What Speech-Language Pathologists Need to Know About Verbal Diversity

During a recent session in my speech-language pathology (SLP) private practice, my client—a child who stutters—shared a challenging moment he experienced at school with me.

One of his classmates had asked him, “Why do you talk like that?”

At the time, he didn’t know how to respond.

Later in the therapy room, he came up with his ideal response: “Oh, I stutter! It’s just how I talk.”

Without fully realizing it, my client’s response hit right on a larger movement happening surrounding speech therapy for stuttering—that that focuses on a different approach to treating communication differences.

What Is Verbal Diversity?

In November 2020, Nina Reeves and J. Scott Yaruss of Stuttering Therapy Resources, Inc., posted on social media that “stuttering is verbal diversity.” They implored their followers to reflect on their own practices and consider the perspectives of people who stutter (PWS).

“If you have a challenge in your life,” they wrote in the caption, “and the message is that you are doing something ‘wrong’ and need to work to ‘fix’ it—then it becomes a source of negativity and can impact the quality of your life over time.” In the same post, they promote acceptance of stuttering as a diverse form of communication—one that doesn’t need changing. 

The concept they’re presenting here largely draws on the social model of disability, which centers on disability as a difference, and society as a barrier for these differences. In the social model, stuttering is considered a “verbal diversity”—a positive difference—and society is the barrier for PWS. 

This social post also echoes the neurodiversity movement, conceptualized by autistic Australian sociologist Judy Singer in the 1990s. Neurodiveristy is the idea that “variations in brain structure, function, and development should be appreciated and accepted as natural variations in human biology.” Examples of neurodivergence include autism, ADHD, and dyslexia. 

It should be noted that not all PWS necessarily share similar experiences as neurodivergent people. However, Dr. Chris Constantino, speech-language pathologist and PWS, noted that “Neurodiversity advocates challenge us to think critically about the objectives of our therapies.” 

In the case of verbal diversity, this movement calls on us as therapists to “appreciate and accept” stuttering in our spaces and practices. Society presumes not stuttering to be the goal of therapy, but through this verbal diversity lens, stuttering is, as my client said, “Just how [PWS] talk.” It’s our job as therapists to understand that. 

How Can SLPs Use Speech Therapy for Stuttering?

Historically, SLPs have approached stuttering through the medical model of disability. Assessments and treatments were geared towards reducing and/or eliminating the listener’s perceptions of disfluencies—such as repetitions, blocks, and prolongations. Clinicians focused on fluency as the indicator of success.

But more recently, research has found that these fluency-only approaches have several disadvantages for PWS. This includes notably high relapse rates (more than 90 percent), the need for effort to implement the strategies, and the potential for unnatural-sounding communication.

Studies have also shown that when fluency was the primary goal of stuttering therapy, clients reported increased anxiety, depression, suicidal ideation, guilt, and shame post therapy. This underscores a critical need for holistic treatment for stuttering.

To support PWS and their experiences of stuttering, SLPs are increasingly addressing the affective, behavioral, and cognitive aspects of stuttering.

SLPs work on helping their clients to “feel less tense and speak more freely in school, at work, and in different social settings.”

Speech therapy for stuttering  can address:

• Core behaviors

  These behaviors can include things like repetitions, prolongations, and blocks. In treatment, SLPs can focus on identifying disfluencies and sources of tension in the speech mechanism, as well as implementing fluency shaping and stuttering modification strategies. 

• Secondary behaviors

  This involves zeroing in on emotions and attitudes toward stuttering, and the behaviors that originate from those emotions and attitudes. 

• Environmental factors 

  This involves recognizing and strategizing with clients about societal barriers they may face at home, work, or school that impact the communication of PWS. 

How SLPs Can Approach Treatment and Affirm Verbal Diversity

This can be a tricky line to walk, but it’s doable. When doing speech therapy for stuttering, SLPs can promote appreciation and acceptance of stuttering by centering the client and their client’s communication, including stuttering, in their practices. 

In my approach to speech therapy for stuttering, PWS are the experts on their own communication. They are decision-makers about the levels of effort they want to use for communication, the implementation of strategies, and their level of participation in communicative activities. “Stuttering is verbal diversity” means that my role is to support the client’s experience of communication. It’s a small mental shift on my part that has a tremendous impact on my clients and their lives. 

I focus on the levels of comfort and confidence my client feels when they are communicating. This might include supporting my clients in identifying areas of tension in the speech mechanism (the structures in the body that contribute to speech) and exploring a stuttering modification strategy to make communication less effortful. We might talk through a challenging moment and think of a way to self-disclose to whoever they are communicating with—which may be as simple as “I stutter! It’s just how I talk!” 

How Can Speech-Language Pathologists Collaborate with Mental Health Providers?

When they work together, behavioral health professionals and speech-language pathologists can provide spaces where people who stutter can explore and reflect on their communication styles and the societal barriers they face, while being appreciated and accepted for their diverse communication. Below are some resources and organizations that mental health providers and SLPs can use to collaborate and better support their clients together.  

These sites host directories of SLPs organized by state and speciality:

• American Board of Fluency and Fluency Disorders 
  This is a directory of Board Certified Fluency Specialists (BCS-F)—speech-language pathologists who are awarded by the American Speech-Language-Hearing Association and have achieved a high level of knowledge about fluency disorders

• The Stuttering Foundation 
  This is a directory of speech therapists by state, so you can filter by where you, your clients, and any additional members of the care team are located. 

• American Speech-Language-Hearing Association (ASHA) 
  Here, BHPs can search for SLPs who specialize/focus their practice in fluency disorders in the ASHA ProFind directory

Interested In Learning More About Speech Therapy for Stuttering?

Whether you’re an SLP or a behavioral health professional, there’s a chance you may eventually work with a client who stutters. If you’re interested in learning more about stuttering and how it relates to speech-language pathology, these organizations have helpful resources you can use. 

• ASHA
  ASHA offers a definition of fluency disorders, including stuttering, through a SLP lens. It also describes the scope of a SLP working with people who stutter. ASHA also has a special interest group focused on fluency disorders, so you can connect with other providers doing similar work and get even more information. 

• Stuttering Therapy Resources
  Nina Reeves & J. Scott Yaruss are SLPs and the geniuses behind the framing that “Stuttering is verbal diversity.” They have incredible print materials, as well as a blog and videos that are helpful for professionals, parents, and clients.

• Stammering Pride and Prejudice
  This book, written by stuttering advocate Patrick Campbell and SLPs Christopher Constantino and Sam Simpson, is a fabulous resource about stammering/stuttering and the social model of disability. It includes multiple perspectives and opinions, and offers suggestions for real-life application. 

At the end of the day, the role of SLPs when providing speech therapy for stuttering isn’t to “cure” clients of their stutter. Rather, SLPs, and all care providers, can follow their clients’ leads, and give them the tools and support they need to communicate how they feel most comfortable.

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