Voice shaming: when speech becomes a target. Preliminary insights among youth who stutter

1 Introduction

Stuttering is a speech disorder characterized by a disconnect between thought and expression: individuals know what they wish to say, yet, their verbal output is interrupted by involuntary disruptions. These include the repetition of sounds, syllables, or words; the prolongation of sounds; and pauses or blocks in speech. Beyond these core symptoms, people who stutter often exhibit secondary behaviors, such as uncontrolled physical movements—eye-blinking, jaw jerking, or movements of the head, arms, or other parts of the body (Prasse and Kikano, 2008; Guitar, 2013).

The disorder most commonly develops in childhood, a form known as developmental stuttering (Büchel and Sommer, 2004; Sommer et al., 2021), affecting up to 10% of children (Yairi and Ambrose, 2013; Bloodstein et al., 2021). While the majority recover naturally within a few years of onset, approximately 1%−2% continue to stutter throughout their lives (Norman et al., 2023), with men being four times more likely than women to be affected (Craig et al., 2002; Yairi and Ambrose, 2013). Stuttering can also arise in adulthood, referred to as acquired stuttering, typically as a consequence of neurological disease, psychological trauma, or as a side effect of certain medications (Theys et al., 2024).

It is worth noting that stuttering behaviors and their severity differ considerably both across and within individuals, and may shift over time in response to situational, emotional, and linguistic factors (Constantino et al., 2016; Tichenor and Yaruss, 2021). Although disrupted speech fluency and timing remain its defining features (i.e., overt symptoms), growing evidence points to stuttering as a multidimensional condition, one that extends well beyond verbal communication to encompass cognitive, social, emotional, and psychological dimensions (i.e., covert symptoms) (Bloodstein et al., 2021).

The social, emotional, and psychological consequences of communication disorders are equally significant. Children and adolescents who stutter or present with other communication difficulties frequently encounter obstacles in social interaction that hinder the formation of meaningful peer relationships (Rice et al., 1991; Blood and Blood, 2004). Underlying this is a reciprocal dynamic between communicative ability and social competence: when one is compromised, the other tends to suffer in turn, leaving those affected at heightened risk of peer rejection (Rice et al., 1991; McCabe and Meller, 2004; Lyons and Roulstone, 2018).

The consequences of communication difficulties extend beyond immediate social impacts, as individuals often present with concomitant immaturity of interpersonal behavioral strategies which further hinders them from achieving social success (Rice et al., 1991; McCabe and Meller, 2004). In fact, their reduced opportunities to socialize frequently lead to negative reactions from peers, which, in turn, further inhibit their social involvement and perpetuate the loneliness that so often characterizes the lives of these individuals (Lyons and Roulstone, 2018). Within this cycle of social interaction each communication attempt serves only to confirm existing speech deficits without providing a positive channel for exchange which, in turn, results in a worsening negative self-image and a further loss of confidence in one's social abilities (Hiller et al., 2017; Mulvihill et al., 2020). An example of this vicious cycle can be found in children and adolescents who stutter. Because of the visible and audible nature of overt stuttering symptoms, people who stutter are particularly exposed to the social evaluation of others and to potential negative reactions from these observers, thereby increasing their vulnerability to negative social dynamics such as peer victimization (Hugh-Jones and Smith, 1999; Blood and Blood, 2004, 2007).

Peer victimization, commonly referred to as bullying, involves repeated acts of deliberate aggression in which the perpetrator exploits an imbalance of power or social standing relative to the victim (Gredler, 2003). The relationship between stuttering and bullying is well-established: those who stutter are disproportionately exposed to social rejection and psychological distress, and the empirical literature consistently shows that children and adolescents who stutter experience bullying at substantially higher rates than their typically developing peers (Davis et al., 2002; Langevin, 2002; Blood and Blood, 2004, 2007). For instance, previous research found that children and adolescents who stutter experience bullying at substantially higher rates (81%) compared to the general school population (49%−58%) (Langevin, 2002). Furthermore, 43% of adolescents who stutter reported bullying experiences compared to only 11% of non-stuttering peers (Blood and Blood, 2004, 2007), and higher rates of peer rejection and lower rates of peer social popularity than non-stuttering children were experienced (Davis et al., 2002). These findings highlight how individuals who stutter frequently experience repetitive negative thought patterns, face social stigma, and internalize negative stereotypes and labels (Guttormsen et al., 2015; Boyle et al., 2016; Connery et al., 2020). This may result in prejudiced emotional reactions and discriminatory behavior from others (Boyle, 2018). People who stutter are often described as shy, anxious, and less assertive, characteristics similar to those usually associated with typical bullying victims, who have been labeled as insecure, anxious, quiet, passive, less motivated, and unwilling to interact with their peers (Blood and Blood, 2004, 2007; Blood et al., 2011). Verbal bullying was defined as the most common form of aggression experienced by children and adolescents who stutter, including speech imitation, which was reported by around 90% of stutterers, followed by mocking and name-calling (Langevin and Bortnick, 1998; Erickson and Block, 2013). These experiences have an immediate impact on academic difficulties, and long-term effects on self-esteem, mental health, and life satisfaction (Hugh-Jones and Smith, 1999; Blood and Blood, 2004; Iverach et al., 2009). The experiences of bullying may lead to chronic feelings of inadequacy, depression, or anxiety disorders that may follow the affected person well into adulthood and influence their professional choices and relationships (Iverach et al., 2009). Family members of the victim may also be affected by this phenomenon, as parents of children and adolescents who stutter have expressed the difficulty in managing their children's frustration and unhappiness, and often are not aware of the bullying their child is experiencing (Langevin and Bortnick, 1998; Adriaensens et al., 2015). Despite this well-documented relationship internationally, stuttering-related victimization has been studied almost exclusively in North American and UK contexts, with no data available from Southern European populations, and few studies have examined parental awareness and perspectives on this phenomenon.

