Jump to: navigation, search

[edit] Table of contents

[edit] Introduction

Speech-Language Pathology/Stuttering/Introduction/Intro

[edit] Overview of Factors that Contribute to Stuttering

Speech-Language Pathology/Stuttering/Introduction/Factors

[edit] What Is Stuttering?

Speech-Language Pathology/Stuttering/What Is Stuttering?

[edit] Self-Awareness of Stuttering Behaviors

Speech-Language Pathology/Stuttering/Self-Awareness of Stuttering Behaviors

[edit] Development of Stuttering

[edit] Pre-School Stuttering

[edit] Indirect Therapy

Indirect therapy is a "gentle nudge." Indirect therapy changes the parents' speech and behaviors. The speech-language pathologist trains the parents to slow down and use simple vocabulary, and not criticize the child, to not put pressure on the child (e.g., don't demand that the child confess guilt), to wait two seconds after the child finishes speaking before answering the child, and to give the child lots of hugs.

Indirect therapy is ineffective. A literature review found

…little convincing evidence…that parents of children who stutter differ from parents of children who do not stutter in the way they talk with their children. Similarly, there is little objective support…that parents' speech behaviors contribute to children's stuttering or that modifying parents' speech behaviors facilitates children's fluency.^[1]

More than a dozen studies found no evidence that altering parental behavior changed children's speech. These studies found no differences for positive statements (praise, encouragement, agreement), negative statements (criticism, reprimands), questions, topic initiations and terminations^[2]; conversational assertiveness and responsiveness^[3]; response time latency or the time between one person finishing speaking, and the other person beginning speaking^[4]; "formal" style vs. a "casual" style^[5]; or illocution.^[6]

The studies I really liked found the opposite of what the "experts" have been telling parents for 75 years:

• A study found that mothers interrupt their child after dysfluencies, not before.^[7] This suggests that not interrupting causes children to stutter!
• A study found that when mothers spoke faster their children spoke slower.^[8] Another study trained parents to slow their speaking rates. The children's speaking rate increased.^[9] This suggests that parents talking slowly causes their children to stutter!
• Parents of children who stutter produced more positive statements (e.g., praise, encouragement) and fewer negative statements (e.g. criticisms, disparaging remarks) than parents of children who didn't stutter.^[10] This suggests that parents' praise and encouragement causes children to stutter!
• A multiyear study followed 93 preschool children. At the start, none of the children stuttered. One year later, 26 of the children stuttered. The researchers compared the speech behaviors of the two groups of mothers, before their children started stuttering. No differences were found, except that mothers of children who would stutter had shorter, less complex utterances.^[11] This contradicts the "capacities and demands model" of childhood stuttering.

More generally, some psychologists now discount the role of parents in the development of children's character and personality. About 50% of the personality differences are attributable to our genes, and the rest due to the child's peers: "…what parents do seems to be nearly irrelevant."^[12]

[edit] Direct Therapy

In contrast, direct therapy changes the child's speech and behaviors. Direct therapy can be more of a big shove, rather than a gentle nudge. It may include:

• Games to encourage speaking.
• Games to train specific speech skills, similar to adult fluency shaping therapy.
• Modeling the child's speech and/or behaviors.

A child's first therapy session may just be playing a game to encourage the child to talk. E.g., the speech-language pathologist and child silently play with separate boxes of trucks, on opposite sides of the room. The speech-language pathologist begins making engine sounds. She then gradually moves to the center of the room, and her trucks interact with the child's trucks.

"Say the Magic Word" is another game to encourage talking. You can play this while looking through a picture book, or while driving. The parent says she sees something. The child guesses what the parent sees. When the child says the "magic word," the parent rings a bell or gives the child a peanut. No particular word is magic—the child is rewarded for fluent words.

A frequency-shifted auditory feedback (FAF) device makes shy children want to talk. They're fascinated to hear their voices sounding like a "little kid" (frequency upshift) or a "monster" (frequency downshift).

Some games teach speech skills. In "Can't Catch Me," one person gets a peanut when the other person asks a question. You then quietly eat your peanut before answering the question. If you answer the question before eating your peanut, you must put your peanut back. The parent should lose more peanuts than the child, by answering too quickly. This reduces the time pressure the child feels about quickly answering questions.

