Assessment of stuttering (and anxiety)

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My seven year old and I read a graphic novel recently (Plumdog by Emma Chichester Clark), and this seems to have prompted an interest in her telling stories in a similar format. Her latest story crosses paths with what I do at work: one of the characters stutters (the purple figure towards the bottom left corner in the featured image). If you can make out the other characters’ speech you will read that he is being criticised for stuttering. So how does this story relate to anxiety and assessment of stuttering?

Someone who stutters cannot help stuttering. If you stutter you likely have some irregular brain activity in speech areas; genetics are involved. None of this has anything to do with anxiety. However, speech is central to being human. Our lives are built around speech. So, living with speech that is stuttered increases the risk of developing anxiety, particularly social anxiety.

Even preschool-age children who stutter have been shown to face negative consequences from peers as a result of stuttering. By the school years, bullying is common and known to be associated with anxiety later in life.

When I assess stuttering, I use a standardised test to screen for whether anxiety might be present. Parents complete multiple choice questions for their preschool-age child, whereas in the case of school-age children both parent and child complete separate questions. It’s brief and indicates any need for further assessment.

I’m much less likely to delay treatment of a preschool-age child who has become anxious owing to their communication difficulties. With an adult who stutters, the presence of anxiety can prevent them from making gains with their speech treatment; and sometimes adults need to work on the anxiety before they are able to work on speech effectively.
Once upon a time it was thought that anxiety caused stuttering. Now we know it’s the opposite; stuttering places you at risk of developing anxiety. And so it’s important that I consider the possibility of anxiety when I assess stuttering and treat it.