To better capture the specific ways in which youth who stutter may be targeted, we compared this phenomenon with other forms of social aggression that stigmatize specific visible aspects of a person's identity, such as body shaming. Body shaming is defined as an unrepeated act in which a person expresses unsolicited, mostly negative opinions or comments about another person's physical appearance, including body shape, size, weight, or other bodily characteristics (Schlüter et al., 2023). This form of social aggression can occur both online and offline, may range from seemingly well-intentioned advice to outright insults, and often leads to emotional harm regardless of the speaker's intent (Schlüter et al., 2023). Both bullying based on speech patterns and body shaming represent social aggression forms that exploit differences between individuals to maintain a power imbalance, which seeks to enforce dominance over someone who lacks the ability to protect themselves. While traditional bullying encompasses a broad spectrum of aggressive behaviors characterized by repetition, intentional harm, and power imbalance that may target various characteristics, this study introduces the concept of “Voice Shaming” as a conceptually distinct phenomenon that specifically targets language-related characteristics in individuals with speech disorders (Schlüter et al., 2023). Drawing parallels to body shaming research, Voice Shaming differs from body shaming in several fundamental ways: (1) it is restricted and specific to audible and visible communication features, and (2) unlike body shaming it does occur independently of physical body features and (3) its potential for significant psychological impact from even single incidents, contrasting with traditional bullying definitions that require repetitive patterns as a defining criterion (Gredler, 2003; Schlüter et al., 2023). According to Schlüter et al. (2023), when body shaming becomes repetitive, it may transition into bullying territory (Schlüter et al., 2023). However, the distinguishing feature of Voice Shaming lies in its capacity to cause harm through isolated incidents targeting communication vulnerabilities (Gredler, 2003; Schlüter et al., 2023).

For people who stutter, Voice Shaming specifically encompasses speech-related mockery, vocal mimicry, negative comments about voice quality, and communication-based exclusion, representing a targeted form of discrimination that exploits the audible manifestations of communication disorders (Schlüter et al., 2023). Body shaming, on the other hand, is intended to single out and shame people for their physical characteristics, while Voice Shaming is instead addressed to people with a communication impairment (Puhl et al., 2007; Alimoradi et al., 2020; Schlüter et al., 2023). Of interest, in 2024, the American Speech-Language-Hearing Association published a commissioned study on communication disorders and stigmas (American Speech-Language-Hearing Association, 2024). The study consisted of a large survey of adults (n = 1,004) with hearing and/or speech-language difficulties. Interestingly, those with speech-language difficulties were more likely to report experienced stigmas vs. 58% of those with hearing difficulties alone. Nearly half (49%) stated that important relationships have been affected. Nearly a quarter of those with speech-language difficulties alone felt there were limited opportunities available to them, and more instances of discrimination were reported compared to those with hearing difficulties. Thus, as proposed here, we believe that speech and language difficulties should have their own status within the growing literature of bullying. Voice shaming should be considered as a distinct bullying behavior and separate from body shaming since it may occur in individuals having no physical body feature to be discriminated against. However, no specific research has examined voice shaming as a distinct construct in the context of stuttering. Similar to how body shaming can make a person with a physical difference feel stigmatized and thus cause mental health issues and isolation, voice shaming directed at individuals who stutter can produce comparable detrimental effects on psychological wellbeing and social functioning (Iverach et al., 2009). The current study is aimed at providing preliminary data on the prevalence and nature of Voice Shaming among children and adolescents who stutter to fill the gap in the literature and inform prevention and intervention strategies. We hypothesize that the prevalence of Voice Shaming will be substantial among children and adolescents who stutter, reflecting patterns observed in international literature on speech-related victimization, though potentially differing from general bullying prevalence rates due to its specific targeting of speech characteristics. While Voice Shaming is conceptually distinct from traditional bullying, we expect it to constitute a significant phenomenon among children and adolescents who stutter, given that the stigmatization of communication disorders has been documented across diverse cultural contexts, suggesting that speech-targeted victimization reflects broader social dynamics of communicative norm enforcement rather than culturally specific patterns. Additionally, this study seeks to examine parental recognition and responses to Voice Shaming experiences, as their awareness and support play a role in intervention effectiveness. By establishing the presence and impact of Voice Shaming, this research will contribute to the development of prevention and intervention strategies, promote social and cultural recognition of this form of prejudice, and ultimately advance our understanding of how communication disorders intersect with peer victimization across different cultural contexts.

