Do girls & women cope with stammering differently to boys & men?

Speech & language pathologist (SLP) Ineke Samson tests her theory that girls/women are more likely than boys/men to hide their stammer as a coping strategy. It might, she says, partly explain the statistic of why more men than women stammer. 

Ineke carried out research which highlights how the stammering experience for teenage girls may be different to teenage boys. She describes two of her recent studies below, which may be of particular interest if you're a speech & language therapist working with teenagers who stammer. 

Before we hand over to Ineke, here's a few things to note: Ineke's based in Sweden, so she uses the term 'stuttering' rather than stammering. Ineke also wanted to point out as a disclaimer that the collected data was analysed as a group, so individual participants may not always show the same pattern as the group averages. Therefore, we shouldn't assume that these findings will apply to all teenagers across the board.

Anyway. Over to Ineke… 

Concealing a stutter

I'm Ineke Samson and I've been working with children, teenagers and adults who stutter for almost 20 years. I knew that it wasn't unusual for people who stutter to hide or minimise moments of stuttering by speaking less or avoiding certain words or situations. However, in my experience, this coping strategy seemed to be particularly common in girls and women. 

I became concerned that girls might tend to hide their overt stuttering behaviours differently from boys so they can pass as being fluent. By 'overt' I mean stuttering that is obvious to listeners. 

What stuttering research tells us is mainly based on findings from men who stutter. There is a risk, therefore, that the stuttering experience in women is overlooked since it may be expressed in other ways.

This couldn't be confirmed with scientific evidence, since it is an area that is largely unexplored in research. We didn't know whether there are differences between the way girls and boys experience and cope with stuttering. Nor did we know how coping strategies develop during childhood and adolescence if you are a girl or a boy. I decided this was an area I really wanted to explore within my research at the Karolinska Institute in Stockholm. 

Why is it important?

These points are important because the fact remains that statistically, fewer women than men stutter and for this reason women are less likely to be included in research. This means that, in general, what stuttering research tells us is mainly based on findings from men who stutter. There is a risk, therefore, that the stuttering experience in women is overlooked since it may be expressed in other ways.

• 'As a teenager I concealed my stammer. Boys were out of the picture back then because I was so insecure.' Read Shiran's story

Testing the theory

So far, my team has completed two studies* investigating the impact of stuttering on teenagers. Our aim was to see if there were any differences in the way girls and boys experience and react to stuttering. In the studies, we gave questionnaires to a group of teenagers and filmed them talking about their experiences. We also asked them to rate the severity of their stammers, which we compared to ratings from SLPs. If you want to read about the tests and how we conducted them, see the header 'Details of My Studies' below, but here's a summary of our findings:

• There was a gender difference in the way stuttering impacted quality of life. It had a greater negative impact on quality of life for girls than it did for boys. 
• There was a link between how the teenagers rated their own stuttering and the impact it had on their quality of life. The more severe they thought their stuttering was, the greater was the negative impact on their quality of life.
• There was a difference between how severe the girls rated their stutter and how severe SLPs rated it. For boys, these ratings were more likely to match.

The results showed that girls had greater emotional reactions than boys to communicating. They reported that they felt more lonely and isolated because of the difficulty they experience in social interactions. They were also less confident in their speech, being more likely than the boys to allow someone else to talk for them and to find that stuttering stopped them from saying what they wanted to say. We did not find these gender differences among the non-stuttering teenagers. The responses of the teenagers who stuttered were in general more negative than those who didn't stutter.

Why are there gender differences? 

When thinking about possible reasons for these differences, let's explore it in a wider context.

In other research fields, a similar gender gap has been found. For example, in a population survey on mental health in schoolchildren in Sweden, almost twice as many 13-year-old girls as boys reported mental health problems (52% among girls and 28% among boys). Those numbers were even higher for 16-year-olds (62% and 35%, respectively) (Public Health Agency of Sweden, 2021).

Other research shows that women tend to have lower self-esteem than men (Bleidorn et al., 2016). The difference between females' and males' levels of self-esteem seems to emerge in late adolescence and persist until early and middle adulthood when that difference becomes smaller (Orth & Robins, 2012). Why is not yet clear, but theories include both biological differences (for example hormonal influences) and socio-cultural factors (such as socially-learned gender stereotypes). 

What an SLP sees and hears of overt stuttering behaviour, especially in girls, doesn't seem to tell us how much impact the stuttering has on the person. So, it is wise for SLPs/SLTs to be particularly careful to explore these issues when working with teenagers.

So why might there be gender differences in the impact of stuttering? It may have emerged because of gender roles, with different performance expectations for girls and boys. Are there higher standards and is more pressure placed on girls? Are the overt stuttering symptoms less pronounced for girls, and easier to cover?

