Developing a stakeholder led stuttering resource for teachers in New Zealand

ABSTRACT

Students who stutter at school often have difficult school experiences. Teachers play a pivotal role in students' lives but need the skills to support those who stutter in the classroom. The overall goal of this study was to develop and evaluate a stuttering resource for New Zealand teachers. In Phase 1, semi-structured interviews with four adolescents who stutter and three teachers revealed six themes: (1) stigma and the impact on the child, (2) things that helped – teachers, (3) things that helped – others, (4) things that did not help, (5) resources / support and (6) difficulties. In Phase 2, six adolscents who stutter were asked to complete an online survey of their preferred classroom strategies. In Phase 3, a draft resource was developed and the most effective strategies were added to the resource including ‘teachers understand the difference between struggling and stuttering', ‘teachers give you time' and ‘teachers create a safe and relaxed learning environment’. In Phase 4, 16 stakeholders provided feedback on the draft resource and as a result, additional elements were included in the resource: learner examples of teacher-student Individual Education Plans, a New Zealand video resource, and a supporting document to use alongside the Individual Education Plan. Finally, in Phase 5, 21 teachers responded to an online survey to judge their confidence in working with students who stutter before and after receiving the teacher resource. Results showed their confidence improved and 90% of teachers would use the Resource and Individual Education Plan.

KEYWORDS:

• Stuttering
• stammering
• teachers
• students
• school
• perceptions
• knowledge
• awareness

Introduction

It is well documented in the literature that stuttering is associated with negative experiences when interacting with others. There is much research about attitudes within the general public that result in negative stereotypes, stigmatisation and discrimination (Boyle & Blood, 2015; St. Louis, 2015). Young people who stutter at school are also impacted as these attitudes are seen in teachers as well as peers (Beste-Guldborg, St. Louis, & Campanale, 2015; Langevin, 2015). It is highly likely that the reactions of others to stuttering significantly contribute to anxiety and negative academic and vocational outcomes for people who stutter. In fact, it has been shown that these negative reactions commence during the preschool years (Langevin, Packman, & Onslow, 2009) and during the school years. Multiple sources document high rates of teasing and bullying and adults remember avoiding not only class presentations and roll call, but also school altogether (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Blood & Blood, 2016; Daniels, Gabel, & Hughes, 2012; Langevin & Prasad, 2012). This can lead to poor mental health outcomes, reduced participation and lower academic achievement. In comparison to their peers, children who stutter have been shown to be at higher risk of repeating a year of schooling and displaying poorer attendance rates (Boyle, Decoufle, & Yeargin-Allsopp, 1994). O’Brian et al., (2011) reported that higher stuttering severity was significantly correlated with lower educational attainment. When surveyed, adults indicate that their stuttering also interfered with their performance and advancement at work (Klein & Hood, 2004).

In addition to these educational and vocational impacts, research clearly shows that adults who stutter have higher rates of trait and social anxiety (Craig & Tran, 2014; Iverach, Menzies, O’Brian, Packman, & Onslow, 2011). Adults who stutter are six times more likely to experience an anxiety disorder and 16–24 times as likely to develop social anxiety disorder (Iverach et al., 2009). There is conflicting evidence in terms of anxiety in preschool children who stutter (Onslow, 2023; Onslow & O’Brian, 2013). However, evidence is emerging to confirm that the anxiety that is present in adults emerges sometime in the school-age years. Kefalianos, Onslow, Ukoumunne, Block, and Reilly (2014) showed there was an absence of temperamental markers for anxiety before and during onset of stuttering. Yet, in a group of 75 Australian school children, 24% of the children who stutter, compared to only 5% of controls, met the criteria for social anxiety disorder. This makes the school-age years an important stage in the life of a young person who stutters in terms of the trajectory of educational, vocational and mental health outcomes. Research has been conducted to develop resources to change attitudes to stuttering in school children directly and some positive outcomes have been reported (Kathard et al., 2014; Langevin & Prasad, 2012; Mallick, Thabane, Borhan, & Kathard, 2018). It is incontrovertible that teachers have an important role to play in this process.

The role of teachers

The impact of stuttering on the life of an individual can be significantly altered by multiple intrinsic and extrinsic factors. Possible intrinsic variables include cognitive, emotional, and behavioural reactions students who stutter have towards their stutter, and the experiences they have of interactions with peers, teachers, siblings, and family. Potential external factors are attitudes and responses of peers and teachers, along with the degree of family support (Eggers, Millard, & Kelman, 2021). All these factors culminate to determine the overall impact of stuttering. Teachers are in a unique position to directly influence of a number of these factors to reduce the impact of stuttering. Teachers who are well educated about stuttering can provide a safe and understanding environment at school, making it more likely that students who stutter can achieve similar educational and vocational outcomes to students who do not stutter. Teachers can help provide protection from the negative social consequences of stuttering by being a role model and providing education to peers of students who stutter. This has the potential to significantly improve the self-esteem, attitudes and beliefs a student may have about their own stuttering.

However, international research indicates that some teachers had misconceptions about stuttering such as that stuttering affects IQ levels and used negative adjectives to describe students who stutter (Kuruppu & Jayawardena, 2015; Lass et al., 1992; Panico, Daniels, Hughes, Smith, & Zelenak, 2018). More recent research, in New Zealand, has shown that teachers generally have a positive attitude towards stuttering in their students, but limited knowledge of appropriate strategies to assist students (Hearne et al., 2021). In order for teachers to support children who stutter, they need accurate information and practical strategies to employ in the classroom.