2 Materials and methods

2.1 Data collection and analysis

Data were collected pseudonymously using alphanumeric codes that linked each parent to their child while protecting participant privacy. The Microsoft Forms platform was used to automate data entry, ensure data integrity, while security features maintained data confidentiality throughout the collection process.

Responses were analyzed using descriptive statistical methods. For each closed-ended question, absolute and relative frequencies were calculated to identify the most frequent response patterns and establish prevalence estimates. Confidence intervals (CI) for proportions were computed using the Wilson method without continuity correction. Means, standard deviations, medians, and ranges were calculated for continuous variables.

2.2 Population

The study included children and adolescents who stutter, ranging in age from 7 to 16 years, and their parents or legal guardians. Participants were consecutively recruited from the Vivavoce Medical Center—a specialized center for stuttering located in Milan—using convenience sampling methodology. The final sample included individuals who met the following inclusion criteria: a confirmed diagnosis of stuttering by a multidisciplinary team including a psychologist, a speech and language pathologist and a child psychiatrist, age between 7 and 17 years (the observed age range in the final sample was 7–16 years), residency in Italy, and provision of written informed consent by a parent or legal guardian. Children or adolescents with other neurological or psychiatric disorders were excluded from participation. A sample size of 110 participants was determined based on the available patient population at the recruitment site during the study period and was considered adequate for this preliminary descriptive study.

During the initial and sole meeting, the parents or legal guardians of the 110 participants were informed of the study's purpose and procedures, and each provided written informed consent for both their own and their child's participation. The study was approved by the Ethics Committee of the Università degli Studi di Milano (approval number 18/25, dated February 11, 2025). All data collection procedures adhered to institutional ethical guidelines, with clinical staff providing immediate emotional support to child participants if needed during questionnaire administration.

2.2.1 Sample characteristics

The final analytical sample comprised 110 children and adolescents who stutter and their corresponding parents or legal guardians, with no participants excluded from the analysis. Participants' ages ranged from 7 to 16 years [Mean (M) = 11.50, Standard Deviation (SD) = 2.15]. The sample exhibited a predominantly male composition, with 87 males (79.1%, 95% CI: 70.6%−85.6%) and 23 females (20.9%, 95% CI: 14.4%−29.4%). Residence data confirmed a nationwide catchment: 58 participants (52.7%, 95% CI: 43.4%−62.1%) lived in northern regions, 18 (16.4%, 95% CI: 9.5%−23.3%) in central regions, and 34 (30.9%, 95% CI: 22.3%−39.5%) in southern regions, spanning 53 distinct provinces. Comprehensive sample characteristics are presented in Table 1.

Table 1. Sample characteristics of the 110 children and adolescents who stutter.

Percentages shown only for categorical variables; blank cells in the % column indicate continuous variables (for which central tendency/dispersion are reported). IQR, interquartile range (Q1–Q3). Percentages for categorical descriptors use total N = 110 unless otherwise specified.

2.3 Questionnaires

This prospective observational study employed a survey methodology using two specialized questionnaires developed through collaborative efforts involving experts in speech-language pathology, phoniatrics, and psychology. The questionnaires were designed to ensure age-appropriate language and sensitivity to the complexities of bullying experiences, with both instruments undergoing pre-testing for clarity and reliability through feedback from children and parents to refine wording and structure.

he questionnaires were aligned with contemporary definitions of bullying while specifically adapted to capture Voice Shaming behaviors, focusing on speech-targeted aggressive behavior and imbalance of power related to speech characteristics (Gredler, 2003). Both instruments employed a combination of closed-ended and open-ended items. Open-ended items allowed participants to describe their experiences in their own words, while closed-ended items, including binary (yes/no) questions, multiple-choice items allowing multiple selections, and a four-level ordinal frequency scale (ranging from “rarely: only once or twice in a lifetime,” to “always: every day or almost every day”), facilitated standardized data collection and cross-participant comparison. Questions addressed variables such as frequency, context, type, and emotional consequences of speech-targeted experiences. Although the questionnaires were informed by established frameworks of peer victimization, items were specifically designed to capture behaviors directed at speech characteristics, the experiences conceptualized in this study as Voice Shaming, rather than general bullying.

