Somayah Al-Ees

rehabINK Knowledge Summary

Speech differences, including stuttering, articulation disorders, and resonance disorders, are commonly framed as problems that reside entirely within the speaker. Thus, their speech is seen as impaired, atypical, or in need of correction (1). Clinical practice has traditionally been viewed through this lens, directing intervention toward modifying the speaker’s production to resemble what is believed to be normative standards. In Speech-Language Pathology, this typically encompasses fluency, intelligible articulation, and typical vocal resonance (2). However, this perspective is incomplete. Increasingly, scholars and clinicians are questioning whether communication difficulties arise solely from the speaker, or whether they are co-constructed within the interaction between the speaker and listener (2, 3).

One way to examine this issue is through considering the distinction between speech intelligibility and speech acceptability. Speech intelligibility refers to the degree to which a listener can accurately understand what is being said (4). It is often treated as the functional core of communication: if speech is intelligible, communication is successful (1). In contrast, speech acceptability refers to how speech is perceived socially, considering whether it is seen as typical, appropriate, and pleasant. It is shaped not only by acoustic or articulatory features, but also by listener expectations, cultural norms, and biases (9).

Importantly, intelligibility and acceptability do not always align. A speaker may be highly intelligible, yet perceived as socially marked or atypical (7). This distinction is particularly evident in stuttering. Many individuals who stutter can be understood without difficulty; their words are clear, and their intended message is accessible. However, disruptions in fluency often draw a listener’s attention, leading to discomfort, impatience, or negative judgments (6). In such cases, the barrier is not a failure of transmission, but a breakdown in social reception. What is affected is not whether the message can be understood, but whether or not it is accepted within normative expectations of “smooth” and efficient speech.

A similar pattern can be observed across a range of speech differences. Features such as how fluent speech flows, how nasal or oral a voice sounds, or how clearly individual sounds are produced, may influence how speech is perceived, even when the words themselves are fully intelligible. Listeners tend to evaluate speech holistically, considering not only clarity but also the social and aesthetic qualities. Ratings of reduced acceptability often reflect a combination of these perceptual factors, regardless of whether they interfere with understanding. Importantly, lower perceived acceptability is associated with social challenges, including stigma, exclusion, and negative impacts on self-esteem and mental health (8). These outcomes underscore that the lived experiences of individuals with speech differences are shaped not solely by the speaker’s production, but by how speech is received, interpreted, and judged within a social context.

This raises an important question: to what extent is speech disability an inherent characteristic of the speaker, and to what extent is it created or amplified through listener perceptions, societal expectations, and normative standards of communication? The concept of verbal diversity (9) offers one way of reframing this issue. The broader neurodiversity movement holds that neurological differences are natural variations in how human minds develop rather than disorders requiring a cure. Drawing on this framework, verbal diversity positions speech differences as natural variations in human communication rather than inherent deficits (2). From this perspective, stuttering, atypical resonance, or nonstandard articulation are not simply errors to be eliminated, but differences to be understood within a wider range of communicative expression (5).

Communication is inherently relational. Speech does not occur in isolation; it unfolds between people. This means that listeners are not passive recipients, but active participants in shaping communicative success (3). In the case of stuttering, for example, fluency disruptions are often experienced not only as internal events but as interactional ones: moments where timing, turn-taking, and listener reactions intersect. Listeners may intentionally or unintentionally interrupt, complete words, avert eye contact, or signal impatience, thereby amplifying the speaker’s difficulty (6). Conversely, attentive and patient listening can facilitate smoother communication, even when individual communication styles misalign. In this sense, stuttering can be understood as a phenomenon that is co-created within the interaction (3).

The idea that communication involves shared responsibility is further illuminated by the concept of temporal accessibility (3). While accessibility is often discussed in spatial terms, such as ramps, elevators, or physical accommodations, less attention has been given to time as a resource (1). Many social and institutional contexts are structured around implicit expectations of speed, rapid conversational turn-taking, time-limited presentations, quick responses in classrooms, or brief interactions in service settings (3). These expectations privilege speakers who can produce fluent, efficient speech, while disadvantaging those whose speech unfolds more variably (2). As a result, individuals with communication differences may face barriers to full participation in educational, professional, and social contexts, not necessarily because of the quality of their ideas or abilities, but because their communication does not conform to normative expectations of speed and fluency. In classrooms, workplaces, and public interactions, individuals may therefore be evaluated less on the merit of their contributions and more on how efficiently or conventionally those contributions are delivered. This can shape access to academic success, employment opportunities, leadership roles, social inclusion, and perceptions of competence or credibility.