Research design and aims

The overall goal of this study was to provide a way of imparting this knowledge and practical information to teachers by developing and evaluating a resource for New Zealand teachers. This multi-phase, mixed design, stakeholder-led study was guided by teachers, speech-language therapists (SLTs), parents, adolescents and adults who stutter. The guiding research questions were: What do teachers need to know about students’ experiences in the classroom? What strategies help students in the classroom? What suggestions for improvement do SLTs, parents and adults who stutter have on a draft resource? What support does a teacher need in order to have a safe and successful Individual Support Plan meeting with a student? What do teachers think of the resource?

Methods

This study received appropriate, national ethical approval. Phase 1 (semi-structured interviews) and Phase 2 (online survey) collected data from teachers and adolescents who stutter to allow the development of a draft resource. In Phase 3, the resource was developed based on published work and Phase 1 and 2 data. In Phase 4, further stakeholder consultation (interviews, written and focus group feedback) was completed and in Phase 5, a revised resource was sent to teachers via an online survey for final feedback before public circulation.

Phase 1 – classrooms experiences of stuttering

In Phase 1, we conducted semi-structured interviews with adolescents and young adults who stutter (16–25yrs) as well as teachers who have worked with a student who stuttered about what they would want from a resource. We asked: what were their experiences of stuttering in the classroom, what worked? what didn’t help? and what did they wish they’d had available to them? Adolescents were recruited through the Stuttering Treatment and Research Trust (START), an organisation which provides stuttering treatment to children and adults in the wider Auckland area. All adolescents (aged 16–25yr) on the START database were sent the study flyer. Teachers were recruited through emails to sixteen principals of local Primary Schools who were asked to pass the study flyer on to their teachers. The flyer was also posted on the New Zealand primary teachers Facebook page. One reminder was sent six weeks after the initial invitation. Four adolescents and three teachers agreed to be interviewed. One mother was present in an interview with an adolescent; however, her input was not recorded. Interviews were transcribed and explored using content analysis by one SLT student with consensus discussions with two experienced practising SLT researchers.

Phase 2 – preferred classroom strategies

Phase 2 comprised of an online survey conducted through Qualtrics. We wanted to build on the advice provided in Phase 1 with specific feedback on classroom strategies for teachers. Participants were recruited through START. Inclusion criteria were being aged 16–25yrs, having a stutter and residing in New Zealand. Participants were recruited via a link to the survey posted on the public START Facebook page. One reminder was sent six weeks after the initial invitation.

The survey gathered basic demographic information (age and gender) and then asked participants to rank classroom strategies into three groups; most helpful, neutral and not very helpful. The strategies included in the survey were sourced from Phase 1 and published literature. They included strategies endorsed by people who stutter, teachers, and strategies recommended by experts in the field, including one literature review which compiled the most commonly recommended strategies (Davidow, Zaroonigan, & Garcia-Barrera, 2016; see Appendix 2 for a detailed list of references).

Phase 3 – resource development

In Phase 3, the resource draft was compiled based on New Zealand literature (Hearne et al., 2021) as well as international resources. All authors contributed to the resource development including two experienced SLTs and five graduating SLT students. The draft resource included: top 10 facts about stuttering, a U.K. video resource, reflections from young New Zealanders who stutter, reflections from New Zealand teachers, helpful classroom strategies from young New Zealanders, an Individual Support Plan template, Individual Support Plan examples, how to refer to SLT, and additional resources. In Appendix 3, we provide a detailed description of the content, rationale and references used.

Phase 4 – stakeholder feedback on Version 1

In Phase 4, we invited the START staff and advisory board (SLTs, teachers, parents of children who stutter, adults who stutter) to semi-structured interviews via an email invitation. We asked for their feedback on the resource. The following areas of feedback were requested: accuracy and appropriateness of the content, errors / typos / missing links, any areas you particularly like and why, any areas you don’t like and why, things you think should be included, and your opinion on the relevancy and practice feasibility of using this in New Zealand (strengths and potential barriers / concerns).

Sixteen stakeholders (8 SLTs, 4 teachers, 2 people who stutters, and 2 parents of children who stutter) provided feedback on the draft resource via email or Zoom interview. In addition, the members of the national SLT Fluency Special Interest Group were asked for feedback during a group meeting with a specific focus on the Individual Education Plan – a document to support teacher: student conversations about classroom management of stuttering. Four members attended the meeting. All interviews and focus groups were recorded and transcribed and merged with written feedback and then explored using content analysis by two SLT students with consensus discussions with two experienced practising SLT researchers.

Phase 5 – teacher feedback on Version 2

Finally, in Phase 5, the resource was revised once again following stakeholder feedback from phase 4 and an online survey asked teachers to provide feedback on the final version of the teacher resource. A flyer was posted on the New Zealand primary teachers Facebook page. Teachers answered basic demographic questions and were asked to rate their confidence in working with a student who stutters in the classroom using likert scale response. Teachers were then provided with the resource. (https://www.stuttering.co.nz/speech-therapy-resources-for-teachers/) They were encouraged to read it carefully. Afterwards, they were asked to rate their confidence again, ticked a list of possible benefits of the resource (including specific strategies, general consideration for having conversations about stuttering, steps of how to use an Individual Support Plan, Checklist form, Easy to read and understand or other) and provide any additional commentary in an open-ended box response.

Results

Phase 1 – classrooms experiences of stuttering

Phase 1 interviewes revealed six themes: (1) stigma and the impact on the child, (2) things that helped – teachers, (3) things that helped – others, (4) things that did not help, (5) resources / support and (6) difficulties. Both the adolescents and teachers expressed that they felt they were not supported well enough through the school system. Participants provided general and specific advice. Illustrative quotes under each Theme are provided in Appendix 1.

