Journal of Fluency Disorders 80 (2024) 106051

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Journal of Fluency Disorders

journal homepage: www.elsevier.com/locate/jfludis

Major discrimination due to stuttering and its association with

quality of life
Michael P. Boyle *, Madeline R. Cheyne
Department of Communication Sciences and Disorders, Montclair State University, United States

A R T I C L E I N F O A B S T R A C T

Keywords: Purpose: This study aimed to identify what types of major discrimination have been experienced
Stuttering by adults who stutter throughout their lives, and investigate the association between the number
Discrimination of different types of major discrimination events experienced and quality of life.
Quality of life
Methods: Measures of quality of life (Kemp Quality of Life Scale) and major discrimination
(adapted Major Experiences of Discrimination Scale) were completed by 303 adults who stutter.
Correlational and regression analyses were conducted with these variables.
Results: A majority (56%) of the participants had experienced at least one episode of major
discrimination due to stuttering during their lives. The major discrimination experiences most
commonly reported included not being hired for a job and being discouraged by a teacher or
advisor from pursuing certain careers or jobs because of stuttering. There was a significant
negative relationship between quality of life and major discrimination. Increased major
discrimination predicted lower quality of life even after taking into account demographic vari­
ables and severity of physical speech disruption.
Conclusions: The findings of a negative association between major discrimination and quality of
life add support to the notion that reducing societal stigma related to stuttering should be a
priority of the field. Discriminatory practices of listeners constitute a social-environmental barrier
to communicative participation and quality of life in people who stutter and should be addressed
by professionals in the field of speech-language pathology and other stakeholders.

1. Introduction

People who stutter face public stigma in the form of stereotypes, prejudice, and discrimination (St. Louis, 2015). Research shows
that PWS are acutely aware of these negative public attitudes and can often internalize negative societal views (Boyle, 2013, 2015;
Boyle & Fearon, 2018; Boyle et al., 2023). Prior research has demonstrated that children and adolescents who stutter are more likely to
be bullied and socially rejected compared to controls (Blood & Blood, 2004, 2007; Davis et al., 2002), considered romantically ‘less
attractive’ than non-stuttering peers (Van Borsel et al., 2011), and significantly less likely to be considered ‘popular’ in their com­
munity (Hurst & Cooper, 1983). These experiences can create negative memories that persist into adulthood (Blood & Blood, 2016;
Daniels et al., 2012). Furthermore, there is evidence that these socially devaluing reactions that PWS experience from other people
throughout their lives are linked to lower levels of mental health (Boyle, 2018; Boyle et al., 2023). However, little research exists on

* Correspondence to: Department of Communication Sciences and Disorders, Montclair State University, 1515 Broad St. Building B – 2nd Floor,
Bloomfield, NJ 07003, United States.
E-mail address: boylemi@montclair.edu (M.P. Boyle).

https://doi.org/10.1016/j.jfludis.2024.106051
Received 27 December 2023; Received in revised form 23 February 2024; Accepted 29 February 2024
Available online 5 March 2024
0094-730X/© 2024 Elsevier Inc. All rights reserved.
M.P. Boyle and M.R. Cheyne Journal of Fluency Disorders 80 (2024) 106051

major discrimination events experienced by adults who stutter and their associations with quality of life . As compared to everyday
discrimination, or minor discrimination, major discrimination is experienced during major events or episodic experiences over the
lifetime (e.g., job promotion, financial, housing) (Kessler et al., 1999). The purpose of this study is to determine how commonly various
types of major discrimination are experienced by people who stutter, identify the more frequent acts of major discrimination, and
analyze how these experiences are related to quality of life.