2.3.1 Children's questionnaire

The children's questionnaire focused on personal experiences with speech-targeted victimization and consisted of 25 items divided into five main sections: experiences of Voice Shaming, context of Voice Shaming incidents, details and frequency of episodes, reactions and consequences, and help, support, and perceived impact on self-esteem. Items included binary (yes/no) questions, multiple-choice items allowing multiple selections, categorical single-response items, one ordinal frequency item with four response levels, and two open-ended narrative items inviting participants to describe a specific episode and to summarize their feelings about speaking in their own words. The questionnaire was administered by clinical staff specialized in communication disorders to ensure participants fully understood questions and had access to emotional support if discomfort arose. Responses were recorded on the Microsoft Forms platform during clinical sessions.

2.3.2 Parent questionnaire

The parent questionnaire captured similar information from the parental perspective, including observations of their child's emotional and social wellbeing, behavioral changes following bullying episodes, support provided to their child, and perceptions of Voice Shaming effects on self-esteem. Parents also provided information about the institutional support their child received, such as from schools, and any family sacrifices made to support their child. The questionnaire was distributed via a Microsoft Forms link, allowing parents to complete the survey at their convenience independently.

The full questionnaires (Italian and English versions) are provided as Supplementary material 1.

3 Results

3.1 Prevalence and frequency of voice shaming experiences

Voice Shaming was reported by 78 of 110 participants (70.9%, 95% CI 61.8%−78.6%) and, from the parental perspective, by 73 of 110 participants (66.4%, 95% CI 57.1%−74.5%). A cross-informant comparison revealed concordance in 61 dyads (55.5%, 95% CI 46.1%−64.4%), while discrepancies arose in 17 dyads (15.5%) where only the child acknowledged Voice Shaming and in 12 dyads (10.9%) where it was recognized solely by the parent; in the remaining 20 dyads (18.2%) neither informant reported any episode. The difference between child-reported (70.9%) and parent-reported (66.4%) prevalence was not statistically significant (McNemar exact test, p = 0.42), indicating substantial cross-informant agreement (76.4% concordance rate). The mean age at first occurrence remained highly comparable across informants (children: M = 8.90 years, SD = 2.10; parents: M = 8.60 years, SD = 1.80).

Regarding episode frequency patterns, the majority of affected children and adolescents (71.8%) and their parents (68.5%) characterized these experiences as occurring rarely, specifically only once or twice throughout the child's lifetime. Nonetheless, approximately one-quarter of both children and parents reported episodes occurring with monthly frequency, while daily or near-daily episodes represented the least common pattern, reported by only 1.3% of children and 1.4% of parents. Detailed frequency distributions are documented in Table 2.

Table 2. Prevalence and frequency of voice shaming.

3.2 Contextual characteristics of voice shaming episodes

3.2.1 Environmental settings and perpetrator characteristics

School environments emerged as the predominant setting for Voice Shaming episodes, with 80.8% of children and adolescents and 72.6% of parents identifying educational institutions as primary locations for these incidents. Leisure contexts, including sports activities, recreational programs, and park settings, constituted the second most frequently reported environment, affecting 44.9% of participants according to self-reports and 49.3% according to parental observations. In contrast, online environments and family settings demonstrated lower prevalence rates, suggesting that Voice Shaming predominantly occurs in face-to-face peer interaction contexts. Complete environmental data are summarized in Table 3.

Table 3. Settings and perpetrators.

Analysis of perpetrator characteristics revealed that known peers constituted the majority of individuals engaging in Voice Shaming behaviors, with this category identified in over 92% of cases according to both participants' self-reports and parental observations. Adult involvement in Voice Shaming incidents was minimal, with known adults such as teachers or coaches implicated in only 6.4% of child reports and 6.8% of parent reports, indicating that these behaviors are predominantly peer-driven phenomena.

3.2.2 Manifestations and types of voice shaming behaviors

Voice mimicry emerged as the most prevalent and characteristic form of Voice Shaming behavior, reported by 82.1% of affected children and adolescents and 61.6% of parents. This was followed by negative looks and laughter, reported by 46.2% of children and 41.1% of parents, and negative comments, which affected 34.6% of children according to self-reports and 41.1% according to parental observations. Social exclusion behaviors were documented in approximately one-fifth of affected participants (21.8%), representing a significant form of social rejection linked to speech characteristics. The complete spectrum of Voice Shaming manifestations is detailed in Table 4.