Phase 2 – preferred classroom strategies

Participants in the online survey to provide feedback on classroom strategies were 6 male young people (M = 18 years, range: 16–24). Strategies are displayed from top to bottom in terms of helpfulness (Table 1).

Table 1. Top strategies as determined by survey results.

Rating	Strategy
1	Teachers understand the difference between struggling (e.g., avoidance, compensatory strategies) and stuttering
2	Teachers give you time to think and talk/be patient
3	Teachers create a safe and relaxing learning environment
	Teachers and students don’t finish your sentences
	Teachers don’t treat you differently, e.g., don’t exclude you from activities
	Teachers allow simple answers, e.g., yes/no
	Teachers and students don’t interrupt you when you are speaking
4	Use a script to prepare for oral speeches in class
	Teachers allow you time to practice
	Teachers work with you and your family to understand you and create specifically designed plans to suit you
	Teachers are educated on stuttering and understand how it may affect you
	Classmates are educated on/ are more aware of stuttering
	Teachers take the pressure off talking and let you know you don’t have to say anything if you don’t want to

Phase 3 – resource development

In Phase 3, the resource draft was compiled. A detailed description of the content, rationale and references used is provided in Appendix 3.

Phase 4 – stakeholder feedback on Version 1

Feedback about version 1 of the resource was positive across participants. Some referred to the gap it would fill in New Zealand, or even to the impact it could have had on their own life had it been developed sooner. A variety of areas for improvement were noted; some common among participants and others unique to an individual or group. It proved helpful having a range of stakeholders as different groups offered different perspectives on the resource. Typographical, content and formatting corrections were reported. Table 2 displays a summary of content-based feedback with illustrative quotes.

Table 2. Stakeholder feedback on draft resource.

Main category	Subcategories	Illustrative quotes
Accuracy and appropriateness of content	Suitability	‘I mean you are directly quoting people and you’re using information from that survey. Like it’s accurate right? As far as all of the facts they seem to be spot on … So I think the fact that all the information comes directly from people makes it really accurate – like really useful information’ (SLT1;1, Zoom interview)
Areas liked	Stakeholder involvement	‘I really like the focus on the learner/ child throughout, with their perspective at the forefront’ (teacher2;3, email) ‘I also liked the examples provided from both students and teachers’ (PWS1;1, email)
	Strategies	‘ … really like the bit about “teachers and students don’t finish your sentences” I think that’s really important because that can really do a number on your confidence around speaking when people start finishing your sentences for you because it sort of takes away that control’ (PWS2;4, Zoom interview) ‘I particularly liked the strategies section, as a teacher this would be the section that actually provides the most practical support’ (teacher1;1, email)
	IEP/Speaking to student	‘ … in my time at school there hasn’t been a single teacher who has actually talked to me about my stutter even though other staff members such as cleaning staff, catering staff and all sorts of other people working at and around school have noticed that I stutter … if there was one thing that could come out of this document I think it would be talk to the student that stutters’ (PWS2;5, Zoom interview)
	Student case examples	‘I really liked the student examples at the bottom and I think there was some really good information in there just some really nice suggestions around what teachers can do’ (SLT1;3, zoom interview).
	Specific details	‘oh man – this [difference between struggling and stuttering] is VITAL. I think more elaboration is needed here – because this really is EVERYTHING … In my opinion the ability to differentiate between “struggling with LEARNING” versus ‘struggling with STUTTERING’ can be the difference between a student feeling safe, secure and strong in their akomanga [class]; versus misunderstood, withdrawn or “dumb”’ (teacher3;1, email)
Areas disliked	Presentation	‘I just wonder if there will be some really simple things, like putting the quotes in into speech bubbles or having some images on it or something just to make it a little bit more engaging?’ (SLT4;2, Zoom interview)
Additional inclusions	Additional documents	‘ … the reality is teachers are really busy and if you hand them something that is you know however many pages thick … you gonna potentially have them gawking at that, whereas if you have them two side and they can read and then they may go “hey this is really good stuff, makes we want to read the 15 pages”’ (SLT4;3, Zoom interview) ‘ … I do think there needs to be an accompanying poster, leaflet or QR code that takes 4-5 key points about how Educators can help stutterers in the classroom. This is the visually appealing thing they can put up next to their desk or access quickly on their device for easy reading and reference’ (teacher3;3, email) ‘I like the part where you talk to the student and fill out the document, could this be a separate questionnaire too for ease of printing?’ (SLT3;1, email)
	Additional details/advice	‘ … later this year and in the next year or two there might be more online classes, I think including something on that could be quite good because I found it significantly harder to talk over online classes … ’ (PWS2;6, Zoom interview)
Relevancy and practice feasibility of using resource (strengths and potential barriers/concerns)	Size	‘Compact enough for a busy teacher to absorb quickly but comprehensive enough to take them to the right place(s)’ (whānau1;1, email) ‘ … if you try to think of a way to make it not as long could you go through the quotes and pick out the really “good” ones’ (SLT4;4, Zoom interview)
	Accessibility	‘My concern would be how such a document would be distributed, as there can be inequitable sharing of resources amongst schools’ (teacher1;2, email)

PWS: person with stutter.

Themes from the national SLT Fluency Special Interest Group on the Individual Support Plan provided useful feedback (Table 3). SLTs described conversations with students who stutter as challenging and complex and offered suggestions to make the Individual Support Plan more supportive and easier to use.

Table 3. National SLT fluency special interest group feedback on the Individual Support Plan.

