Western Michigan University, 2022 New Investigators Research Grant
Real-time Assessment of Daily Discrimination Experiences and Mood States Among Adults Who Stutter
Tell us a bit about this study.
For this study, we recruited 53 adults who stutter to participate in an ecological momentary assessment study, which allowed us to examine listener reactions as they occurred in participants' everyday lives. Each participant attended a baseline session where they learned how to use the study app, received training on different types of listener reactions, and completed questionnaires, including measures of concealment and self-stigma.
Participants then completed six brief surveys per day for seven to 10 days. At each survey, they reported whether they had experienced different listener reactions to their stuttering since the previous assessment, such as being interrupted, stared at, looked away from, mocked, or laughed at. They also reported their current levels of anxiety and depression.
This design allowed us to examine whether experiencing listener reactions was associated with changes in mood in daily life. It also allowed us to explore whether those effects differed based on characteristics measured at baseline, such as how much a person conceals their stuttering.
We found that more frequent listener reactions were associated with increases in anxiety and depression. We also found that the emotional impact of these experiences differed depending on how much a person concealed their stuttering. Adults who reported higher levels of concealment experienced larger increases in anxiety and depression following listener reactions than adults who were more open about their stuttering. In other words, the same types of listener reactions appeared to affect people differently depending on how much effort they were putting into hiding their stuttering.
Overall, the findings suggest that listener reactions can have meaningful consequences for emotional well-being in daily life and that adults who stutter and engage in high levels of concealment may be especially vulnerable to those effects.
What sparked your interest in this research?
I have been interested in environmental influences on the lived experience of stuttering since I first started my career as a master's student in speech-language pathology. When I worked with adults who stutter, I noticed that although we often spent time working on speech itself, many of the things people found most difficult about stuttering involved how they were treated by others. People frequently shared stories about negative listener reactions—being interrupted, judged, or otherwise made to feel uncomfortable when communicating. Those experiences often seemed to affect not only how they felt about themselves, but also how easy or difficult it was for them to speak.
The motivation for this specific study came from recent survey research showing that people who stutter do experience mistreatment and negative listener reactions over the course of their lives. At the same time, I wondered whether traditional surveys might underestimate how often those experiences occur. Based on my time learning from the stuttering community, I suspected that many listener reactions happen during everyday interactions and may not always be remembered when people are asked to reflect on long periods of time.
That led us to use ecological momentary assessment, which involves asking people to report experiences as they happen in daily life. Because the reports are collected in real time, this method is less affected by recall bias and provides a more detailed picture of what people experience from day to day.
One of the most interesting things we learned came after the study was completed. During debriefing, several participants told us they had not realized how frequently they encountered negative listener reactions until they began paying attention to them during the study. In some cases, experiences such as being stared at, interrupted, or having people look away had become such a routine part of daily life that they no longer consciously noticed them. That reinforced for me the value of studying these experiences as they happen rather than relying solely on retrospective reports.
What impact do you hope it will have?
One of my hopes is that this study broadens how we think about supporting people who stutter as speech-language pathologists. Historically, many of our efforts have focused on the individual, which is certainly important. We help people develop greater ease in communication, healthier coping strategies, and more adaptive ways of thinking about stuttering. Those efforts remain valuable and necessary.
At the same time, this study highlights the important role of the communication environment. Our findings suggest that listener reactions can affect emotional well-being in everyday life. Because of that, I hope this research encourages us to think not only about how we support people who stutter, but also about how we can make the environments in which communication takes place more supportive and inclusive.
In some ways, speech-language pathologists are already leading these efforts. Many school-based clinicians, for example, educate classmates about stuttering and help students learn supportive ways to interact with peers who stutter. I believe there is an opportunity to build on this work and promote more positive communication environments in schools, workplaces, healthcare settings, and society more broadly.
A longer-term goal of my research is to better understand why listeners react the way they do and how those reactions might be changed. My suspicion is that uncertainty often plays a role. When listeners are unsure what is happening during a moment of stuttering, they may respond in ways that are unhelpful, even when they have good intentions. Rather than placing all of the responsibility on people who stutter to manage these situations, I would like to see more work focused on helping communication partners respond more effectively and create environments where everyone feels comfortable communicating.
Ultimately, I hope this research contributes to a broader shift in perspective: improving quality of life for people who stutter is not only about helping individuals adapt to their environments, but also about helping communities become more welcoming of different ways of communicating.
How is your approach innovative?
One aspect of the study that I think is particularly innovative is the use of ecological momentary assessment. Rather than asking adults who stutter to reflect on experiences that may have occurred weeks, months, or even years earlier, we asked them to report listener reactions as they happened in their daily lives. This approach reduces the influence of recall bias and provides a more accurate picture of people's real-world experiences.
I also think the study is innovative because it focuses on listener behavior. Much of the stuttering literature has understandably focused on characteristics of the person who stutters, such as speech, attitudes, or coping strategies. In contrast, this study examined how listeners respond to stuttering during everyday interactions. Importantly, these experiences were captured in participants' natural environments rather than in a laboratory setting, giving us a clearer understanding of how listener reactions unfold in real life.
By studying these experiences as they happen, and by focusing on the communication environment rather than only the individual, we hope to gain new insights into factors that shape the daily experiences and well-being of adults who stutter.
What challenges did you face, and how did ASHFoundation support you?
One challenge was that ecological momentary assessment was a new methodology for me. The ASHFoundation award gave me the opportunity to learn and implement a method that I had not previously used in my research. That experience has been incredibly valuable and has helped position me to pursue larger grants and continue expanding this line of work.
The study also presented a number of logistical challenges. Ecological momentary assessment requires substantial participant training, coordination, and ongoing monitoring throughout data collection. The funding allowed us to compensate participants for their time and commitment, which was especially important given the intensive nature of the study.
In addition, the award supported a doctoral student, Molly Stevenson, who played a critical role in the project's success. Molly helped with participant scheduling, training sessions, and managing the weekly rollout of data collection. Her contributions were instrumental, and the project also provided her with valuable research training and hands-on experience conducting an intensive, real-world study.
Overall, ASHFoundation support made it possible not only to carry out the research, but also to build new expertise and train the next generation of researchers.
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