1.1. Discrimination and communication disorders

Although there is no universally accepted definition of discrimination, standard accounts describe discrimination against persons to
consist of actions, practices, or policies that are directed toward them based on their membership in a certain type of social group
(Altman, 2020). Discrimination may take the form of economic and social deprivation, socially-inflicted trauma, and inadequate
healthcare (Krieger, 2000). Different races, religions, and genders can be defined as groups that have potential grounds to be
discriminated against because other members in the community may perceive one group as inferior to their own. Discriminatory
experiences have been categorized in previous research as “everyday discrimination,” sometimes called “minor discrimination,” and
“major discrimination” (Kessler et al., 1999). Everyday discrimination could be experienced on a day-to-day basis (Williams et al.,
1997) but major lifetime events of discrimination would not be expected to occur on an everyday basis due to the nature of the events
in question but could be nonetheless extremely important due to their impact on life (Williams et al., 2008). On a practical level, one
could be asked about how often they experience “minor” or everyday discrimination within the past year, month, or week because it
can be expected to have occurred relatively recently. On the contrary, it is typical to ask about major events of discrimination in the
context of looking back over one’s whole life, or asking people to consider if they have ever experienced a particular event, because it is
likely that the event occurred many years ago (Kessler et al., 1999).
Kessler et al. (1999) stated that despite the fact that they may be less frequently experienced, major events of discrimination can
result in substantial interference in the advancement of socioeconomic interests (e.g., not being hired, being fired, not earning a
degree). In contrast, more typical or day-to-day experiences of discrimination may be characterized by general social devaluation or
character assaults (e.g., being treated with less courtesy or respect than others, being treated as inferior) that may not necessarily
interfere with advancement of socioeconomic position. Kessler et al. (1999) emphasized the importance of separately evaluating “…
the lifetime occurrence of major episodic experiences, such as being denied a bank loan or being passed over for a job promotion, as
well as the occurrence of more minor unfair experiences, such as being treated rudely or dismissively” (p. 210). In summary, it is
helpful to think of the differences between these types of discrimination in terms of major lifetime events that would often impact
socioeconomic position, compared to “minor” day-to-day experiences involving character assaults or social devaluation that do not
necessarily have a socioeconomic impact.
Communities of people with disabilities, including but not limited to those with mental health conditions, vision and hearing
impairments, and language impairments, have experienced discrimination, specifically in the realm of employment, housing, and
social spaces (Parker-Harris et al., 2019). Even 30 years after the enactment of the Americans with Disabilities Act (ADA), the labor
force participation rate for working-aged people with disabilities remains at 37.5%, less than half of the percentage of their
age-matched peers without a disability (Kessler Foundation, 2022). Ruben (2000) reported that “people with severe speech disabilities
are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities.” When asked to
listen to two audio-taped speech recordings, one from a typical speaker and one from an individual with a communication disorder (i.
e., stuttering, voice, articulation, language), adults perceived typical speech to be more favorable regarding employability, self-esteem,
intelligence, and ambition (Allard & Williams, 2008). Research also suggests that individuals with communication disorders, including
those with severe speech disabilities (Ruben, 2000), aphasia (Worrall et al., 2007), autism spectrum disorder (Bunt et al., 2020),
dementia (Farfel et al., 2021), and traumatic brain injuries (Stergiou-Kita et al., 2017) face heightened levels of stigmatization and
work-place discrimination.
Discrimination negatively affects individuals with communication disorders personally. Individuals with communication disorders
face negative public perceptions such as harmful stereotypes, continued enacted stigma, and discrimination (Boyle, 2018). Com­
pounded by external barriers to daily communicative participation, individuals with communication disorders may also face internal
barriers like feelings of non-belonging and relentless assessment regarding the ‘safety’ of particular situations (Baylor et al., 2011).
Negative self-perception can be linked with reduced participation in daily life. Adults with voice disorders reported that they
frequently withdrew from participation in daily life and in social events because of their communicative limitations (Etter et al., 2013).
In addition, a systematic review on individuals with aphasia found that emotional distress, depression, communication and activity
limitations, social networking limitations, and concomitant medical diagnoses affected their health-related quality of life and
self-perception (Hilari et al., 2012). Baylor and Darling-White (2020) stated that participation should be the primary focus and
outcome for intervention across populations in the field of speech-language pathology. Those authors emphasized the importance of
assessing communication skills, physical and social environments, and personal perspectives for the targeted treatment of commu­
nicative participation in specific situations. Public perceptions of a communication disorder, potentially leading to discrimination, can
represent social barriers and contribute to personal disempowerment, leading to reduced communicative participation and satisfaction
(Baylor & Darling, 2020).

