Stammering

Understanding the Impact of the COVID-19 pandemic on the lives of People who Stammer

The COVID-19 virus has resulted in a wide number of changes in our behaviour to reduce the spread of infection. Some of these changes impact on how we communicate with each other. Wearing facemasks, for example, changes our interactions since we are no longer assisted by lipreading and facial expression. Video-calling (e.g., zoom meetings, facetime) can also change the way we interact and make it more difficult to use non-verbal cues to indicate when we want to speak. In contrast a ‘chat’ box on a virtual platform potentially reduces pressure on communication.

Little is known about how these changes to the way we communicate affect people with speech, language, and communication differences. One group who could be uniquely impacted are people who stammer (also known as stuttering). For example, some people who stammer may find wearing masks and using virtual meeting makes speaking easier whilst others could find communication more stressful and difficult. An increase in challenges faced by some people who stammer may lead to an increase or change in contact with speech and language therapy (SLT) services, and with charity support services.Little is known about how these changes to the way we communicate affect people with speech, language, and communication differences. One group who could be uniquely impacted are people who stammer (also known as stuttering). For example, some people who stammer may find wearing masks and using virtual meeting makes speaking easier whilst others could find communication more stressful and difficult. An increase in challenges faced by some people who stammer may lead to an increase or change in contact with speech and language therapy (SLT) services, and with charity support services.

What we did

We collaborated with the Royal College of Speech and Language Therapists and the STAMMA charity, on this project, which gathered the experiences of people who stammer, to learn about the impact of COVID-19 on their lives. The project had 3 parts:

  • a survey of the experiences of adults who stammer living in the UK
  • an analysis of how contacts to STAMMA support services changed during COVID-19
  • an analysis of outcomes recorded on the RCSLT Online Outcome Tool (ROOT) during the pandemic, compared to the pre-pandemic period.

What we found

We have now completed the analysis of 97 survey responses, 1912 contacts to STAMMA support services and 105 episodes of care from the RCSLT Online Outcome Tool, which has given us a comprehensive overview of the experiences of people who stammer during the COVID-19 pandemic. Our main findings are:

  1. Most people who stammer have experienced an increase in stammering and in anxiety during the pandemic.
  2. Changes in our interactions, such as using face masks and video calls, have increased anxiety and reduced participation, in particular for women and younger people.
  3. Contacts to STAMMA support services have increased overall:
      1. particularly around education concerns, emotional support and accessing SLT
      2. particularly from parents of younger children
  4. Fewer episodes of SLT intervention were recorded during COVID-19, and the length of interventions was shorter.
  5. However, when SLT intervention was provided, it was as effective as SLT offered before the pandemic.
  6. Professionals (including employers, teachers and Speech and Language Therapists) have contacted STAMMA less for support. This could reflect overall pressures during COVID reducing the perceived priority of stammering support.
  7. Strategies to manage the challenges of COVID-19 have included telling others about their stammer to increase awareness and empathy, and encouraging use of visuals (e.g., raising a hand) and chat functions in video-calls.
  8. The increased awareness of communication, and of mental health, during COVID-19 has helped support the increased understanding of challenges faced by people who stammer.

Our Recommendations

From these findings, we have produced recommendations to better support people who stammer following the COVID-19 pandemic, and during future similar events:

  • Work and education settings should support reasonable adjustments for people who stammer when remote working, where this continues in the longer-term, to reduce the negative impacts on participation and mental health
  • Support offered should take account of individual needs and recognise the impacts on specific groups such as women and younger people.
  • Increased awareness of good communication practice, particularly in remote working, will be helpful for people who stammer as well as people who do not.  Considering the structure and ‘etiquette’ of video-call interactions will likely benefit anyone who uses video-calls for work or social reasons.
  • Specialist SLT services have a key role to play in reducing the negative impact of the COVID-19 pandemic on people who stammer.  Services require adequate funding and staffing to meet this need.
  • When planning future SLT provision for people who stammer, Clinical Commissioning Groups should consider the increased need related to the:
  • well-known relationship between stammering and social anxiety.
  • increased concern about early communication development in pre-school years. 
  • Charities like STAMMA are key in providing information and resources about stammering. They also represent a community, who offer invaluable peer support for people who stammer and expertise in raising awareness and educating others about stammering.

The need for support during and transitioning out of the pandemic is clear from the increased demand on STAMMA support services. Funding for this continued work is essential.

  • A more comprehensive examination of access to SLT during COVID-19 (for example, an audit of stammering services referrals and attendance) is recommended.

Identifying areas of increased inequity accessing SLT, and considering the factors driving this trend, will be important to ensure that all people who stammer are able to receive the necessary support to mitigate the effects of living through the pandemic.

  • The period of transition out of the pandemic is an important opportunity to capitalise on the increased general awareness of the impacts of communication barriers, anxiety, and social isolation. 

Stakeholders (SLT services, charities working with people who stammer, employers, educational institutions, researchers etc) can work in partnership to further promote awareness and understanding of stammering.

 

Our full report provides more information on the project and our findings.  We have also produced the above animation about the project.

If you would like to get in touch to discuss the project or to provide feedback, please email jennifer.chesters@nbt.nhs.uk.

We will share further work from this project here, and on our Twitter account @Bristol_SLTRU

  • We would like to thank our involvement group of people who stammer and speech and language therapists, for their valuable contribution to developing the survey.
  • PolicyBristol provided support to develop our briefing document and hosted the consultation event where we shared our preliminary findings.
  • Thanks also to all who attended the consultation event and provided useful comments which we have integrated into this report.
  • We worked in collaboration with Clare Williams, University of Bristol, on the animation. Ronan Miller, at Benetalk, and Kirsten Howells, at STAMMA, co-developed the animation script and provided the narration. We are very grateful to Clare, Ronan, and Kirsten for their valuable contributions.
  • This project was funded by the Underwood Trust for research.

The project was funded by the Underwood Trust for research, and the Principal Investigator was Dr Yvonne Wren.

The full report will be added to this web page once it has been published.