______________________________________________________________________________

Volume 3 Article 60
______________________________________________________________________________
2022

The Science Behind Stuttering: Reducing Public

Misconceptions and Stigma
Christine Hekmat Abasi
The University of Texas at Arlington

Recommended Citation
Abasi, Christine Hekmat (2022). “The Science Behind Stuttering: Reducing Public
Misconceptions and Stigma.” The Macksey Journal: Volume 3, Article 60.
This article is brought to you for free an open access by the Johns Hopkins University Macksey
Journal. It has been accepted for inclusion in the Macksey Journal by an authorized editor of the
Johns Hopkins University Macksey Journal.

Published by JHU Macksey Journal, 2022

 The Science Behind Stuttering: Reducing Public Misconceptions and Stigma
Christine Hekmat Abasi
The University of Texas at Arlington

Abstract
Persistent Developmental Stuttering (PDS) affects about 1% of the world's adult
population across all cultures and social classes. Stigma, especially around stuttering, can be
perpetrated in many ways. There has been and continues to be a strong connection between
stuttering in mainstream media and negative characteristics such as lack of intelligence,
nervousness, or lack of social skills. This study investigates the source of negative social stigma
and possible methods to reduce negative stigma. Participants joined in an empirically-based
survey meant to analyze thoughts and beliefs on stuttering and the origin of those beliefs. The
results are analyzed using a paired T-test to determine if interpersonal contact and education
effectively reduce stigma regarding stuttering. Determining an effective way to reduce the
negative stigma around stuttering can be used in other areas of healthcare and increase the
quality of life for people who stutter by decreasing adverse effects such as higher anxiety,
depression, and lower self-esteem.
Keywords: Stuttering, Public Stigma, Reduce Stigma, Persistent Developmental Stuttering,
Speech Pathology

Published by JHU Macksey Journal, 2022 1

Introduction
1.1 Definition
Stuttering is a speech disorder characterized by word or syllable repetitions or
prolongations and silent interruptions in the flow of speech known as blocks (American
Psychiatric Association, 2013). M.E. Wingate coined the earliest found definition in 1964.
Persistent Developmental Stuttering (PDS) affects about 1% of the world's adult population
across all cultures and social classes, and approximately 80% of those who stutter recover in
childhood (Buchel & Sommer, 2004). The recovery rate is much higher in females than in males,
resulting in three to four males who stutter to every female (Buchel & Sommer, 2004). Stuttering
can impair communication and impact people's socioeconomic status who stutter (Andrews et
al., 1983). However, that is not what always happens; there are some strong possibilities despite
not knowing a definite cause of stuttering. Genetics, neurology, and lack of motor control support
the possible causes of stuttering.
1.2 Possible Causes of Stuttering
1.2.1 Genetic Causes
A hereditary component suggests a correlation between affected family members
(Andrews et al., 1982). A study conducted by Andrews and colleagues in 1982 discovered an 18%
likelihood of stuttering between same-sex siblings, 30% for dizygotic (fraternal) twins, and 70%
for monozygotic (identical) twins. People who do not stutter varied among people who stutter,
showing stutterers with lower intelligence scores on verbal and nonverbal tasks on average and
delayed speech development (Andrews et al., 1982). However, these results need to be carefully
considered since people who stutter have a disadvantage in education systems (e.g., reduced or
negative interactions with teachers and/or peers; Andrews et al., 1982).
Stuttering has recently been hypothesized to be affected by a slight genetic mutation. The
importance of the following specified genes is yet undiscovered Riaz and colleagues (2005) show
a significant correlation between mutations and PDS. The first genetic mutation to play a causal
role in stuttering was found on chromosome 12q in a sample of 44 different families containing
people who stutter, showing a genetic relationship (Riaz et al., 2005). The same mutation was
not found in 96 non-stuttering Pakistani families or the foundation for any other genetic disease
at this discovery (Kang et al., 2010); however, it was found only in the members of those 44
Pakistani families with identified PDS. Since then, more gene loci have been identified with highly
significant linkages to stuttering, such as 2, 3p, 3q, 10, 14, and 16 (Freigerio-Domingues & Drayna,
2017). The cause of these linkages is yet undiscovered, but previous twin studies have implied
that it may not be entirely heredity (Freigerio-Domingues & Drayna, 2017).
Genetic evidence supports the theory that stuttering is not the fault of any child or parent
but rather another medical condition. This research shows that stuttering is a legitimate,
involuntary issue that requires support and treatment. The discovery of a genetic root can lead
to further insights into effective stuttering treatment since it gives a more profound
understanding of the cause.

