Study reveals gaps in stuttering assessment and treatment

Variability in an individual’s stuttering pattern has long posed challenges for speech-language pathologists (SLPs) when treating clients, but new research led by Charles Darwin University (CDU) and Michigan State University (MSU) has identified the gaps in clinical practices and how to address them.

The study, which observed 143 SLPs who reported practicing and being certified in the United States, found clinicians consistently observed changes in a client’s stuttering from appointment to appointment, but generalist practitioners were more likely to rely on reactive management than their expert counterparts.

Long-standing gaps in clinical education play a major contributing to factor to this issue, with more than half of graduate students in the US completing their training without acquiring placement hours specifically dedicated to stuttering assessment and treatment.

CDU Lecturer of Speech and Language Therapy Dr Hamid Karimi said broadening SLPs understanding of stuttering could be as simple as increasing specialised education early.  

“Specialised education grounded in evidence-based practice helps SLPs understand that stuttering extends far beyond visible speech symptoms,” Dr Karimi said.  

“By encouraging a holistic view – incorporating the emotional, social, and participation aspects – coursework equips clinicians to assess and address variability more comprehensively and effectively in everyday practice.”

Armed with this knowledge, the specialist SLPs involved in this study were more likely to examine an individual’s stuttering experience beyond observable appointments through interviews with parents and teachers.

Study lead author and MSU PhD candidate Amir Hossein Rasoli Jokar said the more holistic view of a patient’s day-to-day stuttering variability would enable SLPs to provide more balanced and effective therapies using stable, long-term objectives combined with short-term tactics.

“A holistic approach is essential because stuttering variability is not just about changes in speech that we can hear in a clinic setting — it also involves changes in how people think, feel, and engage in communication across different situations,” Mr Rasoli Jokar said.

“If we rely only on brief clinical observations, we risk overlooking how much a person’s experience may fluctuate throughout their daily life, including in school, work, or social interactions.”

“By broadening assessment to include these emotional, cognitive, and participation-related aspects, clinicians can better understand the full impact of stuttering variability and provide care that is more aligned with the person’s lived experience.”

Dr Karimi said CDU’s own speech pathology curriculum was being updated to reflect the study's findings, with significant modifications being incorporated into students’ training from 2026.  

“While learning fluency-shaping techniques remains valuable, comprehensive preparation requires more than addressing physical symptoms alone,” he said.

“At CDU, we already provide valuable opportunities through simulated clients and direct input from people who stutter, but we can strengthen this further by deepening discussions on the biopsychosocial model of stuttering, balancing evidence-based practice with neurodiversity principles, and exploring how personal and environmental factors influence variability and everyday participation.  

“Educating society to view stuttering as a difference rather than a deficit is also essential to support inclusion.

Addressing Stuttering Variability in Assessment and Treatment: Perspectives of Speech-Language Pathologists was published in the American Journal of Speech-Language Pathology.