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Social anxiety disorders among stutterers: effects of different variants



Development of social anxiety disorders (SADs) among stutterers was and is still poorly understood. Despite the absence of clear factors responsible for the emergence of such a disorder among the stuttering population, age, sex, and severity of stuttering remained among the major contributing factors.


The aims of this study were to (a) determine the prevalence of SADs among stutterers and (b) discuss the relation between the age of stutterers, their sex, and the degree of stuttering severity and the presence of SAD.

Settings and design

This study was carried out among the stuttering population attending the phoniatrics outpatient clinic. The data were collected retrospectively.

Materials and methods

A total of 120 stutterers who underwent both phoniatrics and psychiatric assessments between January 2015 and January 2017 were included in this study. Assessment was performed utilizing the protocol of assessment of stuttering (including assessment of stuttering severity using Stuttering Severity Instrument for Children and Adults-3) as well as a structured psychiatric interview using Mini International Neuropsychiatric Interview and Mini International Neuropsychiatric Interview for children and adolescents and Structured Clinical Interview for DMS-IV (SCID) for the assessment of SAD.


A total of 120 patients (92 males and 28 females) underwent phoniatrics and psychiatric assessments. A total of 70 patients (46 males and 24 females) were assessed as a child group and 50 patients (46 males and four females) were assessed as an adolescents and adults group. SADs were obviously present in the adolescents and adults group rather than the child group. Its development is related to the older age of the stutterers and stuttering severity score.


The co-morbidity of stuttering with SAD could be considered a specific sub-type of stuttering. Accordingly, this co-morbidity should be determined during the assessment and management of stuttering. Otherwise, it could markedly affect the course and prognosis of the stuttering condition.


  1. 1

    Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE. What is an anxiety disorder? Depress Anxiety 2009; 26:1066–1085.

    PubMed  Google Scholar 

  2. 2

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 5th ed. Washington: American Psychiatric Association; 2013.

    Google Scholar 

  3. 3

    Bernardini S, Cocco L, Zmarich C, Di Pietro M, Natarelli G, Ghishi M. Releationship between stuttering and anxiety disorders in Italian children and adolescents who stutterers. In: Tomaiuoli D, (editor) Proceeding of 2nd international conference on stuttering. Rome, Italy. 2016.

  4. 4

    Kefalianos E, Onslow M, Block S, Menzies R, Reilly S. Early stuttering, temperament and anxiety: two hypotheses. J Fluency Disord 2012; 37: 151–163.

    PubMed  Google Scholar 

  5. 5

    Kefalianos E, Onslow M, Ukoumunne O, Block S, Reilly S. Stuttering, temperament and anxiety: data from a community cohort aged 2-4 years. J Speech Lang Hear Res 2014; 57:1314–1322.

    PubMed  Google Scholar 

  6. 6

    Riely GD. Stuttering severity instrument for children and adults. 3rd ed. Austin TX, USA: Pro-ed; 1994.

    Google Scholar 

  7. 7

    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59:22–33.

    Google Scholar 

  8. 8

    Sheehan DV, Sheehan KH, Shytle RD, Janavs J, Bannon Y, Rogers JE, et al. Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). J Clin Psychiatry 2010; 71:313–326.

    PubMed  PubMed Central  Google Scholar 

  9. 9

    Field A. Discovering statistics using SPSS. 3rd ed. London: SAGE Publications Ltd; 2009.

    Google Scholar 

  10. 10

    Perkins WH. What is stuttering? J Speech Hear Disord 1990; 55:370–382.

    CAS  PubMed  Google Scholar 

  11. 11

    Beilby JM, Byrnes ML, Meagher EL, Yaruss JS. The impact of stuttering on adults who stutter and their partners. J Fluency Disord 2013; 38: 14–29.

    PubMed  Google Scholar 

  12. 12

    Irwin M. Terminology – how should stuttering be defined? And why? In: AuYeung J, Leahy MM, editors. Research, treatment, and self-help in fluency disorders. 1st ed. Dublin: The International Fluency Association; 2006. 4145.

    Google Scholar 

  13. 13

    Mulcahy K, Hennessey N, Beilby J, Byrnes M. Social anxiety and the severity and typography of stuttering in adolescents. J Fluency Disord 2008; 33:306–319.