Published by JHU Macksey Journal, 2022 2

 1.2.2 Neurological Causes
Alongside possible genetic causes, past research shows neurological connections to
stuttering. Further studies have shown neurological differences between people who stutter and
people who do not stutter. In people who do not stutter, the left-brain hemisphere is more active
during speech and language tasks; however, EGG studies suggest people who stutter have an
abnormal right hemispheric dominance (Moore & Hanes, 1980). This discovery was later
reinforced by Braun et al. (1997). Activity in the left hemisphere was more active in stuttered
speech, while right hemisphere activation was present in fluent speech. These results suggest
that speech disfluency was primarily in the left hemisphere, and the hyperactivity of the right
hemisphere was a compensatory response rather than a cause.
These studies indicate that a problem of timing in speech production exists between the
left frontal cortex and the left central cortex. The study was conducted under the assumption
that hyperactivity was the cause of stuttering. A newfound compensation effect opens the door
for future research to evaluate what causes this compensatory response and why these changes
occur in the brain. In 2008, Watkins et al. discovered an overactivity in the midbrain, abnormal
function in the basal ganglia, and excessive amounts of dopamine in people who stutter. These
brain structures and neurotransmitters are responsible for muscle and motor control, implying
that stuttering is partly caused by excessive muscle contractions (Delong & Wichmann, 2009;
Lindvall et al., 1990). There was also underactivity in motor areas of the brain associated with
articulation and speech production (Watkins et al., 2008).
Further investigation showed reduced integrity of white brain matter in the underactive
motor cortex of people who stutter (Watkins et al., 2008). White matter is responsible for
communication between different brain structures, implying that the brains of people who
stutter have a more challenging time processing and articulating speech (Cees De Groot et al.,
2000). Watkins and colleagues (2008) support the conclusion that stuttering is related to the
disruption and underactivity of motor activity needed for fluent speech production.
More recent studies conducted using fMRI have shown decreased blood flow to the brain
during stuttering (Desi et al., 2017). Regional cerebral blood flow (rCBF) was measured in Broca's
area and inversely related to stuttering severity (Desi et al., 2017). The reduced rCBF in people
who stutter shows an inverse correlation and suggests that the stuttering severity is partly
dependent on rCBF levels in Broca's region (Desi et al., 2017). However, there are some
limitations to task-based fMRI studies. Primarily, participants may differ in response to each task
and may use different strategies to perform the task. The differences in response may lead to
regional activation with little or no relevance to the task or study itself (Desi et al., 2017).
The neurological causes of stuttering are not limited to one particular area and cannot
fully explain the cause of stuttering. It combines activity levels and communication between
various brain structures, the production level of neurotransmitters, and blood flow throughout
the brain. Even though the research states many different causes, it does not invalidate
previously found research but can instead support it.
1.2.3 Motor Control Causes
Speech comprises motor control and various movements coinciding to get the desired
sound (The physiological, n.d.). The vocal tract consists of the trachea (windpipe) to the mouth

