A critical review of a recent decade of stuttering research

The purpose of the present investigation was to catalogue and evaluate portions of the literature on stuttering from 1967 to 1977. Of particular interest was the identification of the research literature. Of 287 articles located and evaluated, 181 were research reports. These reports were categorized according to topics, subject selection, subjects' characteristics, type of research designs and use of randomization, reliability, and statistical methods. Unhappily, many of the faults identified in reviews ten to twenty years earlier tended to persist, and many of the deficiencies recently cited by authorities in the field were found to characterize this literature.     

The effect of punishment and reinforcement procedures on a stutterer's factor II avoidance response

The purpose of this clinical experiment was to investigate the manipulability of a Factor II avoidance response (arm movement). The substantive hypothesis under test was that its suppression would be enhanced by repeated punishment sessions. During the first of nine therapy sessions response-contingent negative stimulation was not delivered. In the next five, after a base-rate period, “wrong” was made consequent upon the target response. In each of these sessions the suppression of arm movement was apparent. However, the magnitude of the suppression decreased from session to session. Evidently, the continued use of punishment did not enhance suppression. Because of this finding procedural changes were introduced in the next three therapy sessions. Verbal praise was added as a consequence of increasingly stringent omission criteria and three consecutive units of praise led to time-out from the reportedly fatiguing task of continuous speech. A marked reduction and then complete extinction resulted. Moreover, learning was evidenced since the frequency of arm movement lessened in the base-rate period of each session.     

An individualistic approach to the evaluation and remediation of stuttering

A decision model is presented to facilitate the evaluation of stuttering behavior. This model calls for the evaluation to be conducted along a continuum with specified initiation and termination points. Following the evaluation, the information is formulated into an organized remediation procedure leading to fluent productions in the individual. This approach allows evaluation and remediation to be individualized to meet the needs and capabilities of each stutterer while allowing the professional the flexibility to choose remediation materials on the basis of objective information. Two case studies are presented to illustrate the use of the approach.     

The relevance of DAF-induced speech disruption to the understanding of stuttering

The literature on delayed auditory feedback (DAF) repeatedly makes reference to the occurence of disfluencies under DAF in nonstutterers. However, no attempt has been made to determine the relative frequency of occurence of various types of disfluencies in nonstutterers under DAF. The present study investigated the frequency of occurence of various types of disfluencies in normal-speaking subjects in five successive oral readings under DAF. Twenty-four young adults read aloud a prose passage five times successively under 200 msec of bilateral DAF. Measures of the frequency of different types of disfluencies, locus of occurence of disfluencies in the speech sample, adaptation and consistency indicate that DAF-induced disfluencies are remarkably similar to those found in stuttering. It is suggested that DAF and stuttering disrupt speech at approximately the same “level” along the speech production process, possibly at the prosodic level.     

The stutterer's reaction to the telephone as a speaking situation

A review of the literature indicates that one of the most commonly feared talking situations among stutterers is speaking on the telephone. One hundred-thirty stutterers who feared speaking on the telephone were interviewed regarding their fear of telephone calling and answering, the age at which they began to fear calling and answering, and their fear reactions to eight specific telephone calling situations.Data was analyzed for all subjects, male/female, black/white, and mild/moderate/ severe stuttering groups. Analysis indicated that telephone calling was judged to be more feared than telephone answering with the exception of the black stutterers. Acquisition of fear of the telephone occured earlier for telephone answering than for calling within most subgroups. When general reactions to the eight telephone situations were considered, the black stutterers had the most severe fear reactions while the male and moderate stutterers had the least severe reactions.     

How school-aged students define stuttering and stammering

Fifty students from each of the grades 2, 4, 6, 8, 10, and 12 were asked to complete a questionnaire containing the following three questions: 1) What is stuttering? 2) What is stammering? 3) How did you know that? Analysis of their responses indicated students were more familiar with stuttering as opposed to the term stammering. From grade 6 onward, we can expect at least three-fourths of the students to define stuttering as a disruption of speech consisting chiefly of sound or syllable repetitions. Only about one-fourth of students in grade 6 and above defined stammering as a speech disruption. This disruption was characterized chiefly by repetitions, injections, and pauses. Most of the students were unable to specify how they learned the definitions. The few who did identified family and friends as their chief source of knowledge.     