Main category	Illustrative quotes
Written checklist format	‘I think it could be useful to have it in a written form … going back to what we mentioned before about teachers being short on time and also having something that they can almost look at and circle or checkbox, I think would be really useful for them to have sit alongside that resource.’ ‘you kind of need to give people information in bitesize and really easy to understand information.’ ‘I think and something that I found with a lot of young people is that young people aren't used to telling teachers what they need. So even though you're opening up this conversation and a teacher is going, I'm here, I'm listening, for a child to still communicate what they need to a teacher is really challenging’ ‘they [student] weren't feeling confident enough to sit down with the teacher’
Specific strategy recommendations	‘I think having some suggested strategies is going to be really, really helpful for teachers, because I think teachers don't necessarily know what they can suggest and what may be appropriate.’ ‘One suggestion that could be worth having under each idea is no adaptations needed. Because some children are completely fine. So having all these options but also having no adaptations needed could be an idea as well.’ ‘Some kids are okay with teachers guessing their words, some aren’t.’
SLT involvement	‘Teachers don’t know whether they are allowed to say something, you know, until a speech therapist gets on board and sort of like works with them about it. They think, oh no, we’ll just pretend it’s not happening, we won’t say anything. So I think there are a lot of people out there that think they shouldn’t say or comment or acknowledge it.’
Sensitive nature of stuttering conversations	‘Does there need to even be an intro part to the individual support plan about how to talk about stuttering? … That seems like quite a big stretch for a teacher doesn’t it? Because it's not always easy even for us (speech-language therapists) to talk to kids about stuttering … to just throw an individual support plan at a teacher and expect them to know how to handle it in a supportive way is possibly quite a big ask.’

Resource revisions

Stakeholder feedback provided the research team with areas for further resource development. Early feedback, in Phase 3, led to the addition of learner examples of teacher: student classroom support plans, the development of a New Zealand video resource and the additional resource page. Following the focus group, the national SLT Fluency Special Interest Group supported the development of an additional element to be included with the Individual Support Plan template to support student-teacher conversations.

Phase 5 – teacher feedback on Version 2

Twenty-one teachers (64% primary school) responded to the survey to gather teacher feedback on version 2 of the resource. The majority of respondents (91%) reported having worked with a student who stuttered. Teachers’ confidence increased after being provided with the resource (Figure 1). Ninety percent of teachers said they would use the resource and teachers selected ‘specific strategies’, ‘general considerations for having conversations about stuttering’ and ‘the format being easy to understand and read’ as their top helpful aspects and offered positive feedback on the resource’s use:

As a partner of a stutterer and parent of two sons who stutter, as well as a teacher who has had students who stutter in class, this is a great resource and is mana [prestige] enhancing for the student, informative for kaiako [teacher] and other students – particularly the checklist of proven supports.

I think this is a valuable resource having had stuttering students and a son who has a bad stutter. For my experience the Speech Language Therapist was annoyed my son wasn’t looked at until he reached primary school. So I guess early intervention is best and are ECE centres equipped/resourced to assist with this. I also wonder if the resource could also include a guide to educating the class around stuttering. There’s the section on bullying but educating the class and ensuring appropriate messages are consistent would also be beneficial.

Great resource – wish I’d had it with the two boys I’ve taught in recent years who stuttered badly – currently teaching a girl who stutters so it will be useful. My husband has a stutter wish teachers had been this aware of stuttering and had resources like this back in the 60’s his school memories would be happier I’m sure.

The teachers provided useful feedback that has been subsequently revised in the resource: ‘Write it in a more kid friendly way « I can » statements’.

Figure 1. Teachers’ self-reported confidence in working with a student who stutters.

Discussion

Students who stutter need to be supported at school in order to develop positive self-esteem and attain their best educational and vocational outcomes. For teachers to provide this support, they need education about stuttering and its impact as well as an understanding of strategies that help. Previous research demonstrated that teachers have unhelpful attitudes about stuttering and knowledge about stuttering is lacking and contains misconception (Beste-Guldborg et al., 2015; Hearne et al., 2021; Klompas & Ross, 2004; Kuruppu & Jayawardena, 2015; Langevin, 2015; Lass et al., 1992. Miles, Hearne, Pang, & Carr, 2018, unpublished; Plexico, Plumb, & Beacham, 2013). Encouragingly however, education is welcomed by teachers and is able to shift perceptions and increase teachers’ knowledge (Abdalla & St. Louis, 2014; Gottwald, Fraas, Hawver, Hartley, & St. Louis, 2011; Hearne et al., 2021; Hobbs, 2012; Panico et al., 2018). However, local research has shown gaps in the knowledge of New Zealand teachers, especially with regards to strategies that can be employed in the classroom (Hearne et al., 2021). Given that teachers are pivotal in providing a safe learning environment for students, a resource specific to New Zealand is in need. This study includes five phases of research to answer five research questions and inform the writing of a stakeholder-driven, New Zealand-specific resource for teachers. This process was underpinned by the three core aspects of evidence-based practice, research evidence, clinical experience of the SLTs who work in the field and stakeholder perspectives including teachers, parents and adolescents and adults who stutter. The phases of research corresponded with the research questions.

What do teachers need to know about students’ experiences in the classroom?

In Phase 1, adolescents and teachers were asked what they would like from a resource, based on their experiences of what worked and what didn’t. The quotes by participants in Appendix 1 indicate that teachers showed awareness and positive attitudes but experienced a lack of support and lack of resources to support students who stutter. Adolescents who were interviewed did not feel well supported by their teachers and bullying was a recurring theme throughout the interviews. These themes are consistent with research suggesting bullying is prevalent (Blood et al., 2007), stigmatisation occurs during the school-age years (Panico, Healey, & Knopik, 2015) and teachers do not receive much, if any, training about teaching students who stutter (Jenkins, 2010).