Perhaps the more negative impact of stuttering in girls is due to the lack of representation and contact. Could it be that girls who stutter very rarely or never meet other girls who stutter, whereas it might be more common for a boy to see, hear or know another boy who stutters? Having no-one to relate to can lead to feelings of isolation and sadness, and a bigger responsibility to try to come up with your own solutions. This, in turn, could lead to stuttering impacting girls in a different way from boys.

I also want to point out that there may be cultural differences at work. My research was done in Sweden, so we don't know if the findings in my studies have been impacted by cultural factors specific for a Swedish context. It may be that Swedish girls and women who stammer are more stigmatised and thereby have a more negative attitude to stammering than women in the UK.

What should we take from this?

The findings of my research show us that stuttering may have a greater impact on teenage girls in their daily life than boys. They also suggest that what an SLP, or speech & language therapist (SLT) in the UK, sees and hears of overt stuttering behaviour, especially in girls, doesn't seem to tell us how much impact the stuttering has on the person. So, it is wise for SLPs/SLTs to be particularly careful to explore these issues when working with teenagers.

At the moment, knowledge of stuttering and gender differences in general, and gender differences specifically for this age group, is limited. My hope is that these findings will improve the support available to young people and especially to girls who stutter, from parents, teachers and caregivers. 

What do you think of Ineke's research? We'd love to hear your thoughts, opinions and experiences. Email editor@stamma.org

Read Shiran's article: 'My multiple identities as a woman who stammers'. Find out how you can Share Your Story too.

Details of My Studies

The following descriptions explain how Ineke and her team collected information and what they were looking for. If you'd like to read about her studies in full, as well as more about the findings, visit the PubMed.gov website.

Back to Ineke...

Study 1: The experience of stuttering

Our aim with our first study was to see if there were any differences in the way girls and boys experience and react to stuttering. We measured the experience of stuttering using a questionnaire called OASES, which is short for the 'Overall Assessment of the Speaker's Experience of Stuttering'. This was developed by Yaruss & Quesal in 2006. It has 80 questions that evaluate the overall impact stuttering has on the person's life. For example, it asks:

• "How often do you not say what you want to say because you might stutter (eg, change words, not answer questions, or order food you don't want because it is easier to say)?" and
• "When you think about your stuttering, how often do you feel isolated or lonely (like nobody understands what you are dealing with because of your speech)?" 

The person is asked to respond with a rating from 0 to 5 (0 meaning 'never' and 5 meaning 'always').  

We wanted to compare the attitudes of teenagers who stutter with those who do not stutter, so we also created an adapted version of the questionnaire called 'Attitude to Speech and Communication' (ASC) and looked for participants who don't stutter to take part too. In total, 56 teenagers who stutter completed OASES and 233 teenagers who don't stutter completed ASC.

Study 2: Does stuttering severity make a difference?

In the first study, we didn't consider the severity of stuttering symptoms when we examined life impact of stuttering. So, we decided to repeat the study, this time including some measures that would help us understand how stuttering severity (both as perceived by the person and by experts) correspond to impact on quality of life. 

A new group of 35 young men and women who stutter took part in the second study. Again, we used the OASES questionnaire to investigate how they felt stuttering impacted on their life. As well as this, we asked them to rate on a 6-point scale how severely they stutter in different speaking situations. We also filmed each of them talking about an everyday topic and showed these films to three experienced speech & language pathologists to evaluate how much they overtly stuttered. We did this to see how closely it matched with how severely each person thought they stuttered.

Again, for full details of Ineke's studies, including more about their findings, see the PubMed.gov website.

References

Bleidorn, W., Arslan, R. C., Denissen, J. J., Rentfrow, P. J., Gebauer, J. E., Potter, J., & Gosling, S. D. (2016). Age and gender differences in self-esteem — A cross-cultural window. Journal of Personality and Social Psychology, 111(3), 396. 

Orth, U. and Robins, R. W. (2014). The Development of Self-Esteem. Current Directions in Psychological Science: a Journal of the American Psychological Society, 23(5), 381–387. https://doi.org/10.1177/0963721414547414

Public Health Agency of Sweden (Folkhälsomyndigheten). (2021). Psychosomatic disorders among school children. Retrieved in July 2021 from the Public Health Agency of Sweden website. (Hopefully your browser should automatically offer to translate the page, so when prompted, click English to read it).

*Samson, I., Lejon, S., Lindström, E., Sand, A., Herlitz, A., & Schalling, E. (2021). Sex differences in life impact of stuttering when controlling for objective and subjective stuttering severity. Manuscript under review.

Yaruss, S. & Quesal. R,. (2006). Assessment of the Speaker's Experience of Stuttering (OASES). Journal of Fluency Disorders, 67, 105822.

(Top images courtesy of Unsplash)