Learning from negative outcomes in stuttering therapy: I. Getting off on the wrong foot

Considering the long history of research into stuttering, it is surprising that so little time has been devoted to the study of factors that contribute to the success of therapy. Even less attention has been devoted to uncovering forces that promote poor treatment outcomes. In this article and the companion piece that follows it, an attempt has been made to delineate what may prove to be predictors of unsuccessful therapy. In this first of the two articles, the focus in on the identification of patient, extraclinical, and clinician variables that could act to negate progress during the establishment phase of treatment.     

A case report on the use of flooding in stuttering therapy

The last several years have seen the development and use of anxiety-reduction procedures in stuttering therapy. Among these types of methods, systematic desensitization and reciprocal inhibition have been employed almost exclusively. Emotional de-conditioning by means of flooding or implosive techniques has been attempted far less often. This article presents a case report on the utilization of the flooding tactic. Results are offered and discussed relative to the question of whether the elimination of anxiety is a realistic goal in therapy. The suggestion is offered that what many stutterers may really need to develop is the ability to generate fluency-enhancing behaviors in spite of the presence of heightened emotionality.     

Vocal changes in stutterers and nonstutterers during monotoned speech

For years, reports have circulated that stutterers experience marked decrements in their stuttering when they speak or read in monotone. Wingate has suggested that the ameliorative effects of various novel speaking conditions on stuttering can be attributed to modifications in vocalization induced by such conditions. The present study was conducted to see whether this explanation would extend to monotoned speech as well. Ten teenage and adult stutterers and 10 normal speakers were tested in control and monotone reading conditions. Dependent measures were the frequencies of disfluency and stuttering, fundamental frequency, fundamental frequency standard deviation, vocal SPL, vocal SPL standard deviation, and fluent reading rate. Only within-group statistical comparisons were made, because members of the two groups could not be matched pairwise along critical vocal parameters. The major findings of this study indicated that across the two conditions, both groups significantly reduced their fundamental frequency, fundamental frequency standard deviation, vocal SPL and vocal SPL standard deviation. Only the stutterers exhibited a significant decrement in disfluency and stuttering. The normals did not evince enough disfluency in the control condition for a reduction to occur during monotoning. Neither group effected a reduction in fluent reading rates. These and other findings and interpretations are discussed relative to Wingate's modified vocalization hypothesis.     

Stuttering and fluency: Exclusive events or points on a continuum?

In recent years, several studies have been conducted in which the fluency of stutterers was compared with that of normal speakers. These investigations have been of two basic types, some involving objective measures of physiologic, aerodynamic, or acoustic features of the subjects' fluent speech signal, and others involving experiments performed in which listeners attempted to distinguish the fluency produced by stutterers from that generated by normal speakers. The body of literature pertaining to each of these two types of investigations is reviewed and interpreted. The interpretations offered are then developed in an effort to shed further light on both fluency and stuttering. Implications for further research, as well as for the evaluation, treatment, and post-therapy assessment of stutterers are drawn.     

Effects of simulated stuttering on listener recall

In an investigation of the effects of simulated stuttering on listener recall, a presentation was varied on two factors: degree of stuttering (mild or severe) and information value of stuttered words (low or high). A control presentation featuring non-stuttered speech also was prepared. Five groups of 16 subjects were randomly assigned to, and participated in, one of the five listening conditions. Then they completed a 20-item recall test. A one-way analysis of variance revealed sognificant differences among the five conditions. Two-way analysis of variance disclosed no main effects. However, a significant interaction showed that recall was lowest in the severe stuttering-high information condition. The results are discussed in terms of attention to critical information.     

Stuttering theory,research, and therapy: A five-year retrospective and look ahead

This article reviews events in stuttering theory, research, and therapy that have transpired during the past 5 years. After the retrospective review, current work in the area of stuttering is examined. This analysis of the past and present was conducted in an effort to give clearer direction to future efforts to understand the disorder, and to study and treat it more effectively.     

The speech production abilities of stutterers: Recent, ongoing, and future research

Recent and ongoing research into the speech production abilities of stutterers has followed four disparate paths. First, there have been objective studies of physiologic, aerodynamic, and acoustic parameters of stutterers' habitual speech patterns and the patterns they display while speaking in the presence of such novel stimuli as DAF or masking. Second, investigators have undertaken the fiberoptic examination of stutterers' larynges during fluent and stuttered utterances. Third, there have been studies of the speed with which stutterers start and terminate voicing independent of the act of speaking. Finally, there have been investigations of possible perceptible differences between the fluency of stutterers and normal speakers. Each of these four types of research is examined. Tentative conclusions are drawn, and directions for future theorizing and experimentation are suggested.     

