NHS Stammering
Network

In adulthood, estimates indicate 1%-3% of the adult population experience lifelong stammering (stuttering), with stammering four times more common in men than women. Stammering is a neurodevelopmental variation that leads to an unpredictable and unique forward execution of speech. In more than 90% of cases, stammering begins early in childhood with no apparent cause when children acquire speech and language skills (developmental stammering); for others (and much more rarely) stammering is acquired later in life, such as following a brain injury.

Traditionally, stammering has been understood from a medical perspective and defined as a ‘speech disorder’. As such, the behaviours associated with stammering are viewed as interruptions to and ‘deviations’ from the natural flow of speech. This locates the problem of stammering with the individual and results in therapy approaches that work primarily with individual differences or deficits. The focus might be learning strategies to reduce tension when speaking, managing stress and anxiety, becoming more accepting to and open about stammering or responding effectively to unhelpful attitudes towards stammering from others.

The disability rights movement has led us away from understanding disability as an individual defect, but rather as a form of social discrimination against certain types of human variation. From a social model and neurodiversity perspective, stammering is affirmed as a natural form of human diversity and as such a different, legitimate and valuable way of speaking. Taking this premise, stammering is only a problem because today’s culture values fluent speech. The dysfluency pride movement questions and challenges the current fluent values of society and takes a much more empowering view of stammering. It also calls for therapy to address the attitudinal, environmental and structural barriers that people who stammer encounter in today’s society.

In order to reflect these alternative perspectives, we use varying language and ways of referring to stammering, deferring to the individual on how they wish their stammer to be talked about.

Everyone’s stammer is unique. Some people’s stammering is more visible or ‘overt’, whereas for others it is less obvious (and ‘covert’ or ‘interiorised’. While the nature of stammering varies considerably among people, common stammering behaviours include repetition or prolongations of syllables and blocking on words and sounds. Additional, secondary behaviours may be verbal (such as adding extra sounds or words to delay moments of stammering e.g. ‘er, er, er’ or ‘um, um, um’) or non-verbal (such as blinking, losing eye contact, throat clearing, facial or body movements). Avoidance of stammering is another key feature and can occur at many levels, including word avoidance or switching, choosing to stay quiet and to not speak or to avoid a feared situation or relationship.

Unhelpful and often unrealistic societal views and expectations on what it means to be an ‘effective’ communicator means that in work contexts people who stammer risk being perceived by others (and themselves) as less competent or unprofessional compared to more fluent speaking colleagues. This is often reinforced by a lack of representation of different speaking styles in the media and society’s unconscious bias towards fluency. This can place significant pressure on people who stammer to be more fluent when speaking in order to feel heard, valued and respected.

There are a wide range of other communication differences which can impact work, some of which may involve a language component as well as speech. These include aphasia (commonly caused by injury to the brain, such as stroke), dysarthria (caused from acquired brain injury and degenerative muscle and motor conditions), selective mutism, cluttering (rapid, irregular and disorgansied speech), spasmodic dysphonia (involuntary movement of the vocal cords when speaking), or other physiological conditions (throat cancer, polyps and other growths on the vocal cords). In fact, it has been suggested that communication impairments form the largest group of people living with disabilities in the United Kingdom, with 14m people affected at some point in their lives.

Staff who experience work difficulties due to these communication differences should consult their local NHS occupational health (OH) department, medical specialist or adult speech and language team for confidential specialist assessment and advice. You may also find helpful advice from the relevant charities (such as Communication Matters , Stroke UK or the MS Society).

Please get in touch with us if you experience one of these communication differences as we may be able to link you up with colleagues with shared personal experience. We can also support you and others in setting up your own network.

For some, stammering can have little (if any) impact on daily life at work, but, for others, it can have a significant impact on job performance, job satisfaction, and career progression. The impact of stammering on work is likely multifactorial and may be due to the employee who stammers feeling reluctant to take on opportunities that might appear to demand more speaking responsibilities and/or managers/others making assumptions about an individual’s abilities/aspirations based on their speech.

The workplace environment can create particular daily challenges and frustrations for staff who stammer, often caused by pressure (from self and others) to meet temporal and fluency norms and expectations in this context. Stammering can often be met with negative, stereotypical and discriminatory attitudes and perceptions, including ideas around that person as less competent, less professional and less effective as a communicator.

These micro- or macro-aggressions may be expressed openly or more subtly, such as talking over someone, or not choosing people who stammer to present or for promotion. For some, this can erode self-confidence and self-esteem at work and lead some to question their professional identity and their capability to perform their job role at the required level.

This can result in attempts to minimise stress and anxiety or compensatory behaviours such as putting more effort into performing well in other areas of work. This can lead to an increase in stress and anxiety, and feelings of embarrassment in challenging speaking situations in the workplace such as:

• Meeting and interacting with people in the workplace (patients, colleagues etc)
• Introductions
• Speaking up and contributing to meetings
• Public speaking e.g. delivering presentations and training
• Speaking with people of authority
• Using the telephone, online platforms (Skype, Teams) or other voice activated devices (Dictaphone, Intercom, conference calls)
• Performance appraisals, workplace assessments and oral examinations
• Job interviews
• Speaking with a face mask

While some people may experience workplace difficulties due to their stammer, it is important to highlight that stammering has enabled many people to develop personal qualities, strengths and skills which are highly valued in the workplace, such as being more adaptable and resilient, possessing quality listening skills and written communication skills and generally being more empathic to the needs of others – the foundations and building blocks for creating a positive and supportive workplace culture and environment. It is also important to point out that many people who stammer have achieved very successful and rewarding careers in the NHS.

Some people who stammer consider themselves as disabled, however some people who stammer do not identify in this way. It is a personal choice. Despite this, it is important to be aware that under UK legislation (Equality Act 2010), stammering is recognised as disabling ‘if this has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities’ (including work activities). This provides important legal protection for individuals who stammer.

You can read more about the The Equality Act 2010, discrimination and stammering here. 

You can access additional practical advice, information and resources on how to thrive at work with a stammer from the British Stammering Association (trading as Stamma).