In this brief presentation, we’ll cover the basics of stuttering. The slides shown here were created by Dr. Rod Gabel, who is the Director of the Intensive Stuttering Clinics here at the University of Toledo.
Everyone has some disfluencies in their speech. We all say things like“um” or “uh” a lot when we talk, and we might occasionally repeat a word or phrase, or start to say something and then say something else. These are examples of typical disfluencies that everyone has in their speech. But for PWS, their disfluencies are characterized by an unusually high amount of less typical disfluencies. These less typical, or stuttering-like disfluencies, are characcterized by partword repetitions, that sound l-l-l-ike this, sound prolongations that sound lllllike this, or blocks, which u—sually sound something like this. The speech of PWS is often very effortful, both mentallly and physically. Young children may not be aware of their stuttering, but older children, adolescents, and adults are usually very aware of their stuttering and the often negative reactions they receive from listeners.
When we work with PWS, including children, we need to consider the ABCs of stuttering—that is, the affective, behavioral, and cognitive aspects of stuttering. Stuttering isn’t just what we hear when someone speaks. The overt characteristics, or PWRs, prolongations, and blocks, are often just the tip of the iceberg. PWS may also have physical concomitants, or secondary behaviors, which may involve facial ticks, grimaces, limb movements, and other maladaptive behaviors that have been learned in response to stuttering. People who stutter often have distorted thoughts about themselves and their ability to communicate. They may often experience negative emotions related to their stuttering, and engage in fewer social activities because of stuttering.
Let’s talk more about secondary behaviors associated with stuttering. PWS often feel that they lack control over their speech mechanism or body when they stutter. In response to these out of control feelings, they may attempt to alleviate stuttering by engaging in physical behaviors that they can control, like snapping their fingers while stuttering. In many cases, these secondary behaviors become even more distracting than the stuttering itself. Speech-language pathologists often help children and adults who stutter to recognize what they do when they stutter and to evaluate how they can communicate with others more effectively without distracting secondary behaviors.
A specific group of secondary behaviors are known as escape behaviors. These are generally the behaviors done to escape the moment of stuttering. They may also be a manifestation of the struggle with the disorder, in an attempt to end stuttering as quickly as possible. Again, these behaviors can become just as much a part of stuttering as the speech disfluencies, and should be addressed in speech therapy.
Similarly, avoidance behaviors allow individuals to avoid the moment of stuttering, such as saying “um” before a problematic word, simply withdrawing from conversation, or talking around words. This type of talk is called circumlocution. For example, if a PWS had trouble saying New York, he might instead say “The big apple.” Many PWS have quite good vocabularies that allow them to circumlocute.
To sum up, avoidance and escape behaviors may feel useful to PWS, because they may be helpful in avoiding stuttering. But often they reflect poorly on the PWS, and become more problematic than the actual stutter.
As we mentioned before, it’s important to also assess a client’s attitudes and emotions toward their stuttering, and not just the stuttering behaviors themselves. Many PWS have emotional reactions to stuttering, including fear of ridicule, guilt, and shame. These feelings tend to develop over time, as the PWS experiences negative reactions from their listeners since childhood.
Here we have a list of only some of the negative emotions and attitudes that PWS may have toward stuttering, themselves, and their listeners, including shame, fear, guilt, low self esteem, and negative attitudes toward speaking and others.
Speech-language pathologists who research stuttering have placed stuttering within the World Health Organization’s International Classification of functioning, disability, and health. Within this framework, a communication disorder occurs when a person’s communication performance frequently fails to accomplish necessary social functions or the manner in which the person communicates is viewed negatively by either the speaker or the audience. Stuttering certainly falls within this framework. Let’s take a more in-depth look at the WHO model and how it applies to stuttering.
The WHO recognizes three types of limitations or restrictions on the functioning of an individual. These are limitation in body functions, activity limitations, and participation restrictions. PWS have neurological differences which render them less capable of fluent speech, so they are considered impaired in their bodily function. PWS may also be said to have a disability, because they are often limited in the activities which they can fluently complete, such as talking on a telephone, or talking in a job interview. Finally, stuttering may be a handicapping condition because PWS may be prevented from participating in certain activities, such as military service or jobs which require lots of communication. When we examine an individual’s stuttering and efforts to cope with stuttering, the WHO framework can be helpful in identifying how we can help the client to participate more fully in life’s activities.
To wrap up our overview of stuttering, let’s consider why stuttering has been so perplexing to PWS and the general public over the years. First, in many instances, PWS can predict when they will stutter, and they may try to avoid stuttering as a result, which leads to an impression of poor communication in general. But PWS seem to adapt to their stuttering. For example, people stutter less when they read a passage aloud multiple times, and they often become fluent in speech therapy due to the supportive nature of their therapist.
