A child who stammers may speak more fluently and feel less anxious when playing outdoors with a parent than when sitting at the kitchen table—and this study will test that possibility. Up to 10% of children develop stammering, a neurodevelopmental condition that can strain relationships and harm long-term wellbeing. Yet fewer than half of UK health providers offer specialist speech therapy for it. Research in other fields shows that natural outdoor settings encourage more responsive, less pressured conversations between parents and children. This project will apply conversation analysis—a method never before used with children who stammer—to video recordings of 15 children aged 3–6 interacting at home and in nature. Surveys and interviews will also capture the emotional impact on both child and parent. If the outdoors consistently reduces stammering severity and improves parent-child interaction, the findings could lead to simple, low-cost guidance for families and schools who currently lack specialist support. The research will also produce training resources for speech therapists, potentially expanding the reach of effective care without requiring new clinical infrastructure.
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Background: Childhood stammering is a neuro-developmental condition that affects up to 10% of children. It can significantly affect a child's relationships and psychosocial wellbeing with long-term cost to quality of life and personal achievement. The severity and emotional impact of stammering is influenced by communicative context and conversational pressures. Specialist speech and language therapy (SLT) for childhood stammering supports parents in minimising conversational pressures thereby creating opportunities for fluent speech and confidence building. However, less than half of UK health providers have specialist SLT stammering services. Empirical research demonstrates that natural outdoor environments support more connected and responsive parent-child interaction, and benefit the psychosocial wellbeing of adults and children. Additionally, Conversational Analysis (CA), as yet unused with children who stammer (CWS), shows that conversations outdoors are likely have less communicative pressure. Given the large numbers of CWS who are currently unable to access specialist therapy, this exploration has potential implications for the provision of non-specialist support and enhanced specialist SLT support, maximising the therapeutic benefits to CWS. Aims: To understand how stammering impacts on everyday parent-child interactions at home and outdoors in nature, and explore the possible benefits of the outdoors for the interactions and emotional wellbeing of CWS and their parents. Objectives: To identify key concepts and knowledge gaps in the literature concerning the impact of context on the speech fluency, social interaction and psychosocial wellbeing of people who stammer. To explore interactions between CWS and their parents across two contexts (home and nature) and investigate the potential interactional and psychosocial therapeutic benefits of natural outdoor environments to parent and child. To co-design a set of resources for specialist SLT services and non-specialist settings (schools/parents/carers). Methods: This is a mixed-methods study involving three work packages. Co-creation and design processes underpin all aspects of the research. A systematic literature review. 15 CWS (aged 3-6) and their parent will be video recorded interacting at home and in nature. Surveys and semi-structured interviews will capture their psychosocial wellbeing. Recordings will be transcribed, and CA will be applied. Study findings will be explored in PPI activities and alongside my supervisory team. Together we will develop a set of resources for the provision of specialist and non-specialist support for CWS. Timelines for delivery: This research will be the focus of an NIHR Doctoral Clinical Academic Fellowship running from September 2025-May 2029. Anticipated impact and dissemination: Study findings will enrich our understanding of childhood stammering in everyday parent-child interactions in the home and outdoors. Anticipated outputs include: Guidance for parents and non-specialist settings. Guidance and training resources for specialist SLT assessment and therapeutic approaches. Publications in relevant peer-reviewed journals. Presentations at national and international conferences. Patient and public updates through Clinical Excellence Networks, social media and newsletters. Patient stories with key messages for stakeholders. PPI activities will help shape dissemination and knowledge mobilisation plans to maximise the impact of the project outputs on the support, specialist and non-specialist, available for CWS and their families.
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