Tokens for stuttering

Four young stutterers were observed during 10 weekly sessions. Each session was divided into pretreatment, treatment, and posttreatment segments. Redeemable tokens were administered contingent upon stuttering behaviors in the treatment segment of the Experimental condition. In a Parallel Control condition, no tokens were administered during the entire session. The differences between the pretreatment and treatment segments were compared for the two conditions. Three subjects had dramatically fewer stuttering behaviors when tokens were being administered, while the fourth had more stuttering under the same condition. The subject whose stuttering increased had a history of therapy in which voluntary, “faked” stuttering had been called for, and the behaviors that increased were judged to be of this type. The decreases were interpreted as suggesting that the contingent tokens acted to countercondition the aversiveness of the stuttering experience, which reduced the anticipation of stuttering and hence the stuttering itself. The increase was felt to be simple reinforcement. The counterconditioning interpretation was borne out in two clinical applications in which money was presented contingent on stuttering behaviors judged to be aversive to the stutterer, and in which dramatically sudden, but long-lasting, improvement was seen.     

Comprehending homographs in aphasia

This study assessed 13 aphasic subjects' knowledge of the multiple meanings of homographs. The results indicated that the various meanings were less available to aphasic subjects than to normal subjects. In addition, specific meanings became less available as they became less typical although the number of meanings associated with a homograph did not influence performance. Aphasia type also did not influence performance. Performance on the experimental test was significantly correlated with auditory comprehension level and picture naming ability. The results were related to recent findings on semantic organization in aphasia.     

The early history of the behavior modification of stuttering: From laboratory to clinic

The knowledge of and attitudes toward stuttering of 152 Alabama vocational rehabilitation counselors were studied using the Alabama Rehabilitation Counselors' Attitudes Toward Stuttering (ARCATS) Inventory consisting of 25 true- false statements designed to assess knowledge of stuttering and 15 statements designed to assess attitudes toward stuttering. Counselors were found to perceive stuttering as being significantly vocationally handicapping and amenable to therapy and to perceive stutterers as almost always benefiting from therapy and as being good candidates for vocational rehabilitation. It was concluded that the vocational rehabilitation counselors studied hold attitudes facilitative to the rehabilitation of stutterers.     

The relationship between treatment exposure times and changes in stuttering frequency during contingent stimulation

Four adult stutterers were exposed to 60 consecutive minutes of verbal contigent stimulation. In each session subjects spoke until a stuttering frequency stability criterion was met (baserate) followed by 60 min of exposure to the word wrong presented contingently upon each instance of stuttering. The data were analyzed according to changes in stuttering which occured following 20, 40, and 60 min of treatment exposure. The results revealed that stuttering frequency was reduced for all subjects during all three 20-min segments of the treatment condition. The only significant reductions in stuttering frequency, however, occured within the first 20 min of treatment.     

The differential effect of three auditory stimuli on the frequency of stuttering behaviors

In view of the frequent clinical use of external auditory stimuli in fluency building programs, the purpose of the present experiment was to compare the effects of rhythmic pacing, delayed auditory feedback, and high intensity masking noise on the frequency of stuttering by dysfluency type. Twelve normal hearing young adult stutterers completed an oral reading (approximately 250 syllables) and conversational speech task (3 min) while listening to the three auditory stimuli and during a control condition presented in random order. The results demonstrated that during oral reading all three auditory stimuli were associated with significant reductions in stuttering frequency. However, during conversational speech, only the metronome produced a significant reduction in total stuttering frequency. Individual dysfluency types were not differentially affected by the three auditory stimuli.     

An awareness approach to the covert symptoms of stuttering

Speech-language clinicians working with the confirmed stuttering client are often faced with the clinical management of the covert symptoms of stuttering in addition to the more observable and measurable overt symptoms. The authors report the successful use of awareness techniques to exaggerate the subjective experience of these covert symptoms and encourage the use of these techniques as an adjunct to the counseling and desensitization procedures traditionally employed. A transcribed clinical management session in which several awareness techniques are used to aid the client in an introspective examination of “anticipation of stuttering,” is analyzed in order to reach some specific recommendations for using awareness techniques in the clinical management of the covert symptoms of stuttering.     

Bibliography of literature pertaining to the onset,development, and treatment of stuttering during the preschool years

This bibliography consists of clinical, experimental, and theoretical papers pertaining to the onset, development, and treatment of stuttering in children five- years old and younger. It is a downward extension of Silverman, F.H., Bibliography of literature pertaining to stuttering in elementary-school children, Journal of Fluency Disorders, 1978, 3, 87–102.     

