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.     

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.     

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.     

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.     

A comparison of the Probe technique and conventional therapy for young stutterers

This study contrasted the gains made in speech theraphy by 39 stutterers, 15 of whom were treated by conventional methods and 24 by the Probe technique. It was found that the Probe technique yielded substantially greater gains in fluency than did the conventional method, having more influence on final performance than factors such as initial fluency, time since onset of stuttering, or the presence of other unacceptable behaviors.     

Vocal changes in stutterers and nonstutterers during high- and low-pitched speech

This study was conducted to provide an indirect test of Wingate's “modified vocalization” hypothesis. In this formulation, the improved fluency that stutterers experience in various novel conditions is attributed to changes in the key correlates of stress, namely, fundamental frequency, vocal SPL, and rate.Normal speakers and stutterers read aloud in an habitual condition following instructions to read at higher- and lower-than-normal pitches. Objective measures were taken of subjects' fundamental frequency, fundamental frequency deviation, vocal SPL, and fluent reading rate. Disfluences were also counted. Findings showed that both stutterers and normals altered several features of voicing from the habitual to the two experimental conditions. Significant condition main effects emerged for fundamental frequency deviation, vocal SPL, fluent reading rate, and disfluency. The only meaningful between-group difference noted showed that the stutterers were more disfluent than the normals across all conditions. Results were interpreted as supporting Wingate's “modified vocalization” position and were discussed relative to how the vocal changes observed might act to promote fluency.     

Reinforcing fluency in stutterers: An experimental study

Subject-specific periods of fluent reading responses of three adult stutterers were positively reinforced with the presentation of a dime. Subjects were run individually through a sequence of two base rate, two experimental, and two extinction sessions, each session lasting 45 min. Periods of fluent reading responses increased during the experimental condition for each of the three subjects. When the reinforcer was withdrawn during the extinction condition, the frequency of fluent periods showed a decrease. Concomitantly, disfluencies decreased during the experimental condition and they increased during the extinction condition. The clinical implications of fluency manipulation as against disfluency manipulation are discussed.     

Fluency and eye contact as factors influencing observers' perceptions of stutterers

The purpose of this study was to determine the effects of different levels of eye contact and fluency on observers' perceptions of a speaker. One of four videotapes depicting an actor (playing the part of a supervisor) interviewing another actor (who played a subordinate) were shown to 127 college students. The four videotapes represented four different conditions comprising combinations of fluent vs nonfluent speech and normal vs low eye contact. Results indicated that these combinations of fluency and eye contact differentially influence listeners' perceptions of a speaker. Highest ratings were obtained for the fluent-normal eye-contact speaker, with lower ratings for all other conditions. In addition, it was determined that the frequency of eye contact rather than fluency was more strongly related to listeners' perceptions. The clinical implications of these findings are discussed.     

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.     

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 use of the psychological stress evaluator with stutterers

A lie detection instrument, the Psychological Stress Evaluator, has been reported by the manufacturer as being capable of quantifying changes in the degree of “stress” as reflected by a subject's voice. Speech pathologists might consider the use of the instrument in clinical and research activities concerning the stutterer's emotional (stress) reaction to stuttering.To test the validity of the instrument, four stutterers and four normal speakers were recorded while making consecutive telephone calls. Randomized recordings were analyzed by a company trained technical to determine the degree of stress for each speech sample.Results indicated that both groups had a significant reduction of stress from the first to the fourth telephone call. However, the groups did not differ in the degree of stress during the ordered series of calls. Due to the inability of the Psychological Stress Evaluator to differentiate between the groups, the validity of the instruments is questioned.     

Implications of evaluating and intervening with incipient stutterers

A study was conducted to investigate the factors involved in the recovery from incipient stuttering without therapeutic intervention. Fifteen subjects were seen on two occasions, once for an initial evaluation after the reported onset of stuttering, and for a second evaluation to determine if they had recovered or become chronic stutterers. Within the constraints of a small sample, several findings are presented: (1) 80% of the children recovered spontaneously from stuttering, (2) subjects who exhibited more types and frequencies of disfluencies upon onset had a poorer prognosis for recovery, (3) the age of onset, if under 4 years, had little bearing on recovery, and (4) children who were seen professionally soon after disfluency onset had the greatest prognosis for recovery. Possible implications of these results are discussed.     

Reading abilities of school-age stutterers

The reading abilities of 20 school-age stutterers and their matched normally fluent controls were assessed by means of the Woodcock Reading Mastery Tests. Results indicate that the reading abilities of school-age stutterers are not significantly different from those of school-age normals. Similarly, knowing whether a subject was classified as a stutterer or normally fluent speaker was of minimal assistance in predicting the subject's reading performance. These findings suggest that school-age stutterers' reading abilities are within normal limits. An individual stutterer, just like an individual normally fluent speaker, may exhibit “reading problems”; however, caution should be employed in extrapolating from one individual stutterer's reading performance to the reading abilities of all stutterers.     

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.     

Manual reaction time to linguistic stimuli in child stutterers and nonstutterers

Ten stuttering and ten nonstuttering children, ages 4–8 yr, served as subjects for a motor reaction task to simple and complex linguistic stimuli. The subjects reacted by pressing one of four panels on a touch-sensitive board that depicted the appropriate semantic relationship in response to 30 simple and complex linguistic stimuli. There was a significant increase in the reaction time of both groups with increasing linguistic complexity. No significant differences were found in the reaction time between the two groups, nor in the interaction between group and complexity. Implications regarding linguistic processing are discussed, and an “overload” hypothesis of stuttering is dispelled. It is concluded that stutterers and nonstutterers in this study did not differ in their reaction time nor in their processing time of linguistic material.     

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 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.     

Phonatory initiation,termination, and vocal frequency change reaction times of stutterers

Four types of voice reaction times were investigated for eight adult stutterers and eight control subjects using a vocal shadowing paradigm. These were voice initiation and termination reaction times (VIT and VTT, respectively) and voice frequency-shift intiation and termination reaction times (SIT and STT, respectively). Results indicated that the stutterers were slower in VIT, but were as fast as their control subjects in VTT, SIT, and STT. It was suggested that a laryngeal discoordination problem of stutterers lies primarily in the stage of adduction (turning on the voicing) rather than in the stage of abduction (turning off the voicing) or in finer frequency control at the larynx.     

Syntactic influences on stuttering in young child stutterers

This study examined the location and rate of stuttering in the spontaneous speech of nine young stutterers (4.0–6.6 yr) in relation to certain aspects of syntax. It was designed to answer the following questions: Is there more stuttering at clause onset (boundary) than at other points in the clause? Does the type of clause influence rate of stuttering? Is there more stuttering on complex than on simple sentences? The syntactic analysis defined 10 clause types (seven pertaining to complex sentences and three pertaining to simple sentences); clause boundaries (taking into account “filler” words occuring in such positions); and hierarchical constituent structure within sentences. Stuttering was found with significantly greater frequency at clause boundaries than at internal (nonboundary) positions of clauses. This was apparent for nine of the 10 clause types, the exception being complement clauses. The word “and” at the beginning of simple and complex sentences provoked a high rate of stuttering. The hierarchical structure within the clause did not influence the location of stuttering, and sentence complexity was not a factor in the rate of stuttering.