What strategies help students in the classroom?

Given the identified lack of practical information for teachers about how to support students who stutter in the classroom, Phase 2 involved asking a group of young people who stutter to rank strategies in order of helpfulness. The strategies presented to the participants were strategies endorsed by people who stutter, teachers, and strategies recommended by experts in the field (see Appendix 2). As ranked by the young people in this study, 13 strategies were included in the first draft of the resource to fill the gap identified in the literature in relation to practical strategies for teachers (Hearne et al., 2021).

In addition to the list of strategies, the first version of the resource included a video resource with reflections from students who stutter in the U.K. and written reflections from students and teachers in NZ. These elements were included based on research by Flynn and St. Louis (2011) that indicated that perceptions about stuttering can be altered by viewing a presentation by a person who stutters and resource. In addition, there is research to indicate that real-life stories and narratives of people with disabilities changed teachers’ beliefs about disability. These first-hand accounts included in the resource aim to have a similar effect on the teachers’ beliefs about stuttering. The video chosen for first draft of the resource, Wait, wait, I’m not finished yet … (Michael Palin Centre, 2018), was informed by Hearne et al. (2021) and was supplemented with a NZ film developed by the Stuttering Treatment and Research Centre (2019) in the final version of the resource.

The first draft of the resource also included facts about stuttering to further reduce misconceptions and lack of knowledge in teachers (Beste-Guldborg et al., 2015; Hearne et al., 2021; Klompas & Ross, 2004; Kuruppu & Jayawardena, 2015; Langevin, 2015; Lass et al., 1992; Miles et al., 2018, unpublished; Plexico et al., 2013) as well as an Individual Support Plan template to support teachers in finding out directly from their own students what support they require. Given the unique experience of stuttering, it is crucial that teachers are supported to not employ strategies without checking their relevance with the student they are supporting, first.

What suggestions for improvement do SLTs, parents and adults who stutter have on a draft resource?

In Phase 3, feedback was sought from stakeholders who provided overall positive feedback about the resource. It was encouraging to hear that the resource would make a difference to the school environment being a safer and more supportive place with openness about stuttering. This was reflected in feedback both from students who stutter

… in my time at school there hasn’t been a single teacher who has actually talked to me about my stutter … if there was one thing that could come out of this document I think it would be talk to the student that stutters’ and also teachers ‘oh man – this [difference between struggling and stuttering] is VITAL … In my opinion the ability to differentiate between ‘struggling with LEARNING’ versus ‘struggling with STUTTERING’ can be the difference between a student feeling safe, secure and strong in their akomanga [class]; versus misunderstood, withdrawn or “dumb”’

They indicated that they agreed with the content included and noted its appropriateness for teachers, particularly in relation to strategies being relevant.

What supports does a teacher need in order to have a safe and successful individual support plan meeting with a student?

In Phase 3, members of the NZ Fluency Special Interest Group also provided specific information in relation to the Individual Support Plan meeting with a student. This is an important element of the resource and feedback indicated the need for the resource to include further instructions and examples of answers to support teachers in having these kinds of conversations with students.

What do teachers think of the resource?

This programme of research finally culminated in a revised version of the resource being provided to teachers in an online survey format. This resource is now freely available to all teachers in New Zealand (https://www.stuttering.co.nz/speech-therapy-resources-for-teachers/). The majority of teachers indicated that they would use the resource. This reflects previous research indicating that teachers are interested in further education about stuttering (Jenkins, 2010). In line with previous research suggesting low levels of confidence among teachers (Hearne et al., 2021), most teachers selected ‘slightly confident’ prior to accessing the resource. Afterwards, confidence increased across all teachers.

Strengths, limitations and future directions

Stakeholder involvement, particularly that of adolescents, is a strength of this research and critical to ensure education to teachers is relevant (Kendall, Murfield, Dillon, & Wilkin, 2008). By providing first-hand perspectives of New Zealand adolescents through videos, top strategies and Individual Education plan examples, teachers felt connected and trusted the information provided ‘I mean you are directly quoting people’ and ‘the fact that all the information comes directly from people makes it really accurate – like really useful information.’ In this study, teachers responded positively to the online, accessible nature of the resource. Most of the teachers who completed the Phase 5 survey had a current or previous student who stutters in their classroom suggesting perhaps that teachers want education that is relevant to their current challenges in the classroom. An online resource was chosen to respond to critique in previous published stuttering education programmes for teachers where time constraints and unsustainable costs were reported as barriers to in-person training programmes (Bennett, 2003; Jenkins, 2010). By providing the education online, teachers can access it when they need it.

However it is important to note that this was a small, local, clinically led initiative with a typical change process cycle of ‘act, evaluation, modify.’ While care was taken to gain stakeholder input, sample sizes in individual phases of the study were small. Further evaluation of the resource is needed in large cohorts of New Zealand teachers. Relevance of the resource internationally needs to be further explored. Well-designed case series of teacher: student dyads using the Individual Education plan would be interesting to evaluate benefits and teacher and student perspectives.