A turtle hand puppet can teach slow speech with stretched vowels. When the child uses the target speech skills, the turtle slowly walks. When the child speaks fast, the turtle retreats into her shell.

Super Duper has other games for stuttering therapy.

[edit] Modeling

Caitlyn, a four-year-old female who began to stutter in the midst of her parents' divorce, was exhibiting significant struggle and tension behavior as well as secondary behaviors. Of most concern was her head-banging behavior during difficult moments of stuttering. After many sessions in which I attempted to eliminate this behavior through fluency-shaping principles, I saw no change. One day, shortly after Caitlyn banged her forehead on the table to interrupt a block, I modeled the same behavior. Caitlyn was shocked and ignored me. After I did this several times she asked me, "Why did you do that? Didn't that hurt?" I responded, "I don't know why I did it. But it sure didn't help me get my word out!" Caitlyn never again banged her head to help her talk. She has been out of therapy for six years and remains fluent.^[13]

This speech-language pathologist's modeling of Caitlyn's behavior was radically different from conventional stuttering therapy practices. The speech-language pathologist improved the child's awareness of her stuttering. In contrast, most "experts" would have pretended not to notice Caitlyn's head-banging behavior. They would have predicted that making Caitlyn aware of her head-banging would have caused emotional trauma and made her stuttering worse.

Imagine that a teenage brother and sister use profanity at the family dinner table. Should the parents act horrified and tell their children never to use such language? Should they refuse to allow dessert or television for the teenagers?

You know that won't work. The teenagers will use profanity at the next opportunity, just for the amusement of horrifying their parents. Instead, the parents should immediately use twice as much profanity. Dad should say, "#$%^, this is best *&^% meatloaf in the whole @#$% world!"

Mom should then respond, "Oh, you big !@#$, you're so &^%$ cool and #$%^ sexy and when you talk ^%$#!"

The teenagers will turn red with embarrassment, and never use profanity again in front of their parents!

In a psychology class about traumatized children we saw a video of a ten-year-old boy destroying a psychologist's office. The boy threw every object he could throw, and smashed everything else. The psychologist sat there calmly telling the boy not to destroy the office. He finally grabbed the boy and hugged him. To me it looked like a full body restraint but the instructor said it was a hug, and that was what the boy really needed. I asked what would have happened if the psychologist had modeled the boy's behavior. E.g., the psychologist could have thrown and smashed stuff. The instructor said that was the worst idea she'd ever heard. But I think the boy would have stopped, watched in amazement as the psychologist destroyed his own office, and then asked, "Why did you do that?" The boy and the psychologist could then have started talking, with understanding of what the boy was feeling, which is what I think the boy needed.--Thomas David Kehoe 02:06, 28 March 2006 (UTC)

The purpose of modeling is to improve the subject's awareness of his or her behaviors. Stutterers are largely unaware of their stuttering, or at least what they do when they stutter. Everyone else can see the stuttering but the stutterer can't. Combining video and modeling can help a stutterer improve self-awareness.

Modeling also dispels a person's mistaken view that a behavior is invisible, or it's acceptable, or everyone does it. If everyone ignores undesirable behavior then the person may think it's OK.

Modeling only works when the modeler or the modelee knows how to replace the undesirable behavior with a target behavior. E.g., it's OK for your speech-language pathologist to model your stuttering because she can show you how to speak fluently. It was OK for my Romantic Disaster of 1996 to make me aware that I was stuttering, because I knew what to do to talk fluently. It's not OK to point out a problem to someone who has no idea what to do about it.