Published by JHU Macksey Journal, 2022 3

and nose, while lips, tongue, and teeth are all individual organs used in speech production (The
physiological, n.d.). The vocal cords are tense as air passes through, which causes vibrations, also
known as the voice; the vibrations will be more or less frequent based on the vocal cords'
tightness (The physiological, n.d.). Frequent places of articulation are between the back of the
tongue to the soft palate and the tip of the tongue to the back of the teeth (The physiological,
n.d.).
In 2007, Visscher et al. conducted a study with 125 children with speech and language
disorders to test their motor development for differences. On the Movement Assessment Battery
for Children, those with speech and language disorders performed worse than those without;
about 51% of children with a speech or language disorder displayed motor problems (Visscher et
al., 2007). Results of this study show when speech production is affected, motor control problems
are more evident in the client. This supports the need to give early support to help children who
show signs of speech disorders, such as stuttering, and educate children and families on proper
techniques to best handle stuttering. Having a speech disorder affects more than just the ability
to communicate and muscle and motor control.
A later study showed that children with a language impairment showed decreased gross
and fine motor skills and increased articulatory variability to monitor speech production errors
(DiDonato et al., 2014). The study showed that children with a language impairment had
significantly lower motor scores than their peers and demonstrated language and motor
discrepancies (DiDonato et al., 2014).
Stuttering is more than needing to breathe and talk slowly but is partly due to involuntary
muscle contractions. As seen with neurological causes, stuttering is more than taking time to
speak; it can also be a mechanical issue of having difficulty controlling muscle movements. Motor
control, combined with neurological and genetic causes, explains the possible reasons why
people stutter. One cause alone is not enough to justify the source of stuttering, but each area
offers insight into a fuller understanding of the causes of stuttering.
Despite not knowing the cause of stuttering, treatment and therapy can still be helpful to
those who stutter. Stuttering therapy means changing behaviors and attitudes primarily for the
people who stutter and, hopefully, those in their lives. Therapies can assist in many ways, such
as reducing disfluency, increasing knowledge about stuttering, learning more effective
communication skills, and decreasing stress and anxiety alongside stuttering.
Stuttering Stigma in Media
2.1 Defining Stigma
Stigma is a broad topic that can often be difficult to define. However, the American
Psychological Association (2021) defines stigma as
the negative social attitude attached to a characteristic of an individual that may be
regarded as a mental, physical, or social deficiency. A stigma implies social disapproval
and can lead unfairly to discrimination against and exclusion of the individual.
Hatzenbuehler, Phelen, & Link (2013) further describe stigma as "the co-occurrence of labeling,
stereotyping, separation, status loss, and discrimination in a context in which power is exercised."

Published by JHU Macksey Journal, 2022 4

2.2 Differences of Stigma Across Cultures
People who stutter face stigma worldwide. Reducing stigma can be challenging when its
root cause can vary between countries, cultures, and people groups. Ustun-Yavuz, Warmington,
Gerlach, and St. Louis (2021) conducted a study to test attitudes between different cultures,
primarily Arab, British, and Chinese. The four primary differences were the cause of stuttering,
how to help people, sympathy towards those who stutter, and the stereotype that those who
stutter are nervous and excitable (Ustun-Yavuz, 2021).
Regarding the cause of stuttering, all three cultures attribute it to genetics. However,
Chinese participants tend to attribute stuttering to emotional trauma and a virus or disease more
than other cultures. British participants tend to reject emotional trauma as the cause of
stuttering more than the different cultures observed. Arab participants tend to attribute
stuttering as an Act of God and part of a larger plan set in place by God (Ustun-Yavuz, 2021).
The way to help people who stutter was also seen differently among cultures. Chinese
participants are the most likely to think they should help by filling in words and telling people
who stutter to slow down or relax. Even though the reason for the response is unknown, Chinese
participants may be pulling from past experiences of their disfluency where they felt nervous or
uncomfortable. Arab and British participants did not differ significantly from each other and did
not believe they should help people who stutter by filling in words or telling them to slow down.
(Ustun-Yavuz, 2021).
Chinese participants were most likely to report stereotypical beliefs concerning sympathy
and concern towards people who stutter. All three groups would be concerned if they stuttered;
however, Chinese participants reported they would be concerned significantly more than the
British participants. On the other hand, all three groups reported little to no concern if their
doctors, neighbors, or siblings stuttered. However, Chinese and Arab participants were most
likely to feel concerned if one of the members above stuttered, and British participants were the
least likely to feel concerned (Ustun-Yavuz, 2021).
Finally, Arab participants were most likely to agree that people who stutter were nervous
and easily excitable, while British participants were least likely to believe in the stereotype. The
belief was present in the British participants but significantly less so in Arab and Chinese
participants (Ustun-Yavuz, 2021).
Despite their differences, there are some similarities. All three cultures tend to believe:
people who stutter are shy and fearful; they would not want to stutter themselves; they did not
know anyone who stuttered; and most of their knowledge came from television, radio, or the
internet, where unreliable sources can be easily accessed (Ustun-Yavuz, 2021). Noting these
similarities is essential because it shows that some beliefs reach across all cultures and need to
be addressed first and foremost.
Ustun-Yavuz et al. (2021) does help shape the way we can reduce the stigma regarding
stuttering. The study limitations should be taken into consideration. The study noted that the
current geographical location did not significantly impact attitudes about stuttering. Anti-stigma
campaigns need to consider the people's culture instead of only the host culture (geographical
location) (Ustun-Yavuz, 2021). Stigma is not localized to one area but can be seen worldwide.