1.2. Public responses to people who stutter

People who stutter may experience negative reactions from listeners. These listener perceptions have been shown to limit a person

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who stutters’s participation in social contexts, as well as within their job or educational endeavors (Bricker-Katz et al., 2013). When
observing stuttered speech, listeners tended to avert their gaze to a speaker’s mouth as compared to their eyes (Zhang & Kalinowski,
2012; Zhang et al., 2010) and exhibit signs of physiological distress and discomfort (Guntupalli et al., 2006, 2007, 2012). It has been
found that adolescents and young adults consider those who stutter to be less attractive than their non-stuttering peers, and that they
are less likely to engage in a romantic relationship with them (Van Boersel et al., 2011). Additionally, those who stuttered at age 16
were found to be more likely to have been bullied (McAllister et al., 2012). These harmful perceptions and acts continue into
adulthood, where there is evidence that people who stutter are regarded as less competent than others in the same occupation (Sil­
verman & Paynter, 1990). Gabel et al. (2004) found that stuttering affects possible career opportunities for those who stutter and
identified over 20 careers that people perceive to be inappropriate for those who stutter (e.g., attorney, judge, SLP, guidance/em­
ployment counselor). Recent research continues to support the notion that PWS experience role entrapment because jobs that require
greater communication skills are seen by as less appropriate for them, even by highly educated university students, faculty, and staff
(Dew & Gabel, 2024). As demonstrated, public perceptions can potentially act as barriers to communicative participation in in­
dividuals who stutter.
In previous research, Boyle (2018) administered a measure of “enacted stigma” to 324 adults who stutter, which was mostly
comprised of “everyday discrimination” items. Results of the study revealed that a large majority of people who stutter reported
experiencing various types of everyday discrimination, or devaluing and stigmatizing events, throughout the course of their lives. For
example, 80% or above reported having been made fun of and being picked on, laughed at, looked away from, treated unkindly, and
taken less seriously. In addition, between 50–80% reported being stared at, patronized, called names, and bullied. Importantly, there
was a significant negative relationship found between global mental health and the frequency of episodes of everyday discrimination
experienced in the past year. Plexico et al. (2019) compared 72 people who stutter with 92 people who did not stutter on various
measures, including an everyday discrimination scale. They found that people who stutter experienced higher levels of discrimination
compared to controls and that discrimination mediated, or accounted for, the relationship between stuttering and job satisfaction. The
authors of that study concluded that reducing discrimination in the workplace may be more impactful than increasing accommoda­
tions for stuttering for enhancing job satisfaction.
Other research has focused on major events of discrimination experienced by people who stutter. Through survey research, it has
been shown that being a person who stutters is associated with reduced earnings, decreased chances of being hired or promoted,
decreased performance on evaluations, an imbalanced delegation of job responsibilities, and a more intense feeling of social alienation
at work (Gerlach et al., 2018; Klein & Hood, 2004; Rice & Kroll, 1997). When asked within a focus group, five out of five adults who
stutter participating in a study reported that they were acutely aware of these trends in their lives and were ‘worried’ for themselves
when striving for a leadership position, renting a house, getting married, or being promoted (Alqhazo et al., 2017). These acts of major
discrimination are likely detrimental to the quality of life and overall well-being of a person who stutters.

1.3. Rationale and purpose of the current study

The review of the literature above suggests that people who stutter can be targets of negative perceptions, stereotypes, and
discrimination. Previous studies have sought information on how everyday discrimination is linked to the well-being of people who
stutter (e.g., Boyle, 2018; Boyle et al., 2023; Plexico et al., 2019). However, the stuttering literature to date has yet to formally explore
the number of different types of major discrimination events experienced by people who stutter. Furthermore, it is currently unknown
how these major discrimination experiences relate to the self-reported quality of life of people who stutter. With a current growing
emphasis in the field of communication disorders on client-centered care (Haley et al., 2019), and the importance of considering
environmental barriers to satisfactory communicative participation and therefore quality of life (Baylor & Darling-White, 2020), the
current study aims to gather evidence on major discrimination faced by adults who stutter and its potential connection with quality of
life. Furthermore, the current study would add to the current literature by ultimately helping to distinguish the relative impacts of
different types of discrimination (“minor” vs. “major”) experienced by people who stutter.
Specifically, the research questions for this study were:
1. What types of major discrimination have adults who stutter encountered in their lives, and what types are most frequently
reported?
2. Is there a relationship between the number of different types of major discrimination events experienced and self-reported
quality of life in adults who stutter?
3. Are there differences in the number of different types of major discrimination events experienced based on gender, employment
status, educational attainment, geographic location, race or ethnicity, and speech disruption severity?
This was an exploratory study into major discrimination faced by people who stutter and it was hypothesized that increased in­
stances of major discrimination events experienced would be related to lower levels of self-reported quality of life (Research question 2
above). No a priori hypotheses were made regarding questions 1 and 3.