The identification of stuttering: Can you look and tell

This investigation focussed on how observers identify stutterers. It was found that stutterers are identified most correctly under visual circumstances as compared to auditory and combined auditory-visual conditions. Therefore, the reduction of stuttering should include removal of noticeable, interfering, and unnecessary nonverbal behaviors, particularly mouth and nostril movements.     

The Missouri Children's Picture Series: Correlates of the aggression scale in normal fourth-grade males

Missouri Children's Picture Series (MCPS) Aggression scale scores and four more traditional measures of aggression were intercorrelated for 40 normal fourthgrade boys. Results indicated that the MCPS Aggression scale must be viewed as a highly specific instrument which has little if any usefulness in a public school setting. In addition, the failure of the five aggression measures to be interrelated significantly suggests that aggression may be a highly situational response, with children varying in the modality through which they are able to express aggressive feelings and motives.     

Dimensions of stuttering and relationship to psychopathology

This article reports two studies. The first attempted to define stable dimensions within the Stuttering Severity (SS) scale. A factor analysis of correlations among its 64 items defined four factor-based subscales, and three additional subscales were developed rationally. Relationships among these seven subscales suggested the existence of two major dimensions. The second study investigated the relationship of the seven subscales to psychopathology. Correlations were obtained among the subscales and MMPI scales for 69 subjects, and were subjected to a second factor analysis. The MMPI scales and the SS subscales clearly loaded on separate factors, indicating little relationship between dimensions of stuttering and psychopathology as defined by MMPI scores. The second analysis also supported the previous identification of two general dimensions for stuttering. Items were selected for two final scales to represent these dimensions, labeled behavior (22 items) and sensitivity (20 items). Norms were developed for them and also for the full 64-item SS scale.     

Effect of sentence structure on stuttering

The elicited speech of 20 adult male stutterers was analyzed to determine the effect of the number, type, and location of relative clause structures on the frequency of stuttering. The selected structures were identified on the basis of transformational grammar. The findings indicate that the frequency of stuttering increases significantly with an increase in the number of relative clauses included in a matrix sentence structure. The results also indicate that the more severe the stuttering is, the more the stutterer is likely to be affected by this variable. Trends toward more frequent stuttering in the postverbal relative clause and the adjectival form of the relative clause were observed.     

Wyckoff's observing response: Pigeons learn to observe stimuli for free food but not stimuli for extinction

Four pigeons received periods of free food delivery alternating with periods of extinction. The experimental chamber was divided in half. Initially the subjects could produce stimuli selectively associated with these schedules by standing on the right side of the chamber and later by standing on the left side. In both phases, subjects produced the free food stimulus most of the time it was available but did not increase above baseline the time spent producing the extinction stimulus. Thus, when alternative stimuli are available, the pigeon prefers the stimulus associated with the greater frequency of reinforcement although the choice results in no biological advantage.     

The effect of punishment on a factor I stuttering behavior

On each of five days the subject of this experiment read aloud different material during an 18-min A₁ (base rate), B (experimental), and A₂ (extinction) period. No stimulation was delivered during the first three days. On the fourth day, the nonsense word “norg” was presented noncontingently during the experimental period. There was no statistically significant difference between the A₁ and B periods on any of these four days. On day five, “wrong” was made contingent on Factor I prolongations during the experimental period. As a result, there was a statistically significant increase in their frequency. When the response consequence was removed in the A₂ priod, there was a reliable reduction in prolongations and the frequency closely approximated that found in the A₁ period. These data suggest that response-contingent negative stimulation is contraindicated as a clinical tactic for use with Factor I prolongations. It not only failed to suppress them, it increased their frequency.     

Issues to consider in the differential diagnosis of normal childhood nonfluencies and stuttering

Historically more attention has been focused on the adult stutterer than on the young stutterer. This article discusses three key issues in the differential diagnosis of normal childhood nonfluencies and childhood stuttering. The three issues are (1) whether early childhood disfluencies are heterogeneous or homogeneous phenomena, (2) whether the relationship between normal childhood nonfluencies and early stuttering is continuous or dichotomous, and (3) whether normal nonfluencies and stuttering differ quantitatively or qualitatively. Theoretical research as well as clinical implications of these issues are discussed.