Published by JHU Macksey Journal, 2022 5

2.3 Effects of Negative Stigma Around People Who Stutter
2.3.1 Social Effects
People who stutter are often met with adverse reactions and feelings from the public (St.
Louis, 2012). They are stereotyped as having negative personality traits (St. Louis, 2012) and
turned away from jobs that require speaking or customer interaction (Gabel et al., 2004; Boyle,
2017). Living in these environments can cause adverse effects on their mental and emotional
well-being since they tend to become highly aware of these attitudes. (Boyle, 2013).
Internalization of negative attitudes and beliefs about people who stutter has been shown to
cause higher anxiety, depression, lower self-esteem, and lower quality of life (Boyle, 2015).
A study conducted by Boyle in 2017 described some of the most common attitudes
towards people who stutter and how they are primarily negative. Some participants believed that
people who stutter are treated differently because they are different from others (Boyle, 2017).
People who stutter are often thought of negatively regarding capabilities (e.g., unintelligent),
often face adverse emotional reactions when speaking (e.g., impatience, irritation, discomfort),
and have negative behaviors displayed towards them (e.g., mocked, ignored, avoided, treated
disrespectfully) (Boyle, 2017).
2.3.2 Health Effects
Alongside adverse social effects, health issues arise with negative stigma towards people
who stutter. The research above shows how people who stutter are aware of the stigma and
internalize those negative feelings. Boyle and Fearon (2018) showed that stigma is positively
related to stress and negatively related to physical health and health care satisfaction. The more
internalization occurred, the more the risk of anxiety increased. Physical health declined to cause
headaches, difficulty sleeping, and gastrointestinal problems (Boyle & Fearon, 2018). As
awareness of stuttering and stigma increased, people who stutter were less likely to seek out
healthcare and support when these issues occurred, causing a further decline in health (Boyle &
Fearon, 2018).
However, this study did not consider digital communication between health providers
and patients, such as email or virtual patient portals (Boyle & Fearon, 2018). Having another
outlet of communication besides verbal communication could increase patient comfortability
and satisfaction when seeking healthcare. There are minimal accommodations around stuttering.
It recently became a partially protected disability under the Americans with Disabilities Act in
2009 on a case-by-case basis (Weiner & Tetnowski, 2016).
Background Literature
3.1 Reducing Stigma Around Stuttering
Corrigan and Kosyluk (2013) listed three primary stigma-reduction approaches for those
with a mental illness. While a speech disorder, like stuttering, varies from a mental illness, both
face stigmatization and disadvantages. The first method is interpersonal contact with the
individual who stutters or has any stigmatized disorder (Corrigan et al., 2013). The individual(s)
share their own stories and experiences living with this condition. This strategy is an exceedingly
popular and primary effort to reduce stigma and begin a change in society (Corrigan et al., 2013).

