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.     

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.     

Rate reduction strategies used by stutterers and nonstutterers during high- and low-pitched speech

Groups of child and adult normal speakers and stutterers were tested in an habitual condition and in conditions where they were instructed to read aloud at pitches both higher than and lower than normal. Objective measures were made of subjects' fluent reading rate, and vowel and pause durations across conditions. Disfluencies were also counted. Findings revealed that all four subject groups reduced their frequency of disfluency from the habitual to both experimental conditions. These decrements in disfluency were attended by significant reductions in fluent reading rate. Spectrographic analyses revealed that most subjects, regardless of age and speaker characteristic, affected their rate reduction by extending both vowel and pause durations. These results are compatible with those obtained in recent studies and are discussed.     

A study of language functioning in Alzheimer patients

Language functioning in Alzheimer's disease is reviewed and the performance of 25 Alzheimer patients on a standard battery is reported. All these hospitalized patients were aphasic to some degree. As a group, they differed from normals on all language variables, and from stroke patients in terms of higher fluency and lower comprehension. Spontaneous speech showed high incidence of circumlocutions and semantic jargon, but no phonemic paraphasias or target approximations. Syllabic perseverations, shouting, inappropriate laughter, and mutism were late-appearing features. Transcortical Sensory, and Wernicke's aphasias were frequent, but Broca's and Transcortical Motor aphasias notably absent. Extent of language impairment correlated with current length of hospitalization but not age. Reading, writing, and performance scores except praxis, were lower than oral language scores. Findings were discussed in relation to previous results, methodology, and language organization in the brain.     

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.     

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.     

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.     

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.     

The effect of partially valid cues on children's discrimination learning

Second grade children were administered a two-choice discrimination learning task in which irrelevant dimensions were correlated .50, .75, or 1.00 with the 100 percent rewarded cue. The results indicated that when a cue was partially correlated with reward .75, learning was retarded. When all cues were relevant and redundant (r = 1.00), learning was most rapid. These results supported an implication of Hypothesis Testing Theory that partially correlated or partially valid cues would not be eliminated rapidly, thus retarding acquisition of the correct response.     

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.     

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.     

Vowel duration in stutterers participating in precision fluency shaping

The purpose of this study was to determine the extent to which stutters manipulate vowel duration to achieve fluency after participating in Precision Fluency Shaping. Nine stutterers who read an all-voiced sentence fluently before and after therapy were selected for study. Wide-band spectrograms were made of the initial phrase of the sentences, and vowel durations were computed. Results indicated that extended vowel durations were characteristic of the fluency of stutterers posttherapy. The subject that had the highest rate of disfluency after therapy also had the shortest vowel durations. Clinical implications concerning the importance of speech rate during carryover practice are made.     

A case of adult onset of stuttering

A 36-yr-old adult male was treated for stuttering after a “sudden onset” of disfluency according to the client, 3 yr before. The treatment method and results are described and the “awareness” feature of stuttering onset is discussed.     

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.     

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.     

A survey of communicative disorders students' attitudes toward stuttering

Cooper's (1975) Clinician Attitudes Toward Stuttering (CATS) inventories were conpleted by 1,902 speech-language pathology and audiology students from 33 universities, each in a different state. The majority of respondents perceived stutterers as having psychosocial problems and believed that client and parental counseling were essential aspects of treatment. These views were relatively unaffected by student training and clinical exposure. In addition, most of the assumptions of Johnson's diagnosogenic theory of stuttering were held by the majority of the students surveyed. Most of the respondents believed that stuttering was difficult to modify and that speech clinicians were neither adept nor comfortable treating stutterers. These latter attitudes were significantly affected by training, i.e., the more advanced the students' training, the more pessimistic their views on clinician competence. Other professional attitudes and the effect of training on them are also discussed.     

Influence of stuttering therapy on clinicians'' disfluencies: Effects of client modeling

This study investigated whether student clinicians working with stutterers subsequently produce more disfluencies than student clinicians providing therapy to clients with other speech and language disorders. Seventeen graduate students working in a 6-wk summer camp setting were divided into two groups: eight who provided treatment for stutterers (group 1) and nine who provided therapy for clients with other communication disorders (group 2). All student clinicians were recorded during spontaneous speaking and oral reading tasks prior to camper arrival and following camper departure. An eight-category classification system was used to determine disfluency types. Findings revealed that Group 1 clinicians significantly decreased their total disfluencies between pre- and post-camp recordings on the spontaneous speaking task. Unexpectedly, this same group also substantially increased part-word repetitions and sound prolongations. The possibilities of incidental learning, reverse modeling, and overidentification with stuttering clients are discussed.     

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.