    PubMed  Google Scholar 

  14. 14

    Yairi E, Ambrose N. Epidemiology of stuttering: 21st century advances. J Fluency Disord 2013; 38:66–87.

    PubMed  Google Scholar 

  15. 15

    Rapee RM. The development and modification of temperamental risk for anxiety disorders: prevention of a lifetime of anxiety? Biol Psychiatry 2002; 52:947–957.

    PubMed  Google Scholar 

  16. 16

    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593–602.

    PubMed  Google Scholar 

  17. 17

    Iverach L, Rapee R. Social anxiety disorder and stuttering: current status and future directions. J Fluency Disord 2013; 40:69–82.

    PubMed  Google Scholar 

  18. 18

    Van der Merwe B, Robb MP, Lewis J, Ormond T. Anxiety measures and salivary cortisol responses in preschool children who stutter. Contemp Issue Commun Sci Disord 2011; 38:1–10.

    Google Scholar 

  19. 19

    Edwards SL, Rapee RM, Kennedy SJ, Spence SH. The assessment of anxiety symptoms in preschool-aged children: the revised preschool anxiety scale. J Clin Child Adolesc Psychol 2010; 39:400–409.

    PubMed  Google Scholar 

  20. 20

    Vanryckeghem M, Brutten G. KiddyCAT: a measure of stuttering & nonstuttering preschoolers’ attitude. ASHA Leader 2002; 7:104.

    Google Scholar 

  21. 21

    Ortega AY, Ambrose NG. Developing physiologic stress profiles for school-age children who stutter. J Fluency Disord 2011; 36:268–273.

    PubMed  Google Scholar 

  22. 22

    Andrews G, Harris M. The syndrome of stuttering. Oxford, London: Spastics Society Medical Education; 1964.

    Google Scholar 

  23. 23

    Craig A, Hancock K. Anxiety in children and young adolescents who stutter. Am J Hum Commun Disord 1996; 24:28–38.

    Google Scholar 

  24. 24

    Spielberger CD. State-trait anxiety inventory. The corsini encyclopedia of psychology. John Wiley & Sons Inc.; 2010.

  25. 25

    Iverach L, Jonesb M, McLellana L, Lyneham H, Menzies R., Onslow M, et al. Disorders prevalence of anxiety disorders among children who stutter. J Fluency Disord 2016; 49:13–28.

    PubMed  Google Scholar 

  26. 26

    Lyneham HJ, Wuthrich V, Kangas M, Iverach L, McLellan LF, Hudson JL, et al. The youth online diagnostic assessment for DSM-IV anxiety disorders (YODA) manual. Macquarie University: Centre for Emotional Health; 2015.

    Google Scholar 

  27. 27

    McMillan CK, Ebesutani C. The etiology of social anxiety disorder in adolescents and young adults. In: Alfano CA, Beidel DC, editors. Social anxiety in adolescents and young adults: translating developmental science into practice. Washington, DC: American Psychological Association 2011. 29–51

    Google Scholar 

  28. 28

    Kearney CA. Social anxiety and social phobia in youth: characteristics, assessment, and psychological treatment. New York: Springer 2005.

    Google Scholar 

  29. 29

    Morris TL. Social phobia. In: Vasey MW, Dadds MR, editors The developmental psychopathology of anxiety. Oxford: Oxford University Press 2001. 435–458

    Google Scholar 

  30. 30

    Rapee RM, Spence SH. The etiology of social phobia: empirical evidence and an initial model. Clin Psychol Rev 2004; 24:737–767.

    PubMed  Google Scholar 

  31. 31

    Ghanem M, Gadallah M, Mourad MS, El-Kholy G. National survey of prevalence of mental disorders in Egypt: preliminary survey. East Mediterr Health J 2009; 15:65–75.

    CAS  PubMed  Google Scholar 

  32. 32

    Davis S, Shisca D, Howell P. Anxiety in speakers who persist and recover from stuttering. J Commun Disord 2007; 40:398–417.

    PubMed  Google Scholar 

  33. 33

    Watson D, Friend R. Measurement of social-evaluative anxiety. J Consult Clin Psychol 1969; 33:457–498.

    Google Scholar 

  34. 34

    Yaruss SJ, Quesal RW. Overall Assessment of the Speaker’s Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment. J Fluency Disord 2006; 31:90–115.

