The Psychology and Dynamics of Stuttering
Reading Samples and Stuttering Dynamics in Oral Reading
Importance of Reading Samples: * For individuals of reading age, obtaining a reading sample is highly encouraged, even if the person is not yet a fluent reader. * Method for Non-Fluent Readers: Reading samples can be gathered by having the individual "read pictures." They look at illustrations and describe them using a reading intonation. * Verbatim Example: The instructor shared an anecdote about reading a book to "Olivia" through the pictures because the text was too dense; to Olivia, it still sounded like a reading intonation. This provides a sample similar to actual reading, where stuttering tends to appear most frequently.
Patterns in Repeated Readings: * Decline in Stuttering: Stuttering typically declines with each successive rereading of the same material. * The Second Reading: The greatest reduction in disfluencies occurs during the second reading (the first rereading). * Gradual Declines: Disfluencies continue to decrease gradually through subsequent readings, typically leveling off after five readings. After five attempts, the brain has often "caught up," and the speaker may revert to the initial stuttering pattern.
The Consistency Effect: * Definition: A pattern during repeated oral readings where the words stuttered on final readings tend to be the same words that were stuttered during the initial reading. * Breaking Down the Effect: Even as the total number of disfluencies decreases, the specific words that remain disfluent are usually the ones the speaker struggled with at the start.
The Adjacency Effect: * Definition: Stuttering tends to occur at the same physical locations in a text as before, even when the specific words previously stuttered upon are removed or replaced. * Mechanism: This phenomenon is believed to be tied to anxiety and memory. If a speaker stutters on the first five words of a paragraph and those words are removed, they will likely stutter on the new first five words because they recall stuttering in that specific location previously. It is an anxious response to a "new" or "threatening" starting point.
The Phenomenology and Loci of Stuttering
Expectancy Phenomenon: * Definition: The ability of a person who stutters to scan ahead in their speech and predict with a high degree of accuracy which words or parts of words they will stutter on. * Cognitive Process: Individuals may anticipate difficulty as early as 18 months of age. Literate individuals scan for sounds they know are difficult (e.g., , , , and sounds). * Triggers: Anticipation can act as a trigger. For example, a highlighted word in a speech might serve as a visual cue that the speaker previously struggled with that word, leading to increased anxiety or motor planning difficulties.
Loci of Stuttering: * Definition: This refers to the linguistic variables that guide where stuttering happens within speech. * Linguistic Variables: Patterning may occur based on: * Content Words: Nouns, verbs, adjectives, and adverbs. * Word Length: Long words (3, 4, or 5 syllables). * Grammatical Positions: Subject, predicate, etc. * Clinical Role: The Speech-Language Pathologist (SLP) must determine these patterns by analyzing various language samples.
Conditions that Diminish Stuttering (Amelioration)
Standard Conditions: * Singing. * Whispering. * Speaking alone/talking to oneself. * Talking to animals or babies. * Talking with a rhythmic beat. * Talking in unison (e.g., reciting the Pledge of Allegiance). * Using a metronome. * Speaking in high-level noise/reverberation (e.g., a noisy gym): This often causes the speaker to increase their volume, which helps decrease stuttering.
Additional Interesting Conditions: * Swearing: Many individuals do not stutter when swearing. This may be due to the level of excitement, the intentional/planned nature of the speech, or the high emotional adrenaline behind the words. * Being Frightened: Similar to swearing, the adrenaline or hormonal response of being scared (e.g., yelling "I'm scared!") can bypass disfluency. * Speaking While Looking in a Mirror: This allows the speaker to see themselves as they would appear in a social group or setting.
Psychological Theories of Stuttering (Chapter 6)
Overview: There are three major classes of psychological theories: Psycho-emotional, Psycho-behavioral, and Psycho-linguistic.
