A self-referred adult with history of dropping out, 30% disfluency, depression and anxiety; most appropriate action?

• A. Re-enrolling remedial services
• B. Encouraging the client to take responsibility for maintaining fluency
• C. Neurological evaluation
• D. Referring the client for psychological counseling

Answer: (D)

When someone who stutters also has depression and anxiety, the most important step is to address the emotional and mental health factors that can amplify disfluency and hinder engagement in therapy. Psychological counseling can assess and treat mood and anxiety symptoms, reduce avoidance behaviors, and teach coping strategies that make fluency work more doable. With mood and anxiety stabilized, the person is more likely to participate effectively in fluency-shaping or other stuttering therapies and to maintain progress. Re-enrolling in remedial services focuses on academics rather than emotional barriers, which this case shows are likely contributing to the challenge. A neurological evaluation isn’t indicated here unless there are specific neurological signs. Encouraging personal responsibility for fluency without addressing the psychological symptoms may leave underlying barriers unaddressed. So, referring for psychological counseling is the best next step to support overall functioning and readiness for fluency work.