Published by JHU Macksey Journal, 2022 6

It relies heavily on sharing personal information by the individual, a willingness to listen, and an
eventual change by the audience.
A second strategy is an educational approach. Education separates myths from facts to
present research on a particular condition (Corrigan & Kosyluk, 2013). Like The Stuttering
Foundation, some groups are a great example of this by distributing materials to educate friends
and family and those who stutter. The Stuttering Foundation has a page of myths versus facts
about stuttering that cover intelligence, causes behind stuttering, and stuttering treatments (The
Stuttering Foundation: Five Myths About Stuttering, 2020).
The final approach listed is the protest method (Corrigan & Kosyluk, 2013). The protest
method offers a chance to speak out about the unfair treatment of individuals with the condition
and give a voice to the people who may otherwise be overlooked (Corrigan & Kosyluk, 2013). The
Stuttering Foundation (SNL Skit, 2012) issued a press release against the show Saturday Night
Live after they released a sketch making a joke of stuttering, claiming, "…[T]hey chose to overlook
the pain felt by many who stutter and their families for just a cheap laugh... Not funny SNL. Not
funny at all."
Corrigan et al. (2012) analyzed 72 articles focusing on the protest method. They
categorized the areas of study in attitudes (stereotypes), affects (emotional responses), and
behavioral intentions (avoidance). They gathered results from over 38,000 participants across 14
countries. They showed education and contact combined improved attitudes, affects, and
behavioral intentions toward individuals with a stigmatized condition (Corrigan et al., 2012).
Education showed a more significant effect on adolescents, whereas contact was more effective
on adults (Corrigan et al., 2012). Interpersonal contact led to a more substantial change in
attitudes where education was more impactful for effect and behavioral intentions (Corrigan et
al., 2012). The average response for protests was not significant enough from zero and had less
support for this strategy's effectiveness (Corrigan et al., 2012). This study was later supported by
Boyle, Dioguardi, and Pate (2016). There is minimal research regarding stuttering and stigma. As
of 2016, there have only been six peer-reviewed journal articles focusing solely on changing
negative attitudes and misconceptions around stuttering (Boyle, Dioguardi, and Pate, 2016).
Flynn and St. Louis (2011) evaluated high-school students' opinions toward people who
stutter before and after watching a presentation by a person who stutters. The study implies that
interpersonal contact with a person who stutters telling their story can be a potentially successful
way to reduce the stigma associated with stuttering.
Abdalla and St. Louis (2014) also saw positive attitude changes after showing pre-service
trainees an educational video discussing educational and emotional aspects of stuttering.
Langevin and Prasad (2012) applied a pretest-posttest to study changes in school-age children's
attitudes about stuttering after using an educational curriculum and bullying prevention
program. The program caused significantly better attitudes towards people who stutter and
decreased bullying.
Methodology
Participants were recruited across multiple university departments. Each participant
received the same treatment by engaging with a 34-question pre-test survey to analyze their
initial thoughts regarding the cause, treatment, and reactions to a person who stutters.
Participants then watched a 10-minute video produced by CBS in 2011 titled Finding their voices

Published by JHU Macksey Journal, 2022 7

– Understanding Stuttering, which explains what stuttering is and acknowledges some of the
most common stuttering misconceptions. Participants finished the project by completing a post-
test, 12-question survey to analyze how education and interpersonal stories changed their views
on stuttering and people who stutter.
4.1 Participant Demographics
Participants were recruited from the University of Texas at Arlington. Thirty-five
participants completed the POSHA-S pre-test survey, and twenty-five completed the POSHA-S
post-test survey. The final analysis and results are dependent on the twenty-five participants who
completed the survey thoroughly. Participants were recruited through various professors to
distribute among university courses across the university. Some students were offered an extra-
credit incentive upon the completion of the survey. The gender balance of participants was highly
skewed and not fully representative of the university average (N: 25; Male: 6; Female: 18; Non-
listed gender: 1). The participants ranged from ages 19-to 60 years old; most participants were
between 19-and 22 years. See Table 4.1 for further demographic information.