2. Methods

2.1. Participants

Participants were 303 adults who stutter, including 191 males (63%), 90 females (29.7%), 3 non-binary/third gender (1.0%), one
who selected a preference not to answer (0.3%), and 18 who did not respond to the question (5.9%). Participants ages ranged from 18

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to 82 years (M = 37.1). The sample was comprised of mostly White participants (66%), followed by Asian (10.5%), Black or African
American (8.4%), and Hispanic, Latino, or Spanish (8%), with the remainder selecting “Other” or preferring not to answer (5.3%). Of
those who responded to the demographic questions, 80.5% lived in the United States (27.2% in the Northeast, 23.7% in the Southeast,
24.1% in the Midwest, 10.1% in the Southwest, and 15% in the West), and 19.5% reported living in other countries (mainly from the
United Kingdom). Of those who responded, most participants had a college degree or postgraduate degree (77.5%), and the remainder
obtained less than that. Most participants who responded (67.3%) were employed for wages or self-employed and 32.7% were un­
employed for various reasons.
Participants were recruited from speech-language pathologists in the United States who were either board-certified fluency spe­
cialists or self-advertised experts in stuttering. Participants were also recruited from adult chapters of the National Stuttering Asso­
ciation, Facebook, and message board posts of the American Speech-Language-Hearing Association. Only 14 participants (4.6%)
reported never receiving treatment for stuttering, while 271 (89.4%) reported having treatment for stuttering at some point in their
lives, and 18 (5.9%) did not respond to the question. Yet, only 53 participants (17.5%) were enrolled in stuttering therapy at the time of
the study, 217 were not enrolled (71.6%), and 33 (10.9%) did not answer the question. Participants in this study had an overall mean
of 4.68 on a self-reported stuttering severity scale ranging from 1 (no stuttering) to 9 (extremely severe stuttering) which was based
purely physical speech disruption (O’Brian et al., 2004), indicating a moderate physical severity on average. Participants in this study
were also included in a larger project focused on analyzing different components of self-stigma in people who stutter, the results of
which have been published (Boyle et al., 2023). However, that article did not report any of the data from the quality of life scale and
major discrimination scale being reported on here, and these data have not been previously published. The Boyle et al. (2023) study
provides additional details of participant recruitment and procedure.

2.2. Procedure

The survey was developed and administered through Qualtrics survey software. The authors contacted specialists and experts in the
area of stuttering within the United States, as well as leaders of adult chapters of the National Stuttering Association (NSA) with a
request to forward the survey to their adult current or past clients, acquaintances, friends, or self-help/support group members who
stutter. Three separate emails were sent to each of these individuals, one week apart from each other, to increase response rate. Once
participants read the email they clicked a link taking them to the study description and informed consent form of the study. Their
completion of the survey or parts of the survey implied their consent, and once they began the survey they completed measures of
quality of life, instances of major discrimination they have experienced in their lives, and demographic details including age, sex,
ethnicity/race, employment status, educational attainment, geographic location, and stuttering-related variables including stuttering
treatment history and self-rated physical speech disruption severity.

2.2.1. Quality of life

Quality of life, defined by the World Health Organization (2008), is “an individual’s perception of their position in life in the
context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.” In this
study, quality of life was measured with the Kemp Quality of Life Scale (Siebens et al., 2015). This is a single-item, self-defined scale of
quality of life with positive and negative extremes. Self-reported quality of life can range from low (negative) to high (positive).
Response options range from “1” (life is very distressing) to “7” (life is great), with a midpoint of “4” indicating that life is neither
negative nor positive but instead “so-so.” The scale intends to measure quality of life globally with all domains pertinent to the
participant taken altogether in one rating. The benefits of the one-item global rating are that they are non-intrusive, quick to
administer, intuitive for the responder, easy to interpret, can provide valuable information, and can be applied to any population due
to a lack of potential items that may not apply to the particular responder (Siebens et al., 2015). The scale has been used with various
populations, including individuals with cerebral palsy, spinal cord injury, rheumatoid arthritis, polio, and stroke, and initial testing
demonstrates evidence of construct validity as seen through correlations with levels of functioning, depression, and social interaction
(Kemp & Ettelson, 2001; Kemp & Bateham, 2010; Siebens et al., 2015). Although single-item measures are less detailed and sensitive
than multi-item measures, these single-item surveys asking a global question are quite commonly used in population surveys
measuring health status and quality of life, and satisfactory levels of validity and reliability have been demonstrated (See Bowling,
2005 for a review).