Psycho-emotional Theory: * Central Tenet: Stuttering is based on a "psychological maladjustment," meaning an individual did not adjust properly to a psychological event or trauma. * Research Limitations: This theory is not well-supported by research because "maladjustment" is difficult to measure objectively; what is traumatic for one person might be a normal adjustment for another. * Sigmund Freud’s Psychoanalytic Theory: * Freud assumed behaviors were triggered by earlier traumas. He believed stuttering was a "deep-seated neurosis" involving a "conversion reaction," suggesting individuals wanted to stutter for a "sexual high." * Psychosexual Development: Freud linked stuttering to issues in early development (e.g., not being breastfed properly or having too much oral stimulation from a bottle). * Parental Blame: Freud suggested parents were the cause of stuttering due to being too strict, not rocking the child properly, or other failures in soothing. * Note on Freud: The instructor noted that Freud was a cocaine addict, which leads modern science to second-guess many of his theories.
Personality Factors: * Research shows people who stutter have the same broad range of personalities as those who do not. There is no specific "stuttering personality." * Some studies suggest a slight tendency toward being more obsessive, compulsive, or aggressive, but this is not significant enough to be a factual rule. * Temperament vs. Personality: * Temperament: Revealed immediately in infancy (e.g., "even-tempered" like the instructor's son Jackson, or "sensitive"/"uneven"). It is hereditary and driven by in utero experiences. * Personality: Takes years to develop and is shaped by environment and the adults around the child. * Connection to Stuttering: Children with "sensitive temperaments" or those who are easily intimidated may show higher rates of stuttering. It is also higher in children with lower emotional regulation.
Clinical Implications and Treatment Strategies
Desensitization: * Aim: Making the client less sensitive to the act and social consequences of stuttering. * Activities: * Purposeful Stuttering: Stuttering on purpose on non-feared words in a safe environment to build confidence. * Self-Disclosure Statements: Explicitly telling people "I am a person who stutters" to reduce anxiety. * Role-Playing: Simulating uncomfortable situations, such as being stared at or cut off by a listener. * Exposure Therapy: Putting the client in spots where they must summarize or answer open-ended questions. * Watching/Listening to Self: Recording an interaction to see what others see, allowing the client to process the visual/auditory reality of their stutter.
Relaxation and Emotional Adjustment: * Mindfulness/Grounding: Helping the client feel their body from the top of the head down to the toes to identify tension (e.g., jaw tension, shoulder tension). * Diaphragmatic Breathing: Focusing on deep breathing rather than shallow, "clavicular" breathing. Tactile cues (holding the stomach/diaphragm) help regulate air expulsion. * Journaling: Using an "Even Though" journal where the client records things they accomplished even though they stuttered (e.g., "Even though I stuttered, I ordered at McDonald's").
Psychobehavioral and Psycholinguistic Theories
Psychobehavioral Theories: * Learned Behavior: The belief that stuttering is acquired rather than constitutionally based. It is a habit reinforced by environmental consequences. * Conditioning: * Classical Conditioning: Making the same response to a stimulus over and over (e.g., responding to a phone ring). * Operant Conditioning: Changing behavior based on what happens after it occurs (positive/negative reinforcement). Stuttering might be reinforced if a child is coddled or given candy after stuttering. * Diagnosogenic Theory (Wendell Johnson): The diagnosis causes the disorder. By labeling a child's normal disfluencies as "stuttering," parents and clinicians create the problem. Johnson believed parents of children who stutter were often perfectionists or over-anxious.
Psycholinguistic Theories: * Speech Production Deficit: Stuttering is explained as a breakdown in the cognitive systems underlying speech production (the retrieval and assembly of language). * Encoding vs. Decoding: It asserts that stuttering is a disorder of phonological encoding. The brain knows what to say, but the millisecond-level process of putting the elements together fails. * Sub-hypotheses: Includes the Covert Repair Hypothesis and Fault Line Hypothesis. * Weaknesses: It doesn't explain the cause (etiology) if the person has no other phonological processing issues. It focuses on disfluent speech rather than the overall phenomenon of stuttering.