You see it in films and read about it in books. You remember it from high school and may continue to experience it: social anxiety. It’s normal to worry about what others think of us. This issue is particularly prevalent among people who stutter. Across several recent studies, around 22-60% of stuttering adults met the criteria for a diagnosis of social anxiety disorder. Individuals with this long-term, highly distressing condition experience intense fear of negative judgements from others in social settings or performance-based situations.
Social anxiety disorder typically interferes with daily activities, restricts educational and occupational achievement and thereby influences socio-economic status. It’s also linked to depression and substance abuse. Onset is generally between 8 and 15 years of age, when social connections become more important and we become more susceptible to social embarrassment.
But how early do these worries really start and what do they stem from? Non-stuttering preschool children have been shown to perceive stuttering negatively and “may sometimes ignore, interrupt, mock, and walk away from stuttering children.” At school, children who are stuttering often face greater communication difficulties and consequences as communication becomes increasingly important in the classroom and playground. A child stuttering may be considered less popular and less likely to be a leader, and be bullied more than his peers. Negative experiences may also affect “communication competence, self-esteem, social development, and even romantic attractiveness.”
A recent Australian study found that the stuttering children demonstrated much higher social anxiety, total anxiety, and internalising* and externalising** problems than non-stuttering peers. A significantly higher rate of subclinical generalised anxiety disorder (GAD) was also noted in children who stutter. While these individuals did not meet the criteria for GAD, it means they still experience a lot of anxiety and worry, which may impair daily functioning. These children may need monitoring or early intervention to reduce the possibility of symptoms worsening over time. However, it’s important to note that all scores (anxiety, emotional and behavioural problems, symptoms of depression, experience of bullying) for the stuttering children fell within the normal range.
Not all children, adolescents and adults who stutter show extreme levels of anxiety. An individual who stutters and has anxiety might find anxiety only arises in certain speaking situations. Unfortunately, many characteristics of social anxiety – poor eye contact, limited social skills, avoidance of social situations – maintain fear of social encounters by lessening opportunities to develop and practise social skills. It also reduces the frequency of positive social interactions. Without intervention, stuttering children with social anxiety disorder may be more likely to develop the same chronic social, emotional, educational and occupational difficulties experienced by adults who stutter.
People who stutter may experience negative evaluation throughout their lives, compounding fears and creating a vicious cycle. So what can we do to help?
– By reading this, you are more aware of the potential for young children who stutter to experience anxiety, which can become chronic.
– Discuss with your speech pathologist how your child’s mental health and wellbeing will be addressed in therapy and whether input from a child psychologist or similar could help.
– Find groups of families with children who stutter, as they can be a great support for your child and you.
Vince Borg has a special interest in child speech issues, especially child stuttering. Book your child an appointment with Vince or one of our other friendly speech therapists at Box Hill Speech Pathology Clinic on (03) 9899 5494 or direct your child speech therapy questions to firstname.lastname@example.org.
*Internalising problems are those directed towards or within the self, eg. internalised negative emotions, anxiety.
**Externalising problems refer to problems directed towards the external environment, eg. conflict with others, conduct problems, hyperactivity or inattention.
Iverach, L., Jones, M., McLellan, L. F., Lyneham, H. J., Menzies, R. G, Onslow, M., & Rapee, R. M. (2016). Prevalence of anxiety disorders among children who stutter. Journal of Fluency Disorders, 49, 13-28.
By Nicola Anglin (Speech Pathologist)