2.2.2. Major discrimination

Instances of major discrimination were documented using an adapted version of the Major Experiences of Discrimination Scale,
which has several different versions depending on the population targeted (e.g., Kessler et al., 1999; Williams et al., 2008). The
wording was adapted for people who stutter because the original scale had a few items that were not deemed particularly relevant for
people who stutter (e.g., two questions about housing and living in certain neighborhoods). The scale was comprised of eight items
asking participants if they had ever received particular types of discriminatory treatment, specifically due to their stuttering. These
included whether stuttering has resulted in being unfairly “not hired for a job,” “fired from a job,” “denied a promotion,” “unfairly
stopped, searched, or questioned by the police,” “discouraged by a teacher or advisor from continuing with education,” “discouraged
by a teacher or advisor from pursuing certain careers or jobs,” “denied or provided inferior medical care,” and “denied or provided
inferior service by a service member.” Responses were recorded as either yes/no, with 1 point added for any “yes” answers and 0 points
recorded for any “no” answers. The number of yes responses are then added up to yield a total score that can range from 0 to 8. Higher
scores indicate a greater frequency of having experienced different types of major discrimination due to stuttering throughout one’s

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lifetime. The scale has been widely utilized for research purposes, and evidence of its psychometric properties including convergent
and divergent validity has been reported (Kessler et al., 1999; Williams et al., 1997).

2.3. Data analysis

First, descriptive statistics and frequency counts were obtained for findings of lifetime major discrimination based specifically on
stuttering. It was of interest to know what percentage of the participants had experienced different types of major discrimination
events and the average number of different types of major discriminatory events that were experienced. Then, the primary analysis
focused on exploring the correlation between quality of life and major discrimination due to stuttering. A regression equation was
calculated to determine whether major discrimination was a predictor of self-reported quality of life. Demographic variables were
analyzed in relation to quality of life to account for potential confounds.

3. Results

3.1. Preliminary analyses

Because this was the first time that this particular scale of major discrimination was utilized with people who stutter, internal
reliability was first determined. A Kudar-Richardson-20 (KR-20) analysis was conducted on the eight items in the scale because
response options were binary (yes/no). The KR-20 coefficient was 0.70 which means that the items in the scale are adequately
interrelated. The average score on the major experiences of discrimination scale was 1.18 (SD = 1.56), and total scores ranged from 0.0
to 8.0, which is the maximum range possible on the scale. More than half of the participants (169, or 56%) reported experiencing at
least one instance of major discrimination due to stuttering during the course of their lives, while 134 (44%) did not. Eighty-four (28%)
participants reported experiencing only one of these incidents in their lives, 32 (11%) reported experiencing two of these instances,
and 53 (17%) reported more than two. All individual items in the scale, along with the numbers and percentages of participants who
answered “yes” or “no” to the question, are presented in Table 1. As can be seen, the two most common types of major discrimination
due to stuttering were “unfairly not being hired for a job” and “unfairly discouraged by a teacher or advisor from pursuing certain
careers or jobs.” Still, the percentage of respondents who answered “yes” to any particular question was 33% or below. One-third of
participants stated that they had unfairly not been hired for a job based specifically on their stuttering, and nearly one-quarter of the
participants reported being unfairly discouraged by a teacher or advisor from pursuing certain careers and jobs due specifically to
stuttering. Other types of discrimination were less common (e.g., unfairly fired from a job, denied or provided inferior services or
medical care).

3.2. Primary analyses

The zero-order Pearson correlation analysis revealed a significant negative relationship between quality of life and major
discrimination experienced due to stuttering, r = − 0.256, p < .001. This result indicates that there is a trend in which increased types of
major discrimination experiences due to stuttering are associated with lower self-reported quality of life. Fig. 1 displays this negative
relationship. Prior to conducting the regression analysis, it was determined whether other demographic and speech-related variables
were significantly related to quality of life. Age was significantly and positively linked to quality of life, r = .166, p = .005, as was
educational attainment, r = .143, p = .016, and self-rated severity of physical speech disruption was significantly and negatively
related, r = − .346, p < .001. However, quality of life was not significantly related to gender, p = .630, ethnicity/race, p = .812,
employment status, p = .238, geographic region, p = .765, having received therapy for stuttering in the past, p = .423, or involvement
in current speech therapy for stuttering, p = .821. Therefore, age, educational attainment, and self-rated severity of physical speech
disruption were entered as covariates in the regression equation with quality of life as the dependent variable and number of types of
major discrimination experienced due to stuttering as the independent variable. Results revealed that major discrimination was a
significant predictor of quality of life, even when taking age, education, and physical speech disruption severity into account, β =
− .197, p < .001. Table 2 demonstrates the nature of the association between quality of life and major discrimination. With age,
educational attainment, and self-rated severity of physical speech disruption held constant, an increase in experiencing one additional
type of major discrimination event throughout the lifetime is associated with an average reduction of 0.2 units in quality of life.

