Demographic characteristics and treatment experiences of women and men who stutter

This paper reports interview data collected from ten men and ten women who stutter. The responses of the subjects tend to (a) highlight the multidimensionality of stuttering, (b) provide additional support for the conclusion drawn earlier of gender differences in stuttering symptomatology, and (c) raise questions about the manner in which stuttering is treated.     

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 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.     

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 onset of stuttering following drug overdose

Recently, some attention has been focused on acquired stuttering, disfluencies that begin in adulthood. The nature of acquired stuttering differs in several respects from developmental stuttering. A case of acquired stuttering following drug overdose is presented and contrasted with previously reported cases. The case is noteworthy in that, while many characteristics of acquired stuttering are evidenced, several symptoms associated with developmental stuttering are also observed. The findings are discussed in terms of a possible link between developmental and acquired forms of stuttering.     

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.     

Word frequency and children's stuttering: The relationship to sentence structure

This study investigated the relationship between word-frequency level and stuttering within the context of four slected sentence types. Fifteen stuttering children, aged 8–12, read 48 sentences of four different transformational types, and three word-frequency levels 12 simple active-affirmative-declarative (SAAD), 12 negative, 12 passive and 12 negative-passive. All sentences were identical in terms of underlying swings and variations of the SAAD sentences. Results agreed with Ronson's study with adults (1976) in that when the group rating was severe and the sentence type was negative, stuttering increased significantly as word-frequency level decreased. It appears that children's stuttering in relationship to word-frequency level is a different response that is subject to variables of sentence type and the severity rating of stuttering.     

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.     

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.     

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.     

Relationship between eight physiological variables and severity of stuttering

The results of this study illustrated the primacy of individual differences in the relationship between physiological responses before speech and stuttering severity.     

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.     

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.     

Cumulative integrated electromyographic activity of selected speech-related muscle groups of nonstutterers during massed oral readings

The electromyographic (EMG) integrated amplitude of masseter and laryngeal muscle groups were analyzed during five massed oral readings of 16 nonstuttering adult subjects. Reduction in dysfluencies were observed over the five trials as was a reduction in reading time across trials. Significant decreases in EMG activity across trials were found for the laryngeal, but not the masseter, EMG activity. This suggests that changes in vocal behavior thought to accompany adaptation are reflected in decreases in EMG activity of select speech-related muscle groups.     

Hemispheric alpha asymmetries of stuttering males and nonstuttering males and females for words of high and low imagery

Alpha hemispheric asymmetries of nonstuttering males, nonstuttering females, and stuttering males were explored with electroencephalographic procedures during exposure to two lists of one-syllable words which the subjects were required to recall following presentation. One word list contained low-imagery words while the other contained high-imagery words. Stuttering males were found to have significantly less alpha in their right hemispheres, suggesting right hemispheric processing strategies. This finding was interpreted as supporting the “segmentation dysfunction” explanation of stuttering suggested by Moore and Haynes (1979b). Nonstuttering males showed less left than right alpha while nonstuttering females revealed no difference between their right and left hemispheres. Differences between nonstuttering males and females are discussed as being task and stimuli dependent relative to the segmental/nonsegmental nature of both task and stimuli. Differential hemispheric asymmetries for words of high or low-imagery were not observed.     

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.     

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.