Table 4.1: Demographics of participants who completed POSHA-S pre-test and post-test survey
Total
25
Gender
Male 24%
Female 72%
Non-listed gender 4%
Age
19-22 56%
23-38 28%
39+ 16%
Nationality
United States 88%
Turkey 4%
China 4%
Mexico 4%
Academic Status
Freshman (0-30 credits) 31%
Sophomore (31-60 credits) 17%
Junior (61-90 credits) 4%
Senior (91+ credits) 24%
Faculty or Staff 24%

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4.2 Materials
4.2.1 CBS – Finding their voices: Understanding stuttering
In 2011, CBS News broadcasted a report to discuss the truth about stuttering. In this
report originally broadcast on "Sunday Morning" on January 30, 2011, correspondent Mo Rocca
talks to young stutterers, a speech therapist, and researchers at Purdue University's Stuttering
Project and visits a workshop run by the organization Stuttering Association for the Young
(formerly known as Our Time), to demystify a condition that's been around since man has been
speaking.
4.2.2 Public Opinion Survey of Human Attributes- Stuttering (POSHA – S)
The POSHA-S is a pre-and post-test assessment of participant attitudes towards people
who stutter and persistent developmental stuttering (St Louis, 2015). The POSHA-S is a 32-
standardized question questionnaire designed to measure public attitudes toward stuttering (St
Louis, 2015). A radial graph visually displays each group's mean scores of each subscore,
representing their attitudes towards individuals who stutter. The graphs represent positive
attitudes towards the outside of the graph, while negative attitudes are closer to the center. An
Overall Stuttering Score (OSS) ranges from 0 to 100 to determine the frequency of a presented
feeling or behavior; 0 represents no behavior and feeling present, and 100 denotes a frequent
behavior or a strong feeling.
The instrument assesses participants' attitudes internationally, representing various ages,
socioeconomic statuses, and cultures. The POSHA-S was chosen for this current study due to the
technical and structural integrity of the tool itself and its general use with diverse populations (St
Louis, 2015).
4.3 Procedure
Participants completed a 34-question pre-test survey to analyze current behaviors and
beliefs toward people who stutter and determine where those beliefs could have originated.
After completing the pre-test survey, participants immediately watched a 10-minute video
produced by CBS News in 2011 titled "Finding their voices: Understanding stuttering" to combine
an interpersonal and education intervention. The footage included people who stutter,
explaining personal experiences with stuttering, and speech pathologists meant to identify and
correct common stereotypes and myths. Following the video, participants immediately
completed a 12-question post-test survey to determine if attitudes and beliefs changed due to
the intervention. This study was a quasi-experimental group design with a pre-test and
immediate post-test measures of attitudes towards people who stutter.
Results
Raw data was converted to a 0 – 100-point scale to analyze the frequency of behavior or
strength of a belief. A score of 0 represents no belief present or no instances of behavior; a score
of 100 represents a strong belief or consistent behavior present. Some negative behaviors or
attitudes, such as filling in words or telling someone who stutters to "relax" or "slow down," have
been reverse coded for testing. A mean Overall Stuttering Score is reported before and after the
intervention to determine participants' average attitudes towards stuttering. OSS is scored

Published by JHU Macksey Journal, 2022 9

between 0 – 100-point scale, where a score of 0 shows the most negative attitudes toward people
who stutter and 100 shows the most positive attitudes toward people who stutter.
Figure 5.1: Radial graphs represent the frequency of behavior or strength of belief. The left
represents the frequency of behavior or power of attitude when interacting with a person who
stutters before intervention. The right represents the frequency of behavior or strength of
attitude when interacting with a person who stutters after the intervention.