For individuals who stutter, access to time is not guaranteed. Even with preparation or rehearsal, the duration of an utterance can be unpredictable. Standardized time constraints, such as a three-minute presentation or the social pressure to respond quickly in a discussion, creates a hierarchy in which fluent speech is normalized and other speech patterns are marginalized (2). Temporal accessibility reframes this issue by recognizing that equitable communication may require flexibility in timing. It also highlights the essential role of the listener in the acceptance of diverse communication as they can choose to wait, remain engaged, and share in the temporal demands of the interaction, rather than transferring the entire burden to the speaker (3).

This perspective challenges some traditional assumptions in rehabilitation. Speech-language therapy has often focused on increasing fluency, reducing nasality, or correcting articulation, with success measured in terms of proximity to normative speech patterns (1). While these goals can be meaningful and beneficial for many individuals, they also raise critical questions. What is the cost of prioritizing normative speech at all times? How much mental effort is required of a speaker to maintain these changes, and how does this effort affect spontaneity, participation, and identity? Even when individuals have the capacity to modify their speech, should society hold expectations that they abandon their natural state of communication in favour of confirming to normative ideals? (7).

Reframing therapy to include both speaker and listener perspectives does not mean abandoning intervention. Rather, it suggests broadening its scope (1). In addition to supporting speakers in developing control, flexibility, and confidence in their communication, clinicians might also consider how environments and listeners may adapt. This could include educating communication partners, advocating for more flexible timing in high-pressure contexts, and fostering acceptance of diverse speech patterns (3). The goal shifts from solely “fixing” speech to enhancing overall communicative participation and well-being from all parties (2).

Importantly, this approach does not minimize the real challenges faced by individuals with speech differences. Experiences of frustration, exclusion, or reduced opportunity are well documented and should not be dismissed (3). However, focusing exclusively on the speaker overlooks the social dynamics that contribute to communication challenges (2). By acknowledging the role of listener perception, social norms, and environmental constraints, we gain a more comprehensive understanding of speech disability as a phenomenon that emerges within interaction (3).

Ultimately, rethinking speech disability requires a shift in perspective. If a speaker is fully intelligible but perceived as unacceptable, is the solution truly to change the individual speaker rather than society? If communication breaks down due to impatience, rigid time expectations, or negative listener attitudes, are the deficits purely within an individual or rather on society’s lack of acceptance and accommodation? These questions do not yield simple answers, but they invite critical reflection on long-standing assumptions within clinical and societal frameworks.

Communication is a shared act. Its success depends not only on how speech is produced, but on how it is received, interpreted, and valued. Recognizing this shared responsibility opens the door to more inclusive and responsive approaches to human communication, ones that honour both the diversity of speech and the complexity of interaction.

References

1. Jordan L, Bryan K. Seeing the person? Disability theories and speech and language therapy. International Journal of Language & Communication Disorders. 2001;36(S1):453–8. https://doi.org/10.3109/13682820109177928
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7. Combiths P, Arenas R, Pérez CI, Rodgers N, Nico J, Phillips M. What’s an error anyway? Reframing “persistent speech patterns” [Conference presentation]. American Speech-Language-Hearing Association Convention; 2025 Nov; Washington, DC, United States.
8. Bickham RS, Ranganathan K, Wombacher NR, Shapiro DN, Carlozzi NE, Baker MC, et al. Speech perceptions and health-related quality of life among children with cleft lip and palate. Journal of Craniofacial Surgery. 2017;28(5):1264–8. doi:10.1097/SCS.0000000000003718
9. Reeves N, Yaruss JS. Practical tips: Embracing stuttering as verbal diversity: How does this change our role as SLPs? [Internet]. Stuttering Therapy Resources, Inc.; 2024 [cited 2026 Mar 25]. Available from: https://cdn.shopify.com/s/files/1/0322/8385/2940/files/STR_Practical_Tips_-_SLP_Roles_in_Verbal_Diversity.pdf