One of the first questions that people ask us when they learn about viewing stuttering from a neurodiversity perspective is this: "if stuttering is verbal diversity, then is it still a disorder?"
We're always glad when people ask this question, because it gives us the opportunity to clarify some of the terminology that can be confusing for clinicians and caregivers alike. These discussions about terminology can enhance our understanding of the life experiences of those who stutter.
It turns out that the specific terminology that we use when talking about stuttering is dependent upon the context of those discussions. That is, we might use different words in medical or legal contexts than we use in the sessions with our clients. Using the right words in the right contexts can help to represent different ways of viewing stuttering.
So, let’s start by defining some terms:
Defining “difference” and “disorder”
Stuttering is a disorder. A “disorder” is typically defined as a condition in which physical or mental functions are impaired. People who stutter have a neurological mechanism for language formulation and speech production that result in moments when they know what they want to say but have difficulty saying it. This difficulty may result in disruptions in the flow of speech, or “speech disfluencies,” that are often referred to as moments of stuttering.
Given this, it is entirely understandable that stuttering has traditionally been defined as a disorder of speech production, and this is the term that is often used in medical, clinical, and legal settings in order to provide a diagnosis or demonstrate a student’s eligibility for therapy.
Stuttering is a difference. Viewing stuttering from the perspective of neurodiversity gives us the opportunity to add to the medical perspective by recognizing that the neurological differences in people who stutter reflect a variation or difference in the way that people’s speaking abilities develop.
The goal of describing stuttering as a difference is to endorse a neurodiversity-affirming view of stuttering. Doing so does not mean that we cannot help people who stutter. It also does not mean that we have simply decided that stuttered speech is the same as non-stuttered speech.
Rather, the goal is to say that stuttered speech does not need to be seen as inherently bad or wrong. We can instead view stuttering as just one of the many ways that human beings can speak. In other words, regardless of its origins, stuttering can be seen as a difference in how people talk.
Stuttering can be described as a difference AND as a disorder! It is perfectly appropriate for clinicians to check the “fluency disorder” box in their clinical assessment of a person who stutters, because the term reflects the fact that the neurological system of a person who stutters is different from the neurological system of a person who does not stutter. This helps to ensure that people who stutter get the services they are entitled to in medical and clinical settings.
At the same time, clinicians can adjust the language that they use when talking about stuttering in other contexts, so as not to over-emphasize the traditional view that stuttered speech is atypical. When we describe stuttering as a difference or variation in how people talk, we help to normalize stuttering, both for people who stutter and by society as a whole, and thereby reduce the stigma that people who stutter too often face.
How does “disability” fit into all of this?
“Disability” is the legal term that is used to refer to the challenges or problems that a person might experience in their lives due to a difference or disorder. For people who stutter, these problems may include negative emotional or cognitive reactions to the sensation of getting stuck while talking, physical tension or struggle during moments of stuttering, avoidance of speaking situations, negative reactions from other people who stigmatize or bully or discriminate against those who stutter, difficulty communicating in real-world situations, and an overall adverse impact on quality of life.
For a review of the potential areas of impact of stuttering on a person’s quality of life, see our blog (which has links to even more resources) on the importance of understanding the International Classification of Function, Disability, and Health from the World Health Organization.
Stuttering may be a disability. Regardless of whether one is discussing stuttering as a disorder or as a difference, all of the negative consequences that a person might experience in their life because of stuttering are properly defined as the stuttering disability. This term is especially important to use in settings where qualification for therapy is dependent upon how a person is diagnosed. In the U.S. public schools, for example, a determination of disability is required in order for a student to receive therapy.
Confusion has arisen in our field, however, because many people (including the author of this post) have tended to use the words “disorder” and “disability” interchangeably. This is due, in part, to the fact that the word “disability” can evoke strong reactions of its own. Still, it is the appropriate legal term that describes the challenges that people may face in their lives due to a difference or disorder, and so it is important to understand when and how it should be used.
If a person is experiencing negative consequences associated with their stuttering, then they do have a disability and should be qualified for therapy. This is the situation that most people who stutter face when they come for a clinical evaluation. Therefore, most of the time when clinicians evaluate people who stutter, they will identify some adverse impact (disability), and that will become the focus of therapy.
If a person is not currently experiencing adverse impact—and if the clinician can document this through an appropriate assessment—then that person does not have a disability and should not be qualified for therapy. In other words, the simple fact that a person stutters does not mean that they need therapy—a comprehensive evaluation is required in order to make that determination, but that’s a topic for another post.
Words matter
While it often is necessary to categorize stuttering as a disorder in clinical and medical contexts, we believe that it is beneficial to also view stuttering as reflecting a difference in speech production, that is, an example of neurodiversity. That is why we say, “stuttering is verbal diversity,” and why we work to create a society that is more accepting of stuttering and of people who stutter. This, in turn, can help to reduce some of the stigma that people who stutter commonly face.
For more information on viewing Stuttering as Verbal Diversity, see our website www.VerbalDiversity.com. Be sure to bookmark the site, as we are always expanding these resources.