    PubMed  Google Scholar 

  35. 35

    Erikson S, Block S. The social and communication impact of stuttering on adolescents and their families. J Fluency Disord 2013; 38:311–324.

    Google Scholar 

  36. 36

    McCroskey JC, Beatty MJ. Communication apprehension and accumulated communication state anxiety experiences: a research note. Commun Monogr 1984; 51:79.

    Google Scholar 

  37. 37

    Iverach L, O’Brian S, Jones M, Block S, Lincoln M, Harrison E. Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. J Anxiety Disord 2009; 23:98–934.

    Google Scholar 

  38. 38

    Craig A. An investigation into the relationship between anxiety and stuttering. J Speech Hear Disord 1990; 55:290–294.

    CAS  PubMed  Google Scholar 

  39. 39

    Ezrati-Vinacour R, Levin I. The relationship between anxiety and stuttering: multidimensional approach. J Fluency Disord 2004; 29:135.

    PubMed  Google Scholar 

  40. 40

    Stein M, Baird A, Walker JR. Social phobia in adults with stuttering. Am J Psychiatry 1996; 153:278–280.

    CAS  PubMed  Google Scholar 

  41. 41

    Blumgart E, Tran Y, Craig A. Social anxiety disorder in adults who stutter. Depress Anxiety 2010; 27:687–692.

    PubMed  Google Scholar 

  42. 42

    Craig A, Hancock K, Tran Y, Craig M. Anxiety levels in people who stutter: a randomized population study. J Speech Lang Hear Res 2003; 46: 1197–1206.

    PubMed  Google Scholar 

  43. 43

    Miller S, Watson B. The relationship between communication attitude, anxiety and depression in stutterers and nonstutterers. J Speech Hear Res 1992; 35:789–798.

    CAS  PubMed  Google Scholar 

  44. 44

    Yairi E, Ambrose N, Cox N. Genetics of stuttering: a critical review. J Speech Hear Res 1996; 39:771–784.

    CAS  PubMed  Google Scholar 

  45. 45

    Wu JC, Maguire G, Riley G, Lee A, Keator D, Tang C, et al. Increased dopamine activity associated with stuttering. Neuroreport 1997; 8:767–770.

    CAS  PubMed  Google Scholar 

  46. 46

    Costa AD, Kroll RM. Stuttering an update for physicians. Can Med Assoc J 2000; 162:1849–1855.

    CAS  Google Scholar 

  47. 47

    Sundheim ST, Voeller KK. Psychiatric implications of language disorders and learning disabilities: risks and management. J Child Neurol 2004; 19:814–826.

    PubMed  Google Scholar 

  48. 48

    Klein JF, Hood SB. The impact of stuttering on employment opportunities and job performance. J Fluency Disord 2004; 29:255–273.

    PubMed  Google Scholar 

  49. 49

    Haley JT. Stuttering, emotional expression, and masculinity: fighting out words, fighting back tears. MD thesis submitted in partial fulfillment of the requirements for the Doctor of Philosophy degree in Psychological and Quantitative Foundations (Counseling Psychology). Graduate College of The University of Iowa; 2009. pp 10–26.

  50. 50

    Craig AR, Calver P. Following up on treated stutterers. Studies of perceptions of fluency and job status. J Speech Hear Res 1991; 34:279–284.

    CAS  PubMed  Google Scholar 

  51. 51

    Menzies RG, Onslow M, Packman A. Anxiety and stuttering: exploring a complex relationship. Am J Speech Lang Pathol 1999; 8:3–10.

    Google Scholar 

  52. 52

    Craig A, Tran Y. Fear of speaking: chronic anxiety and stuttering. Adv Psychiatr Treat 2006; 12:6.

    Google Scholar 

  53. 53

    Huinck WJ, Langevin M, Kully D, Graamans K, Peters HF, Hulstijn W. The relationship between pre-treatment clinical profile and treatment outcome in an integrated stuttering program. J Fluency Disord 2006; 31:43–63.

    PubMed  Google Scholar 

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Correspondence to Hassnaa O. Mohammed MD.

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Ahmed, H.H., Mohammed, H.O. Social anxiety disorders among stutterers: effects of different variants. Egypt J Otolaryngol 34, 155–164 (2018).

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  • severity of stuttering
  • social anxiety disorder
  • stuttering disorder