Conclusions

The phases of this research have led to a resource being created for use by teachers in New Zealand classrooms. Significant in its development has been the stakeholder feedback at various stages to ensure its usefulness. It has been evaluated by the teachers and the students that will use it, as well as the SLTs that work with children who stutter. It is freely downloadable on the Stuttering Treatment and Research Trust website. This resource has the potential to alleviate some of the negative outcomes of stuttering during the school years that were identified in the literature, exposure to teasing and bullying, resulting lower self-esteem, mental health consequences such as anxiety and overall lower academic and vocational achievement (Blood et al., 2007; Blood & Blood, 2016; Daniels et al., 2012; Klein & Hood, 2004; Langevin et al., 2009; Langevin & Prasad, 2012; O'Brian, Jones, Packman, Menzies, & Onslow, 2011). As one of the stakeholders who is a teacher, a parent as well as a partner of a person who stutters, commented

as a partner of a stutterer and parent of two sons who stutter, as well as a teacher who has had students who stutter in class, this is a great resource and is mana [power, prestige or control] enhancing for the student, informative for kaiako [teacher] and other students – particularly the checklist of proven supports.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Appendices

Appendix 1. Experiences of teachers and adolescents who stutter

Table

Stigma and impact on the student
# of responses (n = 4A, 3T)	Illustrative quotes
4A	S1 ‘It was just a minor nuisance that people used to bring up sometimes, someone may impersonate my stutter and use it like I was nervous or scared. When people impersonate me I tell them it’s a proper thing and then after that it basically stops’ ‘Found it didn’t really matter too much having a stutter at school except when it came to transitioning from school to school and going to a new set of people. I was quite concerned about how I would be viewed and how I would look.’ ‘When I was at primary school and I didn’t know how to deal with people who used to talk about my stutter that was always the hardest part was when people would say something and I just froze because it felt like there was something wrong with me and that’s why understanding where it comes from is so important.’ S2‘I remember in year 7 and year 8 was probably the worst because people were just very not mature, that was the worst with the bullying, there wasn’t that much but that was probably the worst. Year 9 and year 10 were a lot better, there was this one incident in year 9 when I was in a class and I was reading something out loud and someone made fun of me and I just broke down into tears.’ ‘But yeah I remember year 7 and year 8 I was really self-conscious of like talking in class but now I just talk a lot.’ S3 ‘I was always scared to talk to my teachers, ask questions in the class. Always scared that I was made fun of, um I would be this timid person who would not ask questions. ‘I did get bullied a little bit at school I guess, not to my face but I knew people were speaking about me when I wasn’t there.’ ‘In year 12 I did not speak a lot in class and would leave the questions to last when it was just the teacher in the room because I knew I could ask more questions and was easier for me not stuttering in front of the whole class’ ‘I remember I had a friend and he used to speak for me whenever the teacher would ask me something and then the class would tease him about why he was talking for me but the thing was my stutter was the issue and nobody understood that.’ ‘So when I was in grade 6 I wanted to do a speech with cue cards, but then I couldn’t do it in front of the teachers and I cried a lot. I could not say words, I was just stuttering all the time’ S4 ‘It [the stuttering] was getting on my nerves and I just always stuttered in a group.’
Things that helped – teachers
# of responses (n = 4A, 3T)	Illustrative quotes
1A 3T	S2 ‘Last year in PE we had to do a presentation and it was a PowerPoint and each slide had a certain amount of time on it so my teacher let me have a few extra seconds which was really good. I also asked if I could listen to music cause there is a guy in the UK whose kid had a stutter but when listened to music and spoke it was fine. So I had music on really loud when I did my presentation and I couldn’t hear myself talk and I feel like that might have done something.’ T1 ‘I just realised that I needed to have a lot of wait time with him, allow him to think through, process and then try to articulate that for me’ ‘Singing also helped, simple things that I guess were embarrassing for him like doing the roll in the morning because he couldn’t say good morning like the other children, so we would try and sing it and he could sing it back to me’ T2 ‘Just not putting him on the spot and giving him time’ T3 ‘Chris (SLT) and sent through a couple of things just like information on different types of stuttering and a little teacher handbook. But the first few things that I saw were things like don’t tell them to slow down and that was like ooo ok cause that’s what I had been doing.’
Things that helped – other
# of responses (n = 4A, 3T)	Illustrative quotes
1A 1T	S2 ‘When people realised it was actually a problem and that I couldn’t actually control it, they just accepted it. The thing that annoys me and that people don’t realise is that I actually really enjoy public speaking but people think I’m nervous but I’m not.’ ‘Probably if everyone had a better knowledge, cause parents are normally really good at it. But teachers sometimes you can see it in their eyes thinking why is it taking so long for her to say this and it’s quite funny.’ T2 ‘Our SENCO had a little bit (of experience) so she came in and worked with the teachers and explained his stutter’
Things that did not help
# of responses (n = 4A, 3T)	Illustrative quotes
3A	S1 ‘Teachers don’t talk about your stutter, unless you go up to them and talk to them about it’ S3‘I think the teachers didn’t have much information they treated it like a disability sort of’ ‘My teachers could see that I stuttered but they never really offered to help with it, they were more worried about studies’ ‘I always hated when the teachers at the beginning of the year would make us tell everyone our name, where we lived, what our hobbies were. We had five teachers so they all made us do that and it was traumatising, because they didn’t know I had a stutter and I didn’t want to put it out to the class that I had just met.’ ‘Once counsellor told me I shouldn’t be a nurse because nurses have to do lots of talking.’ S4 ‘Oh there were a few times it was noticeable in class but it didn’t really affect me that much, so teachers probably wouldn’t pick up on it.'
Resources / support
# of responses (n = 4A, 3T)	Illustrative quotes
3A 3T	S2 ‘I think just tell teachers to wait, just be patient. That is probably the biggest thing is patience with everyone. ‘ S3 ‘Educate the students at school and increase awareness that stuttering is ok’ ‘It would be good if teachers gave them (PWS) ideas that would help, or if they coached people to learn how to speak to a group of people’ ‘I think if teachers did speak about it, and ask the child if they know about stuttering and maybe give them a little bit of information and make them aware that it is ok to have a stutter.’ S4 ‘There should be some posters up like when you go to the nurses there should be posters, there are lots there but never about stuttering. Posters to inform other kids cause some wouldn’t even think to go find help for their stutter.’ ‘I think just if they feel like someone is having trouble they should definitely pursue it, because if you get to an older age and haven’t done anything about it, it is really annoying. Just making them more aware.’ T1 ‘It was quite tricky because there weren’t many resources to begin with that I could use to help him’ ‘There wasn’t anyone who had experienced this before. My team leader had experience with a child who had a stutter but she didn’t have any extra resources or anything for us to use. Our DP who is the SENCO didn’t have a lot of knowledge around stuttering. This made it really difficult’ ‘Having some basic tips and tricks from SLT point of view on what I should do with the child, little things like knowing whether you should correct him when he’s speaking, or do you repeat back what he said correctly?’ ‘What things you should say or what things you should avoid, we don’t know what we don’t know’ T2 ‘There is nothing I’ve seen online, I just worked out what would work with him ’ ‘Something online, but in real simple terms, things you can do when you've got one kid who stutters but 30 other kids in the class’ ‘What to do and how we can help, just some basic answers and real accessible’ T3 ‘Not really, I haven’t spent a lot of time trying to find stuff yet.’ ‘Um, maybe just like some practical exercise type things or word they can practice like what sounds or words to practice. Or strategies they can practice at home.’ ‘It’s hard cause you don’t know if it affects his level, cause he seems to be really progressing but when you’ve gotta answer the PROBE questions, his language and his stutter makes it hard to gauge if he got it. Some kind of assessment to actually be able to see where they’re at behind the stutter.’

