Today is #StutteringAwarenessDay and a #presidential #debate day in which a stutterer will likely be bullied by another candidate.

This is a polite request that, if you do not currently stutter, please do not tweet about stuttering. Retweet adults who stutter. 1/

Many people misunderstand stuttering, and consequently misunderstand Joe Biden’s speech. When Joe Biden says he has overcome his stutter, he does not mean he no longer stutters, he means he controls his stutter more than his stutter controls him. This is no small feat. 2/

As a stutterer myself, I can identify the tools he is using to avoid openly stuttering and I am here to share with you why mocking Biden as a gaffe-machine or as a person who is forgetful is factually inaccurate, and also ableist. 3/

First, you might not actually know how stuttering works! Many children stutter when they are learning to talk - known as developmental stuttering. That's not the focus of this thread. Developmental stuttering might have impacted you as a kid, but it's fundamentally different. 4/

Persistent stuttering - the kind Joe Biden and I have - sticks around for a long time (it persists...). Brain imaging of stutterers and non-stutterers demonstrate that our brains are a little bit different and this difference is likely involved in our stuttering. 5/

Speech happens in Broca's region of the brain - the left interior frontal gyrus (LIFG). This area is UNDERACTIVE in stutterers, while the right frontal gyrus (RIFG) is OVERACTIVE. Recent work suggests the RIFG is activated when stopping actions. Is our stop signal too active? 6/

There is more research that suggests that blood flow to the LIFG (the speech region) is decreased. All these data suggest that something about the balance of activity between these regions is off. The causality is not yet known - does less blood flow in the LIFG promote RIFG? 7/

Speech production occurs via a kind of feedback loop and Broca's region is responsible for speech production AND processing. Some work suggests that speech is monitored at about a one-syllable-long delay. Fluent speakers can be made dysfluent if auditory feedback is disrupted. 8/

But, slightly modulating how a stutterer hears themselves can promote fluency, suggesting this auditory feedback system is impaired in stutterers. Modulating how stutterers hear themselves is called Altered Auditory Feedback and comes in a few types. 9/

Delayed auditory feedback (DAF): Using a small, electronic device that fits inside the ear, the sound of a stutterer's voice is delivered on a slight time delay. The delay is very short - tens to hundreds of milliseconds - and essentially overrides that processing. 10/

Wearing a device that fits inside your ear is not unusual - people wear hearing aids! BUT a lot of Biden's detractors spread a rumor that he would be wearing "an earpiece" to get help from his campaign team, so he was checked for bugs on his way into the first debate. 11/

As you've learned, Biden would have been well within his rights to wear a Delayed Auditory Feedback earpiece to promote his fluency, but ableism made that an impossible choice. I don't know if Biden would have worn one, but he should have been able to, not mocked. 12/

The device would have leveled the playing field - not given Biden any unfair advantage. But I cannot imagine that the opponent’s campaign or supporters would have believed in the utility of such a device, and Biden would have been portrayed as a liar and a cheater. 13/

Frequency Auditory Feedback (FAF): Altering the pitch or volume of voice can work similarly to the DAF discussed above. Personally, when I stutter I get very LOUD because it works! I stutter less. Biden tends to slow down and get quiet. This may make him seem "sleepy"... 14/

But Biden is just modulating his voice so that it sounds a little different to his own ear so he can be more fluent. That's creative and smart. When his opponents call him "Sleepy Joe" they are being ableist. 15/

Masking Auditory Feedback (MAF): Introducing other noise to drown out stutterer's feedback loop of their own sound production. Playing loud noises can actually promote fluency. However the timing of the noise can be hugely influential. Interrupting is not usually helpful. 16/

Clearly his opponent has been interrupting Biden to throw him off his game. It is unfair and is essentially a schoolyard bullying tactic. Don't interrupt a stutterer. 17/

Importantly, these feedback techniques vary from person to person, so a tactic that works well for me might not work well for Biden. But you should still give him the benefit of the doubt that he's not a gaffe machine, but is working against ableism all the time... 18/

When reading, many stutterers are more fluent, so a teleprompter is just a tool for his fluency. Many of his opponents have mocked him for using one. Mocking him for using one is ableist. 19/

When Biden is in a debate, he's thinking about his answer and trying to craft a response that is going to cause him to stutter the least. This is because stuttering is seen as weakness, fear, or lack of preparedness. Biden does what is called "covert stuttering." 20/

Essentially, he does what he has to do to hide his stutter. Sometimes he will come to a word that he knows will make him stutter, so he switches that word around to another, similar word. This is hard. I was once asked what color my shoes were. They were purple. I said blue. 21/

When this happens, Biden looks like he doesn't know the answer, or sometimes he looks like he's saying something racist. At a debate he said "white kids" when he meant "wealthy kids." You can hear him stutter if you're paying attention. 22/

He knew "wealthy" would make him stutter (it's 2 syllables) while "white" wouldn't (only 1 syllable). In the moment, he was searching for any suitable substitute word. In some contexts white and wealthy would be interchangeable, when talking about systemic racism and poverty. 23/

In the moment, the substitute word wasn't the right fit, just like blue is not a substitute for purple. So while Biden is crafting an answer that is intelligent and that will make him stutter less, he's constantly crafting alternative answers, and fighting interruptions. 24/

This is called cognitive load: the amount of resources dedicated to getting the words out. It's higher for stutterers. He also battles time pressure: the small amount of time you have to answer some questions, like your name, before someone thinks you're "weird." 25/

This time pressure crops up when he's in the middle of a sentence, realizes that he's about to stutter, but can't come up with a word to swap in. In that case, he starts over entirely. Some people mock his forgetfulness, but he's just trying to answer fluently. 26/

Biden has to navigate REAL time pressure in the debates, when he's given only 2 minutes for an answer and is being interrupted all the time. Anyone would be stressed out by that situation! 27/

To mitigate that stress, Biden likely uses other strategies, too. I've never seen Biden physically fight through a stutter like I sometimes do. But I can see - for just a second - the moment a stutter almost happens. The muscles near his temples flex a bit and his eyes widen. 28/

If we stopped mocking people for their differences, Biden would feel more comfortable stuttering. He might openly stutter, or more openly discuss the challenges he's faced. He might ask for extra time in the debates, because that's a reasonable accommodation. 29/

You don't need to stutter to see the humanity in others. You don't need to stutter to know how to interact with a stutterer. You just need to be willing to listen a little better and wait a little longer. Tonight I'll be watching the guy who stutters. And cheering. 30/