Many of our SLP colleagues have noted an increase in referrals for stuttering assessments and therapy since the COVID-19 pandemic began. Many people who stutter have also reported an increase in the frequency and severity of their stuttering since the spring of 2020.
When we know the facts about stuttering, this phenomenon is not surprising. Current research informs us that stuttering is a neurologically based disorder that is known to be largely genetic in origin. Unfortunately, past theories regarding the origins of stuttering continue to dwell in the minds of those who do not fully understand the condition. One of these disproven theories is that stuttering is somehow caused by psychological factors. This is why, when we are experiencing a world-wide stressful situation (global pandemic), the increase of stuttering referrals can seem confusing.
Let’s unwind what many SLPs are reporting by stating that increased referrals do not necessarily mean an increase in the incidence of stuttering. Furthermore, increased reports of stuttering during stressful times do not mean that stress caused the stuttering. Increased referrals can be a natural by-product of many other factors.
First, it’s important to realize that many parents and caregivers are experiencing an increase in their overall stress levels and in their general levels of worry about their children’s wellbeing. Issues that may not have raised concern before COVID may now be more worrying to caregivers, and this can lead them to notice and wonder about differences in their children’s speech that may not previously have caused concern.
Second, due to changes in school and work schedules, many caregivers are spending much more time with their children throughout the day than they might be accustomed to. They are hearing their child talk more, and this may mean that they are also hearing their child stutter more. Some caregivers may be noticing speech disfluencies that they had not previously “tuned in” to. This factor—coupled with the increased general stress and concern noted above—can move parents to make more referrals to speech-language pathologists.
Third, children are also experiencing changes in their daily environments—and in their communication opportunities. While we know that stuttering is not caused by anxiety or other psychological factors, we also know that environmental changes and internal stressors can exacerbate stuttering. Young children who are at risk for stuttering may exhibit more surface stuttering behaviors when stressors are present. Older children may also experience an increase in stuttering behaviors when they are faced with new situations, such as using video conferencing for class meetings. (Some of our school-age students have told us that it is particularly difficult for them to speak when they know that their image is visible on their classmates’ computer screens.) When caregivers observe these more frequent disfluencies, they may become concerned, and this, again, can lead to increased referrals.
Fourth, many children who stutter who would typically be participating in therapy may not be receiving their normal sessions due to the disruption in school schedules. The lack of ongoing therapy can have a negative effect on speech fluency, as children may not be getting the same level of practice and support that they usually receive. Without ongoing practice, speech handling skills tend to become less effective. This can compound parents’ fears about their children’s speech, especially if parents are already concerned about missed schooling or other related opportunities.
Finally (for now), one of the most important facts to remember about stuttering is simply this: stuttering behaviors vary. People who stutter may experience increases in their stuttering at some times and in some situations, and they may experience decreases in their stuttering at other times and in other situations. This is a normal part of the daily experience of stuttering. Increases in observable stuttering behavior can be alarming to children who stutter and caregivers alike, but if we can help them remember that this is just part of the natural ebb and flow of stuttering, then we can help to reduce their concerns.
There are other reasons that children who stutter may be experiencing increased stuttering—and reasons that parents are seeking more referrals—during this stressful time. Regardless of the specific reasons, however, we have an opportunity as speech-language pathologists to provide steadfast support and education for our students and their families. We can resist the temptation to write off the increased stuttering as just a response to stress or anxiety, and we can help people understand that stuttering is not a psychological disorder. We can replace old beliefs with new facts about what truly contributes to stuttering. And, in doing so, we can help to reduce the fears that students, teachers, caregivers, and others are experiencing.
When people are equipped with current knowledge and a deeper understanding of what stuttering really is, they are better prepared to handle the ups and downs of dealing with stuttering. We hope this brief overview will help debunk any myths and strengthen the facts so that our colleagues can help caregivers and clients who stutter understand the phenomenon that is being reported during this challenging time.