But there are other factors that increase stuttering and cause PWS to be less fluent. These things involve speaking on the phone, saying one’s name, speaking to an authority figure or large audience, and telling a joke. Waiting to speak is often torturous for PWS, as in the case of going around the room to introduce oneself. Having to repeat oneself and trying to stutter may also cause PWS to be less fluent, as can experiencing intense emotions. Speech-language pathologists need to be able to help clients who stutter understand why they might be more fluent in some situations than others, and must encourage clients to not try to hide their stuttering behind maladaptive and distracting coping mechanisms.
When all these factors are taken into account, speech-language pathologists must take the role of a counselor, educator, and mechanic. They must help PWS process their thoughts and feelings related to stuttering, educate them about the causes stuttering and why people who stutter are more fluent at certain times rather than others, and diagnose how the speech mechanism in PWS is failing to produce fluent speech and what therapy techniques will be helpful. Given that there is no cure for children who continue to stutter past early childhood, it is important that SLPs assess the emotional and cognitive component of stuttering as much as the more readily observable speech characteristics of stuttering.
Introduction to Stuttering
What is stuttering?Rodney Gabel, Ph.D.
Guitar (2006)• Stuttering is characterized by an abnormally highfrequency of stoppages in fluency.a) Part word repetitionsb) Sound prolongationsc) Blocks• People who stutter are usually aware of theirstuttering and are often embarrassed by it and use ahigh amount of mental and physical effort to speak.• Children may not be aware- but may show signs ofphysical and mental effort.
Six Major Dimensions- Yairi andSeery (2011) Overt characteristics Physical concomitants/secondary behaviors Muscular activity Affective features Cognitive processes Social Dynamics
Secondary Behaviors- A key pieceof the complex disorder People who stutter usually feel a loss of controlwhen they stutter. The person who stutters will develop a wholegroup of secondary behaviors to cope with theproblem. Also known as concomitant or reactivebehaviors.
Escape Behaviors Loss of eye contact. Jerking or abnormal movements of the head. Blinking of the eyes, wrinkling of the forehead,distortions of the mouth and quivering of the nostrils. Abnormal variations in speaking rate, the loudnessand/or pitch of the voice. Flushing, pallor, or perspiration. Autonomic arousal. A feeling of tension.
Avoidance Behaviors Behaviors that allow individuals to avoid themoment of stuttering. Will be used as the person anticipates theirdifficulty. Anticipates, then inserts a behavior to avoidstuttering. Not talking, interjections, circumlocutions, and othertypes of behaviors.
Avoidance and Escape Behaviors A learned part of the condition. Rewarding at first and a large part of the problemlater. Will often be a major part of therapy for individualswho have a more chronic form of the disorder.
Emotions and Attitudes-Anotherpiece of this complex disorder Feelings are created by stuttering, the opposite isalso true. Can make the process of speaking much moredifficult. Emotional reactions will develop along withstuttering. People will also develop negative communicationattitudes.
Negative Emotions & Attitudes Shame Fear Guilt Lower self-esteem Negative attitudes towards speaking Negative attitudes towards others
World Health Organization (2000)A communication disorder occurs when aperson’s communication performance frequentlyfails to accomplish necessary social functions orthe manner in which the person communicatesis viewed negatively by either the speaker or theaudience.
CDIS- World Health Organization Limitations in Body Functions- Impairment– Any loss or abnormality of psychological, physiological, oranatomical structure or function. Activity Limitations- Disability– Any restriction or lack of ability to perform an activity inthe manner or within the range considered normal for ahuman being. Participation Restriction- Handicap– A disadvantage for a given individual resulting from animpairment or a disability, that limits or prevents thefulfillment of a role that is normal for that individual.
Anticipation and Adaptation People who stutter are able to anticipateand/or predict when they will stutter.– Not only in individual words, but situations.– Often leads to avoidances. People seem to adapt to their stuttering.– Less stuttering over subsequent passages.– Also may adapt in certain situations.
Situations That Reduce Stuttering/IncreaseFluency Acknowledging or not avoiding stuttering ortrying to stutter. Speaking in chorus. Playing a role. Suggestion/hypnosis.
Factors That IncreaseStuttering/Decrease Fluency Speaking on thephone Saying his/her name. Speaking to anauthority figure. Speaking to a largeaudience. Telling a joke. Waiting to speak. Repeating amessage or askingfor clarification. Trying not to stutteror trying to hide it. Experiencingemotional arousal.
Role of the Speech-LanguagePathologist Counselor Educator Mechanic