Appendix 2. Sources of strategies included in the survey to adolescents.

Table

Strategy	Source	Recommended/validated by
Teachers create a safe and relaxing learning environment	Hearne et al. (2021); Panico et al. (2011)	Teachers, authors
Teachers encourage you to relax	Hearne et al. (2021); Gottwald and Starkweather (1995)	Teachers, authors
Teachers slow down their speech / their questions	Hearne et al. (2021); Gottwald and Starkweather (1995); Davidow, Zaroonigan, and Garcia-Barrera (2016)	Teachers, authors, literature review
Use a script to prepare for oral speeches in class	Hearne et al. (2021)	Teachers
Teachers allow you time to practice	Hearne et al. (2021)	Teachers
Teachers give you time to think and talk / be patient	Phase 1 data; Hearne et al. (2021); The Michael Palin Centre for Stammering Children (2024); Davidow et al. (2016); Guitar (2019)	Teachers, PWS, literature review, author
Teachers and students don’t finish your sentences	Hearne et al. (2021); The Michael Palin Centre for Stammering Children (2024)	Teachers, PWS
Teachers work with you and your family to understand you and create specifically designed plans to suit you	Hearne et al. (2021)	Teachers
Teachers show empathy	The Michael Palin Centre for Stammering Children (2024)	PWS
Teachers don’t ignore your stutter – talk to you about it, ask you what helps and how it makes you feel	The Michael Palin Centre for Stammering Children (2024); Guitar (2019)	PWS, author
Teachers don’t treat you differently e.g., don’t exclude from activities	The Michael Palin Centre for Stammering Children (2024; Lees (1999); Panico et al. (2011)	PWS, authors
Teachers are educated on stuttering and understanding how it may affect you	The Michael Palin Centre for Stammering Children (2024); Hearne et al. (2021); Guitar (2019)	PWS, teachers, research, author
Classmates are educated on/more aware of stuttering	Phase 1 data; Panico et al. (2011); Davidow et al. (2016); Lees, 1999; Guitar (2019)	PWS, authors, literature review
Teachers take pressure off talking and let you know you don’t have to say anything if you don’t want to	The Michael Palin Centre for Stammering Children (2024); Panico et al. (2011); Hearne et al. (2021)	PWS, authors, teachers
Teachers give you the option to do your oral language tasks away from the rest of the class just in front of the teacher e.g., at lunchtime	The Michael Palin Centre for Stammering Children (2024)	PWS
Teachers allow simple questions e.g., yes/no	The Michael Palin Centre for Stammering Children (2024)	PWS
Teachers build up your confidence gradually e.g., when reading aloud give you smaller parts to read and build it up	The Michael Palin Centre for Stammering Children (2024 Lees (1999); Guitar (2019)	PWS, authors
Teachers praise and encourage you	The Michael Palin Centre for Stammering Children (2024); Roseman (1999)	PWS, authors
Teachers retain eye contact with you when you are talking	The Michael Palin Centre for Stammering Children (2024)	PWS
Listening to music in headphones while doing oral presentation	Miles et al. (2018), unpublished	PWS
Teachers and students don’t interrupt you when you are speaking	Gottwald and Starkweather (1995); Davidow et al. (2016); Guitar (2019)	Authors, literature review
Teachers do not tell you to ‘slow down’ – don’t ‘advise’ you on your speech	Panico et al. (2011); The Michael Palin Centre for Stammering Children (2024)	Authors, PWS
Teachers do not ask you to repeat yourself when you stutter	Panico et al. (2011)	Authors
Teachers focus on what you say, not how it is produced	Panico et al. (2011); Gottwald and Starkweather (1995)	Authors
Teachers do not show concern via their body or facial reactions when you stutter	Roseman (1999)	Author
Teachers implement an anti-bullying programme to modify the attitudes of the rest of the class	Langevin and Prasad (2012)	Research
Connecting with other people who stutter – if not possible in person set up video calls, group chats etc.	Henderson (2019)^a	Author, PWS
Teachers understand difference between ‘struggling’ (e.g., avoidance, compensatory strategies) and ‘stuttering’	Henderson (2019)^a	Author, PWS
Teachers give you examples of adults who stutter to show you your potential	Henderson (2019)^a	Author, PWS
Teachers call on you earlier (but not first) or have a prearranged order in a verbal classroom activity to avoid buildup of anxiety when waiting to be called on	Davidow et al. (2016), Guitar (2019)	Literature review, author
Teachers use group work with classmates you are familiar with, or 1–1, rather than whole class	The Michael Palin Centre for Stammering Children (2024); Hearne et al. (2021); Gottwald and Starkweather (1995)	PWS, teachers, authors

^a Henderson (2019) fell into two different categories, both academic author and person who stutters.

