Do different types of stuttering require different ways of thinking?
The term “stuttering” is used by different people to refer to different things. For example, stuttering can be overt or covert. It can also be primary (sometimes “core” or “open” stuttering) or secondary (avoidances, “struggle” behaviour etc). There can also be different causations. For example, of adults who stutter overtly about 84% have childhood onset stuttering (typically genetic/neurodevelopmental) and about 16% have adult onset stuttering. This can be neurogenic (e.g. stroke or head trauma) and can also be pharmacogenic or psychogenic.
If we’re saying “stuttering is OK” or “stuttering needs to be fixed”, are we referring just to certain types of stuttering? Consider for example the viewpoint in which primary stuttering does not need to be fixed – such an opinion can be expressed quite stridently. How does it relate to pharmacogenic stuttering? Suppose that a medication for some healthcare issue unrelated to stuttering introduces stuttering as a side effect. Clinician and patient might alter the medication in order to find one where primary stuttering does not appear as a side effect. Should we criticise these people for considering stuttering as something that needs to be fixed?
How do decisions for pharmacogenic stuttering compare to those for neurogenic stuttering, psychogenic stuttering or the developmental stuttering which is so frequently transient? Are some types of stuttering OK but not others? Should people who stutter feel shame if they don’t think that stuttering is OK? What about people who stutter who want to change how they talk – do they have a right to do so?
Is there a decision tool or generalised framework which might enable clinicians to respond in a consistent and justifiable manner to the issues raised? What ethical considerations are involved?