Table 4. Content/type of voice shaming.

3.3 Behavioral and emotional consequences of voice shaming

3.3.1 Child-reported adaptive and maladaptive responses

Among participants who experienced Voice Shaming episodes, significant proportions demonstrated adaptive behavioral modifications in response to these experiences. Specifically, 39.7% reported deliberately modifying their speech patterns with the explicit intention of avoiding mockery, while 29.5% engaged in avoidance behaviors by deliberately abstaining from participation in activities or games due to concerns regarding their speech characteristics. When characterizing their emotional state following Voice Shaming episodes, participants most frequently endorsed feelings of worry (19.5%) or anxiety (9.1%). However, in the absence of pre-episode baseline data and a control group, these emotional responses cannot be attributed solely to Voice Shaming experiences and may partly reflect the broader psychosocial burden associated with stuttering.

3.3.2 Parent-observed behavioral and emotional modifications

Parental observations revealed that behavioral changes occurred in 67.1% of children and adolescents following Voice Shaming episodes, indicating an impact on daily functioning and social engagement patterns. Among those exhibiting behavioral modifications, avoidance of certain places or people emerged as the most frequently observed manifestation (44.9% of those showing changes), while difficulty socializing affected 40.8% of those displaying behavioral alterations.

Mood changes were documented by parents in 69.9% of affected children and adolescents. Among those exhibiting mood alterations, sadness constituted the predominant emotional response (43.1% of those with mood changes), followed by irritability and nervousness (23.5%) and anxiety (19.6%). Comprehensive behavioral and emotional responses to Voice Shaming are presented in Table 5.

Table 5. Behavioral and emotional correlates of voice shaming.

Base n indicates denominator for each block (children with ≥1 episode = 78; parents with ≥1 episode = 73). Sub-rows under behavioral or mood change use only those endorsing any change (49 and 51, respectively). Multi-response items may sum >100%. “Other single responses” aggregates very low-frequency categories.

3.4 Parental recognition, responses, and institutional support

3.4.1 Immediate parental reactions and intervention strategies

Analysis of immediate parental responses revealed that engaging in conversation with their child constituted the most common initial reaction (34.2%), followed by expressions of sympathy and emotional support (28.8%). The majority of parents (97.3%) reported undertaking concrete actions to address Voice Shaming situations. Among parents who implemented interventions, providing direct emotional support to their child emerged as the most frequently employed strategy (42.3% of acting parents).

School involvement was actively pursued by 39.4% of acting parents, while 31.0% initiated or seriously considered psychological or speech therapy support. However, despite these parental efforts to engage educational institutions, schools were reported to have adopted specific measures in response to Voice Shaming incidents in only 19.2% of cases.

3.4.2 Perceived impact on child well-being and development

The majority of parents (94.5%, 95% CI: 86.4%−97.9%) perceived that Voice Shaming episodes negatively affected their child's self-esteem and emotional wellbeing. Comprehensive documentation of parental responses, implemented actions, and perceived impacts is presented in Table 6.

Table 6. Parental responses, actions, and perceived impact.

Base n indicates the denominator for each percentage. Rows under “Actions undertaken” use Base n = 71 (parents reporting any action). Multi-response items may sum >100%. “Other single responses” aggregates very low-frequency categories.

4 Discussion

This preliminary survey conducted among children and adolescents who stutter provides initial evidence supporting the prevalence and characteristics of Voice Shaming. Consistent with this overall picture, Voice Shaming emerged as a pervasive lifetime experience, with more than two-thirds of our sample reporting at least one episode. Episodes typically surfaced around the age of 9 years and were most often situated within school contexts, where familiar peers engaged in vocal imitation. Although these incidents were reported as rare, they nevertheless carried significant psychological and behavioral repercussions, most notably mood disturbances and speech-avoidance strategies, confirming that Voice Shaming is a distinct phenomenon whose impact exceeds its frequency.

It is important to acknowledge, however, that the emotional and behavioral consequences reported by participants cannot be exclusively attributed to Voice Shaming experiences. Children and adolescents who stutter are likely to experience distress arising from multiple, interacting sources: the intrinsic frustration and communicative fatigue associated with stuttering itself, the social awareness of being communicatively different, anticipatory anxiety about speech situations, and the well-documented anxiety–stuttering cycle in which emotional tension exacerbates disfluency, which in turn increases self-awareness and fear of speaking (Iverach et al., 2009, 2011; Bloodstein et al., 2021). Voice Shaming may, therefore, function as an amplifier of pre-existing emotional vulnerability rather than as the sole cause of the distress observed. The current study design does not allow us to disentangle the specific contribution of Voice Shaming from the broader emotional burden inherently associated with living with a fluency disorder. Future research employing control groups and longitudinal designs will be essential to isolate the unique impact of speech-targeted victimization from the multidimensional psychosocial experience of stuttering.

