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What are the Different Aspects of Stuttering that Influence Each Other

Shelley B. Brundage, PhD, CCC-SLP, BCS-F, ASHA Fellow

August 15, 2023



What are the different aspects of stuttering that influence each other in complex ways?


Stuttering involves affective, behavioral, and cognitive aspects that interact in complex ways (Bloodstein, Bernstein Ratner, & Brundage, 2021). The affective reactions to the challenges of stuttering can lead to speaking-related fear and anxiety. This might involve fear of stuttering in certain speaking situations or worrying about how listeners will react to the stuttering. The behavioral aspects of stuttering include stuttered speech, muscular tension, and secondary behaviors. These behaviors can be influenced by the affective reactions, as fear and anxiety may increase muscular tension and make stuttering more likely. Cognitive aspects of stuttering involve anticipation, avoidance, and attitudes about one's communication skills and stuttering. For instance, a person who anticipates difficulty in a particular speaking situation may avoid it altogether. These cognitive factors, in turn, can be affected by negative listener reactions, leading the person who stutters to further avoid certain speaking situations. This interconnectedness of affective, behavioral, and cognitive aspects can result in negative psychosocial impacts over time, especially in the lives of children who stutter.

This Ask the Expert is an excerpt from the course, 20Q: Consensus Guidelines for the Assessment of Stuttering Across the Lifespan, authored by Shelley B. Brundage, PhD CCC-SLP, BCS-F, ASHA Fellow.

shelley b brundage

Shelley B. Brundage, PhD, CCC-SLP, BCS-F, ASHA Fellow

Shelley B. Brundage, PhD, CCC, BCS-F, Fellow-ASHA, is professor and chair of the Department of Speech, Language, and Hearing Sciences at the George Washington University (GWU). She is a certified SLP and a board-certified specialist in fluency disorders. Her research addresses clinical questions that enhance the lives of persons who stutter, by improving procedures for assessment, treatment, and clinical education in stuttering. Recent work has merged her expertise in assessing student learning outcomes with her expertise in the development and use of virtual reality technologies; this work has led to a number of grants, publications, and awards for innovation. She teaches graduate courses on stuttering and research methods and is the recipient of numerous awards for teaching excellence and mentoring. She is the co-author of two books, the seventh edition of A Handbook on Stuttering and Writing Scientific Research in Communication Sciences and Disorders. 

Related Courses

20Q: Consensus Guidelines for the Assessment of Stuttering Across the Lifespan
Presented by Shelley B. Brundage, PhD, CCC-SLP, BCS-F, ASHA Fellow


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The rationale and methodology for assessing six core areas in school-aged stuttering children are described in this course. These areas include stuttering-related background information; speech, language, and temperament; speech fluency and stuttering behavior; reactions of the speaker and of people in the environment to stuttering; and adverse impact of stuttering.

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This is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)

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This course is Part 4 in a four-part series. It will provide an overview of stuttering peer support communities and the clinical importance of incorporating community experience into therapy. Current research and practical application questions will address goal writing, SLP roles and responsibilities, and common challenges connecting therapy to the community. Case studies will be shared to highlight assessment and treatment across various age ranges. (Part 1 - Course 9278, Part 2 - Course 9286, Part 3 - Course 9301)

20Q: Early Childhood Stuttering: Less-Direct and More-Direct Treatment
Presented by J. Scott Yaruss, PhD, CCC-SLP, BCS-F, Nina Reardon-Reeves, MS, CCC-SLP, BCS-F


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This course addresses key issues in the treatment of early childhood stuttering, with a focus on less-direct and more-direct treatment approaches. The course will discuss ways that clinicians can draw upon various approaches to develop individualized treatment so that each child’s and family’s individual needs are addressed.

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