are differences in the research areas and age groups. Methods: A total of four databases (two Korean and two English databases) were used in the current study for article search. A total of 51 articles (50 English, 1 Korean) met the inclusion/exclusion criteria and were analyzed in the current study. Results: There was a statistically significant difference in overall speech motor control between PWS and PWNS. In addition PWS in all age groups showed statistically significant differences from PWNS and there was no statistically significant difference across age groups. Furthermore, PWS showed statistically significant differences from PWNS in three research areas; reaction time, fluent speech, and motor control, whereas the differences across the three research areas were not statistically significant. Conclusion: The meta-analysis results of the current study showed that PWS showed insufficient speech motor abilities, and such insufficient speech motor abilities would be typical characteristics of stuttering. As such insufficient abilities are found across age groups and research areas a more comprehensive approach is needed in stuttering assessment and treatment.

Purpose: Many research studies have con- sistently found that a variety of individuals who do not stutter report stereotypical attitudes toward stuttering and people who stutter (PWS). There is less agreement regard- ing whether certain characteristics of listeners, such as their relative familiarity with PWS and their gender, have any effect on the attitudes they report regarding PWS. The purpose of this study was to explore whether normally flu- ent speakers would report negative stereotypical attitudes toward PWS and whether they perceived certain careers as less appropriate choices for PWS. In addition, the impact of the participants' familiarity with stuttering and gender were explored using both quantitative and qualitative methods. Method: One-hundred and fifty-four individuals from the general population completed a questionnaire that included both open-ended and forced-choice items. The participants'

Purpose: A limited number of studies have ex- plored attitudes toward people who stutter (PWS) in different cultures. Recent studies have looked at the attitudes of Arab parents toward PWS. The current study explores attitudes reported by Arab teachers from Kuwait and provides a pre- liminary comparison with attitudes reported by teachers from the United States. Method: This study used an English version and an Arabic translation of a 14-item semantic differential (SD) scale (Bur- ley & Rinaldi, 1986) to assess differences in American and Arab teachers' attitudes toward PWS. Results: A majority of Arab teachers from Kuwait reported neutral to positive attitudes toward PWS on the SD scale. However, ~ 1

People Who Stutter (PWS) are often characterized by the presence of cognitive-emotional issues, resulting in conditions such as social phobia and avoidance behaviors. Emotions have been demonstrated to have a role in modulating speech-motor systems. Thus, in PWS, emotion and cognition (i.e., higher levels of trait-stable-neuroticism-and contextual-anticipation-anxiety) could negatively influence speech-motor networks, resulting in an increased number of dysfluencies. To test this hypothesis, we recruited 13 PWS who were matched to 13 Fluent Speakers (FS). Participants were all Italian speakers and completed the NEO-PI-3 scale to assess neuroticism, and the ASI-3 scale for anxiety sensitivity. Successively, participants considered 55 words (repeated two times) and 55 sentences, and completed a task in which they had to evaluate their anticipation of stuttering before reading them aloud. Anticipation scores, reading times, and frequency of stuttering were evaluated and used for analyses. Findings suggest that PWS mainly had higher social concern than the fluent speakers. Moreover, a tendency toward higher levels of neuroticism is evident. Linear regressions suggest that reading times in PWS (positively related to frequency of stuttering) may be mainly explained by stuttering anticipation scores and, secondarily, by neuroticism levels. Stuttering anticipation was also positively related to the recorded frequencies of dysfluencies. Stuttering anticipation and neuroticism may be useful indexes for predicting dysfluencies and speech behavior, in PWS. Surely, this may be related to long-life stuttering and adaptive/maladaptive compensation attempts. In every case, in a clinical context, this also suggests the importance of fully evaluating behavioral/emotional aspects of stuttering, to obtain a more complete picture of patients' needs and "tailored"/multidisciplinary interventions.

Previous research suggests that people who stutter (PWS) tend to have heightened general anxiety (i.e., trait anxiety) and situational anxiety (i.e., state anxiety) compared to people who do not stutter (PWDS). Most research with anxiety and stuttering utilizes self-perception scales; however, few studies have looked at anxiety over time. The current study examined self-reported state and trait anxiety in PWS and PWDS over six weeks, along with an investigation of the effects of audio-recording on anxiety. Results indicated no significant group differences in trait (general) anxiety over six weeks; however trends indicated that PWS may have increased trait anxiety compared to PWDS. Furthermore, for both groups, state (situational) anxiety was lower after a recording session compared to before.

Purpose Working memory (WM) deficits are implicated in various communication disorders, including stuttering. The reading span test (RST) measures WM capacity with the dual task of reading sentences aloud and remembering target words. This study demonstrates a difference in strategy between people who stutter (PWS) and people who do not stutter (PWNS) in performing the RST. The impact of the effective strategy and the stuttering-like disfluencies during the RST were investigated. Method Twenty-six PWS and 24 people who do not stutter performed the RST and a simple reading aloud task. After the RST, they were asked which strategy ("imagery" or "rehearsal") they had used in order to remember the target words during the task. Results The proportion of those who used an "imagery" strategy during the RST was significantly smaller in the PWS group. However, the RST scores of those who used an "imagery" strategy were significantly higher than the RST scores of those who used a "rehearsal" strategy in both groups. The "rehearsal" users were asked to undertake one more RST with an "imagery" strategy, which resulted in an increased score for both groups. The disfluency frequency of the PWS group was significantly reduced during the RST than during the oral reading task, irrespective of the employed strategy. Conclusions PWS tended to use the less effective verbal "rehearsal" strategy during the RST. The differential effects of switching strategies on the measured WM capacity and on the disfluency rate suggest that the enhanced fluency during the RST would be mostly attributable to the reduced attention to speech motor control. Therefore, the use of the "imagery" strategy and focusing on the contents of communication, away from speech motor control, should help PWS communicate better in daily conversation.

We explored the perceptions about work experiences and discrimination that people who stutter (PWS) report. A total of 184 PWS responded to a paper and pencil or an online version of a questionnaire that included 13 Likert-type scale and demographics questions. Of the respondents, 68 completed a pencil and paper version of the questionnaire and 116 completed an online version. Participants reported that their stuttering affected some aspects of occupational experiences and that their employers had made negative judgments during job interviews and promotional opportunities due to stuttering. Conversely, participants reported that stuttering did not affect whether they were asked to perform supervisory activities, that their coworkers appeared to accept their stuttering, and that stuttering did not affect their choice of careers. Stuttering severity, gender, treatment experiences, type of employment, and differences in salary did not affect participants’ reports related to occupational experiences. Finally, there were no differences between the responses provided by participants responding to the paper and pencil or electronic versions of the survey. In this paper, we discuss relationships between these findings and past research studies exploring occupational experiences of people who stutter.