An additional interpretative framework that merits consideration concerns the interaction between stuttering, gendered social expectations, and anxiety-related communicative processes. Given the predominantly male composition of our sample (79.1%), it is worth noting that boys who stutter may face compounded psychosocial pressures. In many social contexts, boys are implicitly encouraged to display verbal fluency, confidence, assertiveness, and emotional control, qualities that stuttering may directly challenge. Consequently, children and adolescents who stutter may develop heightened self-monitoring, anticipatory anxiety, and fear of negative evaluation even in the absence of explicit victimization episodes. Since emotional tension is known to exacerbate speech disfluency, this may contribute to a self-reinforcing cycle in which communicative anxiety increases disfluency, which in turn intensifies social vulnerability (Iverach et al., 2011). Within this framework, external victimization (Voice Shaming) and internal psychological vulnerability (self-stigma, communicative hypervigilance) may interact dynamically rather than operate as separate phenomena, and some of the emotional consequences described in this study may partly reflect these broader processes.

Voice Shaming most commonly takes the form of voice mimicry, targeting audible disfluency markers as conspicuous social cues. Aggregating child and parent accounts, mimicry therefore stands out as the predominant manifestation of speech-related victimization in children and adolescents who stutter. Consistent with stigma models, such overt divergence from fluent norms invites peer derogation (Blood and Blood, 2004; Blood et al., 2011). The clustering of first episodes around age 9 years coincides with developmental transitions in which peer evaluative norms intensify and social hierarchies consolidate, amplifying vulnerability to communicative discrimination (Blood and Blood, 2004; Adriaensens et al., 2015). Behavioral changes in participants, despite infrequent incidents, suggest that qualitative significance, rather than the total number of occurrences, is the primary factor influencing psychosocial effects. This pattern suggests a threshold model, where the social and emotional impact of Voice Shaming is driven more by anticipated stigma and hypervigilance than by a straightforward dose-response effect, as seen in more traditional bullying scenarios (Hugh-Jones and Smith, 1999; Blood et al., 2003; Blood and Blood, 2004). This finding substantiates our conceptualization of Voice Shaming as qualitatively distinct from traditional bullying: while bullying definitions require repetition as a core criterion (Gredler, 2003), Voice Shaming episodes in our sample, though predominantly rare (71.8% reporting only 1–2 lifetime episodes), generated significant behavioral and emotional consequences. This aligns with Iverach, Menzies, O'Brian, Packman and Onslow (2011) framework suggesting that shaming behaviors targeting specific characteristics can inflict psychological harm independent of frequency, distinguishing them from repetition-dependent bullying patterns (Schlüter et al., 2023).

The fact that most incidents happen at school and involve familiar peers highlights the main social environment where Voice Shaming takes place. Minimal adult involvement (6.4%) points to both gaps in supervision and the subtlety of mimicry behaviors. However, the low frequency of adult-perpetrated Voice Shaming should not be taken to indicate low impact: given the position of trust and authority held by teachers and coaches, speech-targeted behaviors from these figures may carry disproportionate psychological weight compared to peer-driven episodes, an aspect that warrants specific investigation in future research. Speech changes reported by 39.7% of participants reflect adaptive self-protection strategies, yet they also fuel cycles of hypervigilance and avoidance that reinforce social anxiety (Blood et al., 2003; Adriaensens et al., 2015). Taken together with the 69.9% parental reporting of mood disturbances, these converging behavioral and affective reactions highlight the pervasive emotional impact of Voice Shaming and underscore its multifaceted psychological consequences. Such effects may extend beyond immediate distress to shape lasting patterns of withdrawal and behavioral adaptation. The substantial parental recognition of negative self-esteem impacts (94.5%) shows that even occasional Voice Shaming can have a deep psychological impact, provoking longer-term anxieties about social competence and self-worth. From the parental perspective, such episodes represent a serious threat to their child's psychological development and social adjustment, underscoring both the severity and the lasting impact of Voice Shaming.

Since this is the first study to define and measure Voice Shaming as its own concept, direct comparisons with earlier research are not possible. However, our Voice Shaming prevalence of 70.9% can be meaningfully contextualized within existing bullying literature, particularly considering that previous research has identified speech-related teasing and vocal mimicry as the predominant forms of victimization in children and adolescents who stutter (reported by approximately 90% of affected participants), suggesting that Voice Shaming represents a substantial component of what has been broadly categorized as “bullying” in earlier studies (Langevin and Bortnick, 1998; Erickson and Block, 2013). In particular, our prevalence aligns with the range of heightened victimization rates documented in prior North American and UK studies (43%−83%, Hugh-Jones and Smith, 1999; Blood and Blood, 2004; Erickson and Block, 2013).