Appendix 3. Draft resource contents with rationale and source.

Table

Resource content	Rationale	Source
10 Top Facts on Stuttering	Teachers’ poor knowledge about stuttering is well established (e.g., Hearne et al., 2021; Miles et al., 2018, unpublished; Klompas & Ross, 2004; Plexico et al., 2013). Local study, Hearne et al. (2021), found common misconceptions about stuttering were evident among New Zealand teachers for example, 52% of participants either agreed (n = 5) or were undecided (n = 26) when presented with the statement ‘in general, children who stutter can be considered as being psychologically different from children who do not stutter’. This fact list dispels some of these common untruths and gives teachers the important facts in a clear and concise manner.	The fact sheet was compiled by START SLTs. It made up part of the online stuttering educational package trialled in Hearne et al. (2021) with positive results.
Video Resource	Through assessing adolescents’ attitudes towards stuttering before and after viewing a presentation by a person who stutters, Flynn and St. Louis (2011) found peoples’ perceptions about stuttering can be altered. This demonstrates that learning about stuttering and the experiences of someone who stutters from the person themselves is valuable, and therefore justifies the inclusion of a similar video in the present resource. Flynn and St. Louis (2011) found attitudes improved more when the presentation was live than when it was recorded, however due to the goal of this resource being as accessible as possible the video remained the preferred option. The video chosen for the resource, Wait, wait, I’m not finished yet … (Michael Palin Centre, 2024, 2018), was informed by Hearne et al. (2021). The authors determined this video was best suited to the needs of New Zealand teachers, by comparing available options based on the principles of; contextual relevance, attitudes, knowledge, practicality and feasibility.	The Michael Palin Centre for Stammering Children (2024), chosen for New Zealand context by Hearne et al. (2021).
Reflections from New Zealand Students	Including the voice of young New Zealanders who stutter in this resource was a crucial component from the beginning. Reiff et al. (1993) conducted interviews with adults with learning disabilities aiming to capture how these adults themselves define their learning disability. They found value in their first-hand conceptualisations which included real-world examples and metaphors, adding meaning to current definitions. The authors concluded that future definitions should incorporate experiences of these individuals. Likewise, including these first-hand accounts of young PWS aims to add meaning and operationalise the other more theoretical information within the resource. Chrysostomou and Symeonidou (2017) found when teachers engaged with life stories and narratives of people with disabilities, their beliefs about disability changed. These first-hand accounts from young New Zealanders who stutter aim to have a similar effect on the teachers’ beliefs about stuttering.	Quotes chosen from interviews in Phase 1
Reflections from New Zealand Teachers	These quotes have come from and are for, New Zealand teachers. The hope is that teachers reading the resource will be able to relate to the reflections, as they are from people in their same position and context. Moskaliuk, Bokhorst, and Cress (2016) discuss the value of learning from others’ experiences, and then integrating that with first-hand experience and knowledge.	Quotes chosen from interviews in Phase 1; Hearne et al. (2021).
Top Ranked Strategies by New Zealand Students	Past research has found that teachers do not know how best to help their students who stutter (e.g., Hearne et al., 2021; Miles et al., 2018, unpublished). Additionally, Hearne et al. (2021) concluded that teacher education should include both general knowledge and practical strategies. Classroom strategies to support students who stutter was identified as the most desired stuttering resource by teachers in Placencia (2014). This list gives teachers the most helpful strategies as determined by the students themselves, presented in a clear and concise list.	Strategies from Phase 2 survey
How to Refer to Speech-language Therapy in New Zealand	This section aims to outline all options available across New Zealand, both public and private, to give direction to teachers who believe a student may benefit from speech-language therapy.	This section was compiled for the resource with the help of local speech-language therapy academics.
Example of Individual Education Plan	This planning sheet has been included based on the strategies ‘Teachers don’t ignore your stutter – talk to you about it, ask you what helps and how it makes you feel’ (The Michael Palin Centre for Stammering Children 2018; Guitar, 2019), and ‘Teachers work with you and your family to understand you and create specifically designed plans to suit you’ (Hearne et al., 2021). The latter strategy was also fourth equal most helpful strategy in Phase 1 of the present study, demonstrating the importance of this strategy to New Zealand young PWS. This template is provided to facilitate the discussion and make it easier for teachers, who have such busy schedules, to create an individualised plan with the student who stutters.	This sheet has been adapted from the Pupil Planning Sheet included in the Supporting Pupils who Stammer: Suggestion Sheets resource (The Michael Palin Centre for Stammering Children, 2024.).
Student Case Examples	This technique is common within the Ministry of Education and aims to help teachers relate new knowledge to their own practice. Ideas for supporting a student who stutters are given in context, and across different realms e.g., learning environment, student as person.	Student examples are often included in Ministry of Education resources for teachers e.g., Speech, language and communication needs: A resource for educators (Ministry of Education, 2015).