Dichotic speech perception: A comparison between stuttering and nonstuttering children

A stop consonant-vowel dichotic listening task was administered to 90 right- handed boys, 30 in each age group of 5, 7, and 9 yr. Half in each group were stutterers, half nonstutterers. Two and a half times as many stutterers as nonstutterers were found to display either a left-ear advantage (LEA) or no ear advantage (NEA). This finding suggested a greater tendency on the part of stutterers, as opposed to nonstutterers, for reversed or bilateral representation of the auditory speech areas of the brain. In addition, both stutterers and nonstutterers displayed significant developmental increases in the number of times they were able to identify both dichotic speech stimuli, thereby supporting the hypothesis of an age-related increase in children's total information processing capacity. The results are discussed in terms of the differences between stutterers and nonstutterers with respect to the issues of motor representation, cognitive modes, and higher-order linguistic processes.     

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 effects of pacing and masking on stutterers' and nonstutterers' speech initiation times

The present study was undertaken to determine whether pacing and masking would facilitate improved speech initiation times (SITs) both for stutterers and for nonstutterers. All subjects were tested in control, pacing, and masking conditions. The results showed that both stutterers and nonstutterers (1) improved their SITs during the pacing condition as compared with the control condition (p = 0.01), (2) had slower SITs in the masking condition as compared with the control condition (p = 0.05), and (3) had faster SITs during the pacing as compared with the masking condition (p = 0.01). The SIT between-group findings demonstrated that stutterers were slower than nonstutterers across all SIT conditions (p = 0.08). The discussion of these results centers on the facilatory nature of novel stimulation in modifying speech-system functioning.     

Nonspecific elements in therapy with stutterers

Currently, many different strategies are employed by respected professionals working in the area of therapy for persons who stutter. This phenomenon serves as a point of departure for reflections on the nonspecific elements involved in therapy. Drawing on the literature of holistic medicine and psychotherapy these elements are identified as follows: (1) active participation of the client in the therapy process; (2) role of self-management skills; (3) influence of client's expectations regarding treatment; (4) suggestion as a factor in therapy; and (5) the therapeutic relationship.     

The effects of situational performance constraints on intrinsic motivation and satisfaction: The role of perceived competence and self-determination

Situational performance constraints, task interest, and pay contingencies were manipulated in a laboratory study in order to investigate the cognitive mechanisms associated with the previously observed detrimental effects of constraints on affective task reactions. It was hypothesized that feelings of task competence and self-determination would account for both the direct and the interactive effects of constraints on motivation and satisfaction. The results of the study indicated that despite the fact that participants' performance was being constrained and they were aware of these constraints, the mere presence of the constraints alone failed to result in lower levels of satisfaction or motivation on a proofreading task. Post hoc analyses suggested that the constraints, in fact, led to negative affective task reactions when they also reduced participants' feelings of competence and self-determination. Interestingly, participants' generalized locus of control was associated with such effects. Internals tended to maintain stronger feelings of competence and self-determination than externals in the presence of constraints, thereby also maintaining greater motivation and satisfaction.     

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.     

Learning from negative outcomes in stuttering therapy: II. An epiphany of failures

Proceeding on the premise that learning advances on the feet of failure, a litany of therapeutic failures with stutterers across 3 decades is recounted. The basis for these failures included the assumptions that stuttering is a neurotic symptom; that “lucky fluency” can be maintained permanently; that a fluent drone is preferable to stuttering; that controlled fluency, once established, can be maintained permanently; that a proper task for clinicians is to motivate clients to achieve and preserve fluency; that the clinician has the responsibility for marching clients through their therapeutic paces; and that stuttering is punishing to the stutterer, so it is not preserved by reinforcement. Unfortunately, more has probably been learned about what does not work than what does.     

Teacher attitudes toward stuttering

Attitudes of 100 elementary school teachers toward stuttering were studied using the Teacher Attitudes Toward Stuttering (TATS) Inventory. Teacher attitudes, as indicated by TATS Inventory scores, were compared with teacher knowledge of stuttering, age of teacher, number of years teaching experience, educational level, and whether the teacher had personal experience with a stutterer. Results indicated that significant positive correlations existed between teacher attitudes toward and knowledge of stuttering. Significant negative correlations were demonstrated between teacher attitudes/knowledge of stuttering and the presence of a stuttering child in the classroom. The applicability of the TATS Inventory as a clinical instrument in its current form and the research needed to enhance its flexibility are discussed.