Table 1
Frequency counts for major discrimination due to stuttering over the lifetime.
Item N (%) “no” response N (%) “yes” response

Unfairly not hired for a job 205 (67.7) 98 (32.3)

Unfairly fired from a job 286 (94.4) 16 (5.3)
Unfairly denied a promotion 248 (81.8) 55 (18.2)
Unfairly stopped, searched, or questioned by police 271 (89.4) 32 (10.6)
Unfairly discouraged by a teacher or advisor from continuing education 255 (84.2) 48 (15.8)
Unfairly discouraged by a teacher or advisor from pursuing certain careers or jobs 232 (76.6) 71 (23.4)
Denied or provided inferior medical care 288 (95) 15 (5.0)
Denied or provided inferior service by a service member (plumber, car mechanic, etc.) 279 (92.1) 24 (7.9)

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Fig. 1. Scatterplot of the relationship between the number of different types of major discrimination events experienced throughout life and self-
reported quality of life. A jittering effect is produced to better highlight the association and reduce the effect of overlapping data points. A linear
regression line is included indicating that as frequency of experiencing different types of major discrimination events due to stuttering increases,
self-reported quality of life decreases.

3.3. Ancillary analyses

Following up on the primary analysis, it was of interest to determine whether experiences of major discrimination differed across
age groups. Two groups were created based on a median split of age (median = 32), and an independent samples t-test was conducted
to determine differences in discrimination based on age. One group included participants who were aged 18 through 32 (n = 144), and
the second group included participants who were above age 32 (n = 138). Splitting the groups by the median age maximized statistical
power for the analysis by dividing the overall sample roughly in half and accounted for the right-skewed distribution of ages in the
study. Please note that not all participants provided their age, which is why this particular analysis includes fewer participants than is
included in the overall sample. Results revealed that the group of participants older than 32 reported a higher mean of major
discrimination, M = 1.44, SD = 1.75, than the group of participants age 18–32, M = 0.90, SD = 1.33, and this result was statistically
significant, t = − 2.92, p = .004, with a large effect size, Cohen’s d = 1.55.
There were no significant differences in self-reported major discrimination due to stuttering based on gender, race/ethnicity,
employment status, educational attainment, or geographic location. Scores on major discrimination were, however, positively and
significantly related to self-reported severity of physical speech disruption, r = .212, p < .001. Increased self-reported major
discrimination was associated with more severe physical speech disruption.

4. Discussion

The hypothesis of the study that an increased amount of major discrimination experiences would be significantly related to lower
levels of self-reported quality of life was supported.
The current findings also support a variety of qualitative (e.g., Bricker-Katz et al., 2013) and quantitative (e.g., Boyle, 2018; Plexico
et al., 2019) studies that have documented the perceived discrimination of people who stutter (Gerlach et al., 2018; Klein & Hood,
2004), as well as negative attitudes and reactions from listeners and the public (St. Louis, 2015). The current study adds new infor­
mation to this area of research through distinguishing major discrimination events from everyday discrimination events, and

Table 2
Regression of quality of life on number of different types of major discrimination experienced due to stuttering controlling for age, education, and
speech disruption severity.
Predictor variable B (unstandardized) Std. Error β (standardized) t-value p-value

Age .009 .005 .114 1.98 .049

Education .149 .170 .050 0.88 .381
Speech severity − .240 .048 − .295 − 5.01 < .001
Major discrimination − .157 .045 − .197 − 3.46 < .001

