We are all aware that anxiety levels continue to rise from COVID-19 and its many attendant difficulties. And, as is well-known, anxiety is at the root of many mental health disorders and other problems. Since many people believe that anxiety causes stuttering, has there been, or can there be expected to be an uptick in stuttering from COVID-19?
To answer this question, we first need to understand the different kinds of stuttering and the relationship between anxiety and stuttering.
Developmental stuttering is the most common type of stuttering. Typical among children ages 2-6 who are learning to speak, it usually goes away on its own. Five to ten percent of children stutter at some point, and at least 75% outgrow it. For the remaining 25%, stuttering may continue to be a challenge in adulthood.
Developmental stuttering is often much worse when a child is anxious. The speech of children who stutter may improve when they speak for more extended periods. This means the first few sentences of a conversation may be slow and halting, but as children become more relaxed, they may stutter less.
Neurogenic stuttering is much less common than developmental stuttering. It’s due to a problem with the brain caused by an injury, developmental disorder, or disease. For example, some people develop a stutter following a stroke or a traumatic brain injury (TBI).
Although anxiety may make neurogenic stuttering worse, anxiety is more closely tied to developmental stuttering. Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.
Does Anxiety Cause Stuttering or Vice Versa?
The question as to how stuttering and anxiety are related to one another had been the subject of debate in both the speech therapy and mental health worlds for years. Among professionals, the prevailing opinion throughout the 20th century was that the cause of stuttering wasn’t physiological but rather was due to psychological factors such as anxiety.
However, recent research has shown this presumption to be erroneous. There is little to no evidence supporting the contention that anxiety causes stuttering in children. Studies have shown that those children who stutter aren’t more anxious than other kids.
That said, anxiety does impact stuttering. Since speaking is essential to social interaction, and stuttering complicates this interaction, anxiety can hamper social relationships. A 2009 study found stuttering increased an anxiety diagnosis by six- to seven-fold and increased the likelihood of a diagnosis of social anxiety 16- to 34-fold. Another 2009 study found that 50% of adults who stutter have social anxiety.
This may be because stuttering can change the way people relate to the person who stutters. Children who stutter can experience bullying and isolation. Adults may struggle to feel heard at work or shy away from high-pressure situations, such as speaking publicly at a conference. Negative social experiences can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse, often resulting in social anxiety.
In the June 2014 Journal of Fluency Disorders, Dr. Lisa Iverach published an article tackling this point. She intended to raise awareness regarding the impact of stuttering in children as they grow into adolescence and adulthood, and their accompanying vulnerability to social anxiety disorder.
Dr. Iverach argued that it is a mistake to dismiss stuttering as a bad habit that children will outgrow. On the contrary, clinical studies have shown that stuttering is a direct cause of social anxiety throughout one’s entire life.
Getting more specific, Dr. Iverach writes that, “One of the main characteristics of social anxiety is the fear of negative evaluation or the fear of being judged. Children and adolescents who stutter may be the targets of bullying, not only due to their stuttering but also in response to their displays of anxiety and nervousness.”
We all know that children will pick on each other for even the tiniest reason. And who could be a more inviting target to bully than the kid who is incapable of getting a sentence clearly out of his mouth? Sound like a perfect recipe for bullying?
Dr. Iverach has the following recommendation. She suggests that speech therapy to correct the stuttering, while undoubtedly necessary, may not be sufficient — the child who stutters needs treatment for the growing social anxiety that will invariably be suffered as collateral damage. In other words, the concerned parent must address the psychological facet of stuttering in tandem with the speech problem. In most cases, this will mean some mental health therapy to address the related psychological issues of the child.
Therefore, based upon the most cutting-edge scientific research, the increased anxiety during COVID-19 is not expected to spawn a marked uptick in stuttering. How quarantining, isolation and social distancing may impact children who already stutter due to these communication constraints is still an open question.
Help Your Students Cope with the Crisis
The response to the COVID-19 Pandemic is unprecedented. Because of our unique role in children’s K-12 education, including online speech therapy, we feel a responsibility to do what we can to assist schools, therapists, and students with this transition to online learning and seclusion. To ensure that our students remain engaged and supported, our therapists are providing complimentary “Support Sessions” to the country’s youth. We are also assisting schools by training their therapists for remote therapy.