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.     

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.     

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.     

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.     

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.     

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.     

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.     

Rate changes in the speech of stutterers after therapy

The fluent speaking rate of nine adult male stutterers was compared before and after stuttering intervention. The subjects, ranging in age from 18 to 37 yr (mean, 25 yr, 3 mo), exhibited mild to severe stuttering prior to treatment. The only rate reduction strategy taught to subjects during intervention was to slow the first phoneme or syllable of sentences spoken. In addition, however, subjects significantly reduced their overall rate as determined by measurements made of their fluent speech at the middle of sentences, as well as overall sentence durations (excepting the first word of utterances). The data from this investigation are interpreted relative to the facilitation/simplification hypothesis.     

Stuttering: Training the therapist

In order to sensitize therapists in training to the dynamics of helping others change, eight members of a graduate seminar in fluency disorders were asked to develop and maintain a program of personal behavioral change for a period of 4 wk. Their reflections on several features of this experience are discussed under the following categories: (1) Selecting the behavior for modification; (2) developing the contract; (3) motivational factors; (4) personal reflections, and (5) implications for working with stutterers.     

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.     

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.     

Stuttering adaptation under distributed and massed conditions

An identical-subject-repeated-measures design, involving two counterbalanced conditions, was employed to investigate adaptation when the presentation of a 100-word list is distributed and when it is massed. In Condition I, the entire list was read aloud during each of five successive trials. Since a specific word reoccurred only after all of the others were displayed, the presentation may be said to be distributed. In contrast, the Condition II presentation was massed. Only after a word was read five times was the next one presented. The results indicate that significant adaptation occurred in both conditions. However, adaptation plateaued in the distributed condition. This was not the case when massing was employed. The among-condition analyses revealed that significantly more adaptation occurred in the massed than in the distributed condition.     

Vocal changes in stutterers and nonstutterers when speaking to children

Within the last few years, considerable attention has been devoted to the possibility that the amelioration of stuttering in many novel speaking conditions is a function of vocal changes with or without accompanying modifications in prosodic expression. These formulations have made reference primarily to conditions in which stutterers were induced into one or another novel speech pattern by an external stimulus such as masking noise, a rhythmic cue, or by instructions to sing, or read in unison with another speaker. In contrast, far less attention has been paid to other ameliorative conditions that lack a novel external stimulus or special instructions that direct the stutterer to speak in some unique manner. Speaking or reading to a child is an example of this latter type of condition. The present study was conducted to see if nine adult stutterers and a matched group of nonstutterers would evince vocal changes as they read aloud to another adult, a child, and a child and adult together. There was also a fourth control condition wherein the subjects read to one of the experimenters. Dependent measures of disfluency and stuttering, fundamental frequency, fundamental frequency deviation, fluent reading rate, and peak vocal sound pressure level were made and treated statistically. The major findings of this study indicated that, relative to the control condition, both subject groups exhibited several vocal changes when reading to a child alone and to a child and adult together. In addition, the stutterers experienced a reduction in disfluency, but only when reading to the child alone. The normal speakers exhibited too few disfluencies in the control condition for any meaningful change to occur in that dependent variable. The fact that the stutterers evinced vocal changes in both experimental conditions but a significant drop in disfluency in just one bears importantly on hypotheses that emphasize vocal changes in conditions that ameliorate stuttering.