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determining that a link exists between major discrimination events and quality of life in individuals who stutter. Overall the findings
support recent multidimensional models of disability such as the International Classification of Functioning, Disability, and Health
(ICF) (Yaruss, 2010) and the Participation-Focused Framework for Intervention (Baylor & Darling-White, 2020) in emphasizing the
role of environmental barriers in communicative disorders and differences. Discrimination from the public would clearly fit into the
ICF’s environmental categories, which is one of the “contextual factors” that impact activity and participation of individuals with
communication disorders. Discrimination also clearly fits into the category of social environmental barriers (e.g., attitudes and
knowledge of the public) in the Participation-Focused Framework that Baylor and Darling-White (2020) proposed for explaining the
communicative participation of individuals with communication disorders.
The task of speech-language pathologists is to enhance communication and thereby quality of life in individuals with communi­
cation disorders (American Speech and Hearing Association, 2016). It makes sense that public discrimination would be a significant
environmental barrier for not only socio-economic advancement but also for one’s feelings about their life and themselves. Ultimately,
facing discrimination due to a communication disorder such as stuttering can result in fewer opportunities to communicate. For
example, being discouraged by an educational counselor from pursuing certain types of education or jobs, not getting a job or being
fired from a job that would provide more opportunities to talk, would likely have a large impact on the frequency of an individual’s
communication. Furthermore, episodes of discrimination may reduce satisfaction with communication in particular environments as
well. Additionally, as the current result indicate, those individuals who stutter with increased severity of physical speech disruption
may be particularly vulnerable to major discrimination and the limitations resulting from it.
When compared to research on everyday discrimination, major events of discrimination are experienced less frequently than
everyday discrimination, as would be expected given the nature and definitions of these constructs. Everyday discrimination would be
expected to be experienced nearly every month, week, or even daily, whereas major events of discrimination may happen infrequently
or may have occurred a long time ago. Boyle (2018) found that large majorities of people who stutter experienced several types of
everyday discrimination throughout their lives (e.g., being laughed at, stared at, made fun of, or mimicked, etc.), however the current
study found that instances of major discrimination were much less common. Despite the relative infrequency of major discrimination
in the lives of people who stutter in this sample, the fact that these events can be integral to the future socioeconomic and social
advancement of the individual makes them crucially important to consider as an impact on clients’ lives. On the other hand, it is also
clear that “everyday” discrimination, sometimes also referred to as “minor discrimination,” is important to consider in the lives of
clients as well. Although it may be tempting to equate “minor” discrimination with a milder or more benign type of discrimination due
to its probable lack of direct socioeconomic impact, these events strike at the character of the person and devalue them in the eyes of
others. If repeated frequently day to day and year after year, these everyday or so-called “minor” evens can also have serious im­
plications for mental health, as prior research has shown (Boyle, 2018). In fact, comparing the effect sizes of the correlations in the
current study between major discrimination and quality of life to previous effect sizes on correlations between everyday or “minor”
discrimination and mental health (Boyle, 2018), it seems as though everyday or “minor” discrimination could be more impactful. Due
to these reasons, it is advisable to refrain from using the term “minor discrimination” and instead use “everyday discrimination.”
Another point worth highlighting is that participants aged 18–32 reported significantly fewer instances of major discrimination
than did adults who were age 33 and older. This finding could simply reflect the fact that as people age, the probability of experiencing
major discrimination increases purely based on increased exposure to different situations. This is particularly true when it comes to
higher education and employment. This finding supports the idea that even if a younger client has not experienced discrimination yet,
the probability of encountering it increases with age, and therefore they need to be prepared for how to handle it. Another more
optimistic possibility is that society has improved its perceptions and treatment of people who stutter over time, and therefore younger
people who stutter are not facing the negative attitudes that older generations felt to the same extent. Only future research will be able
to answer that question by continuing to monitor public perceptions of stuttering and perceived enacted stigma by people who stutter.
Overall, the current findings, building on the previous research, show that all different forms of discrimination, major events, and
everyday social devaluation should be accounted for, evaluated, and addressed in a therapy plan if relevant. For example, counseling
and desensitization to stuttering and reducing shame may be an important first step in helping the client feel more empowered to
impact their environment in ways that will support their communication. Then, depending on the situation (e.g., a situation in which
everyday social devaluation may occur or a situation in which major discrimination may occur), particular therapy strategies can be
selected and practiced. For example, if a client who stutters receives a rude comment, look, or laugh in response to stuttering in a daily
communicative situation, the client may be able to respond appropriately with an relatively brief educational statement about the
nature of the speech disruption and how the listener would be most helpful in responding. These types of responses can be practiced in
therapy with role-play. Alternatively, if a client is preparing for a big event in life that could expose them to major discrimination and
negative socioeconomic impacts (e.g., a job interview or speech), an introductory and more formal disclosure statement could be
made. The point being, the particular type of therapeutic tool or strategy could be differentiated and selected based on the type of
discrimination anticipated given the situation. Also, given that increased speech disruption severity was found to be associated with
increased likelihood of discrimination, targeting communication skills that reduce struggle in speech may also be effective. Regarding
professional domains of advocacy, outreach, and education, professionals can use evidence-based methods for improving attitudes
about stuttering. These include differentiating myths from facts about stuttering and educating the public accordingly, encouraging
members of the public to have personal contact and positive interactions with people who stutter, and publicly pushing back against
negative treatment such as stereotypes and discrimination (Boyle et al., 2016), in order to reduce social-environmental barriers faced
by people who stutter.
There are some limitations to consider in this study. The study is correlational in nature, so statements of causality between
variables cannot be made with confidence. In addition, many other variables may impact quality of life in people who stutter, and the