The current prevalence lines up with the higher international figures to some extent, though somehow lower than the more extreme rates (≥80%) reported in broader studies on victimization (Hugh-Jones and Smith, 1999; Blood and Blood, 2004). This difference is probably linked to how the study was designed rather than with cultural factors. By focusing specifically on speech-related acts and rare but impactful episodes, the study may have left out milder teasing that tends to push prevalence rates higher in studies with broader definitions. Using the Voice Shaming construct helped sharpen the lens on voice-specific experiences, offering a more precise alternative to traditional bullying measures that often group together very different kinds of victimization.

The fact that voice mimicry was reported by 82.1% of affected participants lines up well with earlier findings showing that imitating someone's speech is the main form of verbal aggression toward children or adolescents who stutter. This aligns with the approximately 90% rate of speech-related mimicry reported in prior studies (Langevin and Bortnick, 1998; Erickson and Block, 2013), supporting the external validity of the Voice Shaming construct.

Notably, parents' reports were pretty closely aligned with what their children reported; this is quite different from what literature documented about general bullying research, where parents tend to underestimate the problem (Langevin and Bortnick, 1998; Hugh-Jones and Smith, 1999). The 4.5 percentage point gap between child-reported (70.9%) and parent-reported (66.4%) prevalence did not reach statistical significance (McNemar test, p = 0.42), confirming a high level of cross-informant concordance (76.4% of matched dyads). This represents a markedly smaller discrepancy than the 20–30 percentage point gaps typically observed internationally (Hugh-Jones and Smith, 1999). This higher level of parental awareness might be due to the use of targeted, construct-specific questions that helped them notice speech-related behaviors they might have missed otherwise, or it could be that voice-specific teasing stands out more emotionally in families already engaged with specialized support services.

The absence of previous national Italian data on stuttering-related victimization underscores both the novelty of these findings and their contribution to addressing a gap in cross-cultural literature. Even though the way Voice Shaming manifests seems to follow global trends, pointing to underlying links between how someone communicates and how they're socially targeted—the higher parental awareness observed might be shaped by cultural or study-specific factors, warranting further investigation across diverse contexts.

The findings demonstrate implications across multiple levels of intervention and understanding. Clinically, the high proportion of behavioral and mood alterations, even after infrequent episodes, makes a strong case for routine Voice Shaming screening in stuttering assessments. Equally, the fact that 97.3% of parents undertook concrete actions to support their child demonstrates high levels of parental engagement and concern, an asset that intervention programs could harness. The finding that 39.7% of participants modify their speech to avoid mockery highlights the need for routine assessment that explores not just overt victimization experiences, but also the more subtle coping strategies that can quietly feed into ongoing communication anxiety (Iverach et al., 2009, 2011). Early counseling protocols should emphasize adaptive coping strategies while addressing maladaptive avoidance patterns that limit social skill development opportunities.

School-focused intervention is warranted given that 80.8% of incidents occur in educational settings and 92.3% involve known peers. Moreover, roughly one-third of acting parents initiated or seriously considered psychological or speech-therapy support, evidence of an emerging recognition of the need for professional intervention, whereas schools took specific action in only one-fifth of cases, revealing a persistent gap between parental expectations and institutional responsiveness. Teacher professional development initiatives should prioritize the identification of subtle mimicry behaviors and voice-targeted ridicules, as this escape routine anti-bullying surveillance focuses on more overt aggressive acts. Embedding voice diversity awareness within existing anti-bullying curricula enhances recognition of communicative discrimination as a specific form of peer victimization requiring targeted intervention approaches.

Theoretically, differentiating Voice Shaming from general bullying constructs refines models of communicative stigma by isolating speech-targeted behaviors that accelerate distinct psychosocial pathways (Blood et al., 2003). This differentiation helps tailor interventions more effectively and track outcomes more accurately in both clinical and school settings. Importantly, the concept of Voice Shaming should not be limited to stuttering but may be applied more broadly to conditions in which altered speech, language, or communicative patterns contribute to social stigma, exclusion, or discrimination. Similar forms of social exclusion and discrimination have been previously described in individuals with severe aphasia (Shadden, 2005; Parr, 2007). Likewise, voice stigma and mimicry have been documented as a distinct phenomenon affecting individuals with dysphonia and other voice disorders, with some studies showing that voice shaming in dysphonia leads to significant psychological consequences, including anxiety, depression, social withdrawal, intensive self-monitoring, and avoidance behaviors that can be more debilitating than the physical voice symptoms themselves (Revis et al., 2013; Misono et al., 2014). These parallels across different communication disorders reinforce the potential of Voice Shaming as a broader theoretical construct for understanding speech- and language-related stigma. For measurement advancement, these findings provide foundation for developing and validating standardized Voice Shaming assessment instruments grounded in clear definitions and that can work across different cultural contexts.

