"Hide and survive:" A conceptual model of stuttering concealment

Stuttering concealment is a common but understudied experience with important implications for research, clinical practice, and the lives of people who stutter. This study presents a comprehensive conceptual model by defining stuttering concealment, categorizing its many forms, and examining its underlying motivations and consequences.

Semi-structured interviews were conducted with 30 adults who stutter in the United States. Using reflexive thematic analysis, we identified patterns in how participants described and enacted concealment.

Concealment is a dynamic, context-dependent process that extends beyond simply hiding moments of stuttering. Participants described two interconnected levels of concealment: minimizing overt characteristics of stuttering and shaping whether others perceive them as a person who stutters. We identified five categories of concealment behaviors: linguistic, speaking mechanics, pragmatic, self-presentation, and situational. Motivations for concealment included accessing communication opportunities, maintaining social norms, and self-protection. Participants reported psychological and social consequences that were predominantly negative (e.g., shame, disconnection), though a few described incidental positives, such as increased creativity and emotional maturity.

This study offers an integrated conceptual model that links the forms, motivations, and consequences of stuttering concealment. It challenges rigid covert-overt distinctions by illustrating concealment as a fluid and socially responsive process shaped by identity, context, and interpersonal dynamics. These insights have implications for assessment and intervention, including the need for clinicians to explore concealment sensitively and recognize its emotional and social impacts. Therapy can support clients in examining when and why they conceal, and in setting individualized goals related to openness in communication and self-presentation.