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current study did not intend to maximize prediction of quality of life in this population. The quality of life variable was measured
generally with one item, which although easy to administer and easy for participants to complete, reduced variability and therefore
covariance between variables. Further research with more detailed instruments would provide a more nuanced analysis. Additionally,
the discrimination measured in this study was based on self-report rather than direct observation. Therefore, the results need to be seen
from the perspective of perceived discrimination on the part of the participant. Also, the major discrimination scale only asked whether
participants had ever experienced certain types of discrimination. Follow-up questions on how many different times they had expe­
rienced each type of discrimination were not asked. Future research on this topic should include frequency as a follow-up question,
likely increasing data variance. This increased variance in major discrimination through additional items or response options, or
focusing on everyday discrimination, could make it more likely to uncover subtle differences in experienced discrimination between
sub-groups (e.g., gender, sexuality, race/ethnicity) of people who stutter. Given the recent emphasis on intersectional stigma in the
area of stuttering (Daniels et al., 2023; Dean & Medina, 2021; Nang et al., 2018), and different earnings deficits due to stuttering
between sexes (Gerlach & Totty, 2018), determining which subgroups of people who stutter more commonly experience certain types
of discrimination and stigma should be a strong research priory moving forward.
The correlation between major discrimination and quality of life was considered a small effect size, however, this may change in
future studies if the measurement of variables becomes more specific. Future research should aim to compare the relative contributions
of everyday discrimination and major discrimination on a variety of outcome variables, including quality of life, communicative
participation, and communicative satisfaction. In addition, as mentioned previously, future studies should continue to monitor the
levels of discrimination faced by people who stutter over time so that potential trends can be identified. This can be done with both
studies of the public (looking at public perceptions of stuttering), and with self-report of people who stutter (looking at perceived
enacted stigma). It will be important to document the impact of anti-stigma campaigns and greater societal awareness of stuttering via
levels of self-reported discrimination of people who stutter. Ideally, negative public perceptions and self-perceived enacted stigma will
decrease over time with effective education, advocacy, and outreach.
Despite the limitations of the study, we are confident in the conclusion that there is a significant negative relationship between
experiencing major discrimination events due to stuttering and self-reported quality of life in people who stutter. This finding con­
tributes to a more refined understanding of the implications of discrimination on people who stutter and highlights the continued need
to acknowledge and reduce the social-environmental barriers to their communication.

Declaration of Competing Interest

The authors received no external funding to complete this project. They report no financial or non-financial conflicts of interests
related to this paper.

Data Availability

Data will be made available on request.

Acknowledgements

We would like to thank the participants who volunteered in this research project, as well as the speech-language pathologists,
researchers, and individuals who stutter who shared the research opportunity with others. We would also like to thank the National
Stuttering Association and FRIENDS (The National Association of Young People Who Stutter) in the United States for help with survey
distribution and advertising.

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Michael P. Boyle, Ph.D., CCC-SLP, is an Associate Professor and Graduate Program Coordinator of the Speech-Language Pathology Master’s Program in the
Department of Communication Sciences and Disorders at Montclair State University.

Madelyn R. Cheyne, M.A., CF-SLP, is a 2024 graduate of the Speech-Language Pathology Master’s Program at Montclair State University. She currently works as a
speech-language pathologist at Universal Institute Rehab in Livingston, New Jersey.

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