A paired-samples t-test was conducted to compare the attitudes towards people who
stutter before and after education and interpersonal contact intervention. There was a significant
difference in the scores before intervention (M= 54.35, SD= 8.35) and after intervention (M=
65.53, SD= 8.35); t(24)= – 6.69, p < 0.01. Participants reported having a significant change in
attitudes and beliefs after the intervention. There was a 73% self-reported increase in
understanding the life experience of a person who stutters. 87% of participants reported they
agree or strongly agree they should be aware of listening behaviors when talking with a person
who stutters.

Published by JHU Macksey Journal, 2022 10

Table 5.1: POSHA-S means (percentage out of 100) for individual items, sub-scores, and mean
Overall Stuttering Score Before After
intervention intervention
54.35% 65.53%
Traits/Personality Before After
intervention intervention
Have their selves to blame* 92% -----
Nervous* 54% 26%
Shy* 57% -----
Should hide their stuttering* 89% -----
Potential
Can do any job 71% 86%
Can make friends or have a 73% 90%
meaningful relationship
Have jobs that decide
important things 92% -----
Accommodating/helping Before After
intervention intervention
Act normally 100% 99%
Fill in words* 78% 37%
“Slow down” or “relax” * 70% 35%
Make jokes* 97% 38%
Self-reactions to stuttering
Feel comfortable 86% 93%
Feel pity* 73% 35%
Feel impatient* 84% 37%

Conclusion
6.1 Discussion
Negative behaviors and attitudes such as making jokes or filling in words for people who
stuttered were reduced by 41%. These results supported the hypothesis that education and
interpersonal contact are successful intervention strategies to reduce the stigma around
stuttering. There was an increase in positive behaviors and attitudes towards people who stutter,
such as feeling comfortable with people who stutter. Participants' mean OSS increased after
viewing a short educational and interpersonal contact intervention that effectively reduced
negative stigma. Education about stuttering and interpersonal contact, or "putting a face to the
issue," significantly impacted participants and indicated more positive interactions with a person
who stutters.
6.2 Limitations
While research shows an increase in positive attitudes, there are some limitations to the
significant findings. Due to the scope of the study, there was a small sample size of participants
who participated virtually to analyze immediate behavior and attitude change.
A small sample size of 25 participants responded that it was not representative of the
diverse university community. Participants were primarily American females between the ages
of 19-and 22. Having a limited sample size with limited data can increase the chance of producing

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a type 1 error by incorrectly rejecting the null hypothesis. There was not enough diversity in the
participant demographics to test for differences across gender and cultural communities. A
second limitation of research involves intervention occurring virtually. Even though the video
intervention was relatively short, at 10 minutes to watch, participants may have lost interest
during the task. Loss of interest could result in participants not retaining or understanding
information that could have impacted their responses.
Finally, follow-up on behavior change in the future was not possible, and long-term
change could not be evaluated. This study supported a change in behavior and attitude
immediately after the intervention that may not continue. Testing could not be done to analyze
if education and interpersonal contact were effective for long-term change. Carefully considering
the limitations, the current study results still offer significant support for the ability to change
attitudes and behaviors towards people who stutter through education and interpersonal
contact intervention.
6.3 Future Directions
Future research can analyze long-term behavior and attitude change toward people who
stutter with a more diverse participant pool. A prospective study may be completed to analyze if
culture or gender differences impact the effectiveness of education and interpersonal contact
interventions. Alongside correcting negative stigma and stereotypes, research can examine
preemptive steps to stop stigma from forming toward people who stutter. Data can be collected
to determine the most influential sources of information about stuttering and minimize
misinformation from being spread.
These findings can be applied to educate individuals who frequent contact with a large
population of people, especially people who stutter. Using education and interpersonal contact
can train frontline workers who interact with the public often to increase listening behavior and
reduce negative reactions towards people who stutter or those with any communication
disorder.

Published by JHU Macksey Journal, 2022 12

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