This study does face several methodological limitations, the most significant of which concerns sampling bias. Participants were recruited from a single specialized center, representing families who actively sought professional assistance for stuttering. This treatment-seeking population may have experienced more severe stuttering or more pronounced psychosocial difficulties compared to the broader population of children and adolescents who stutter. Clinical caseloads are known to exclude approximately 50%−70% of individuals who stutter who either recover naturally or do not seek treatment (Craig et al., 2003), meaning that our sample likely represents a small fraction of the total population of youth who stutter nationally. Consequently, prevalence estimates and reported experiences should be interpreted as documenting the existence and characteristics of Voice Shaming within this clinical population rather than as nationally representative rates. To strengthen generalizability and establish population-level prevalence, future research should employ multi-center recruitment and community-based sampling strategies. Also, because of the cross-sectional design, no definitive causal links can be drawn, especially regarding its potential long-term impact on psychosocial outcomes. Longitudinal studies are needed to map developmental patterns and test the proposed pathways more rigorously.

Moreover, the use of study-specific questionnaires that have not undergone formal psychometric validation represents an important limitation. Although the instruments appear clinically relevant and well-aligned with the study's aims, the absence of established reliability (e.g., test-retest stability, internal consistency) and validity data (e.g., factor analysis, convergent, and discriminant validity) limits measurement precision and cross-study comparability. To solidify Voice Shaming as a measurable construct, future research should prioritize formal psychometric validation of dedicated assessment instruments. Additionally, the absence of a control group of typically fluent peers limits the ability to determine whether the reported emotional and behavioral consequences are specific to Voice Shaming or whether they may also reflect broader psychosocial difficulties frequently associated with stuttering itself, as discussed above.

A further conceptual consideration concerns the boundary between appropriate awareness-raising and Voice Shaming. Just as body shaming research has grappled with the distinction between harmful stigmatization and legitimate health communication (Schlüter et al., 2023), Voice Shaming must similarly contend with a degree of vagueness. Some severe manifestations of stuttering may indeed limit life opportunities, and sensitively acknowledging these realities does not necessarily constitute Voice Shaming. The threshold between empathic observation and shaming behavior is not sharp, and future research should explore how contextual factors, speaker intent, and the relational dynamics between speaker and listener shape whether a comment about speech is experienced as supportive or harmful.

Future research should include comparisons with fluent peers and children with other communication disorders to better understand differential vulnerability, in addition to focusing on developing and validating assessment tools, modeling longitudinal pathways to explore potential moderating factors, and testing interventions, both school-based prevention programs and parent-led coping strategies. Comparative studies across cultures will also be important to understand how these dynamics play out in different contexts. Given the wide age range in our sample (7–16 years), future studies should also examine potential developmental trajectories of Voice Shaming, investigating whether its prevalence, manifestations, and psychosocial impact change from childhood to adolescence, which would help clarify the role of age as a moderating variable. As adolescents increasingly engage online, it will be especially important to investigate how Voice Shaming manifests in digital spaces and how social media shapes peer interactions.

In conclusion, this study identifies Voice Shaming as a prevalent issue, affecting 70.9% of Italian children and adolescents who stutter in this clinical sample. It introduces a distinct conceptual framework that sets speech-targeted harassment apart from traditional bullying, offering a look at stuttering-related victimization within a treatment-seeking population. The alignment between child and parent reports, alongside behavioral adjustments and mood changes despite mostly infrequent episodes, suggests that the impact of communication-based discrimination is driven more by the intensity and meaning of individual incidents than by repeated exposure. This challenges the dose-response model often assumed in bullying research. The higher parental awareness we observed, compared to what is typically seen in the literature, could point to opportunities for family-focused interventions and show how targeted assessment tools can uncover overlooked experiences among individuals with communication differences. Moving forward, research should prioritize longitudinal studies and intervention trials to identify protective factors and shape effective prevention strategies across different settings. Ultimately, these findings position Voice Shaming as both a clinical concern to be addressed in routine assessments and a lens through which to explore how communication differences intersect with peer acceptance in today's social environments.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/frsps.2026.1877638/full#supplementary-material

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Footnotes

Edited by: John T. Jost, New York University, United States

Reviewed by: Maria Àngels Vialdot, Open University of Catalonia, Spain

Max Gattie, Northwestern University, United States