[edit] References

1. ^ Nippold, M., Rudzinski, M. "Parents' Speech and Children's Stuttering: A Critique of the Literature," Journal of Speech and Hearing Research, 38:5, October 1995.
2. ^ Meyers, S.C., & Freeman, F.J. (1985a) "Are mothers of stutterers different? An investigation of social-communicative interaction."  Journal of Fluency Disorders, 10, 193-209.
3. ^ Weiss, A.L., & Zebrowski, P.M. (1992) "Disfluencies in the conversations of young children who stutter: Some answers about questions." Journal of Speech and Hearing Research, 35, 1230-1238.
4. ^ Kelly, E.M. & Conture, E.G. (1992) "Speaking rates, response time latencies, and interrupting behaviors of young stutterers, non-stutterers, and their mothers." Journal of Speech and Hearing Research, 37, 1256-1267; Kelly, E.M. (1994) "Speech rates and turn-taking behaviors of children who stutter and their fathers." Journal of Speech and Hearing Research, 37, 1284-1294; Yaruss, J.S., Conture, E.G. (1995) "Mother and Child Speaking Rates and Utterance Lengths in Adjacent Fluent Utterances: Preliminary Observations," Journal of Fluency Disorders, 20, 257-278; Yaruss, J.S. (1997) "Utterance Timing and Childhood Stuttering," Journal of Fluency Disorders, 22, 263-286.
5. ^ Howell, P., Kapoor, A, Rustin, L. "The Effects of Formal and Casual Interview Styles on Stuttering Incidence," in Speech Production: Motor Control, Brain Research and Fluency Disorders, edited by W. Hulstijn, H.F.M. Peters, and P.H.H.M. Van Lieshout, Amsterdam: Elsevier, 1997.
6. ^ Rommel, D., Häge, A., Johannsen, H., Schulze, H. "Linguistic Aspects of Stuttering In Childhood," in Speech Production: Motor Control, Brain Research and Fluency Disorders, edited by W. Hulstijn, H.F.M. Peters, and P.H.H.M. Van Lieshout, Amsterdam: Elsevier, 1997.
7. ^ Meyers, S.C., & Freeman, F.J. (1985b) "Interruptions as a variable in stuttering and disfluency." Journal of Speech and Hearing Research, 28, 428-435.
8. ^ Meyers, S.C., & Freeman, F.J. (1985c) "Mother and child speech rates as a variable in stuttering and disfluency." Journal of Speech and Hearing Research, 28, 436-444.
9. ^ Stephenson-Opsal, D., & Bernstein Ratner, N. (1988) "Maternal speech rate modification and childhood stuttering." Journal of Fluency Disorders, 13, 49-56.
10. ^ Meyers, S.C. (1990) "Verbal behaviors of preschool stutterers and conversational partners: Observing reciprocal relationships." Journal of Speech and Hearing Disorders, 54, 706-712.
11. ^ MKloth, S.A.M., Jannsen, P., Kraaimaat, F.W., Brutten, G.J. (1995) "Communicative Behavior of Mothers of Stuttering and Nonstuttering High-Risk Children Prior to the Onset of Stuttering," Journal of Fluency Disorders, 20, 365-377.
12. ^ Gladwell, Malcolm. "Do Parents Matter?" The New Yorker, August, 17, 1998, reviewing The Nurture Assumption: Why Children Turn Out the Way They Do, by Judith Rich Harris, 1998, ISBN 0684857073.
13. ^ Mary Wallace and Patty Walton, Fun With Fluency: Direct Therapy With The Young Child (Imaginart, 1998).

[edit] School-Age and Teenage Stuttering

Speech-Language Pathology/Stuttering/Childhood Stuttering/School-Age and Teenage Stuttering

[edit] Auditory Processing

[edit] Central Auditory Processing Disorder

Speech-Language Pathology/Stuttering/Auditory Processing/CAPD

[edit] Delayed Auditory Feedback

Speech-Language Pathology/Stuttering/Auditory Processing/Altered Auditory Feedback

[edit] Sound Quality, Background Noise

Speech-Language Pathology/Stuttering/Auditory Processing/Sound Quality, Background Noise

[edit] Speech Motor Learning and Control

[edit] Open- and Closed-Loop Speech Motor Control

Speech-Language Pathology/Stuttering/Speech Motor Learning and Control/Open- and Closed-Loop Speech Motor Control

[edit] Three Stages of Motor Learning

Speech-Language Pathology/Stuttering/Speech Motor Learning and Control/Three Stages of Motor Learning

[edit] Feedback and Biofeedback

Speech-Language Pathology/Stuttering/Speech Motor Learning and Control/Feedback and Biofeedback

[edit] Automatic, Effortless Fluency

Speech-Language Pathology/Stuttering/Speech Motor Learning and Control/Automatic, Effortless Fluency

[edit] Zen in the Art of Stuttering

Zen in the Art of Stuttering

Eugen Herrigel taught philosophy at the University of Tokyo in the 1920s and 1930s. To learn the Japanese philosophy of Zen Buddhism he studied archery for six years with a Zen master. In 1953 he wrote Zen in the Art of Archery about his experiences.

Daisetz T. Suzuki wrote in the introduction to Herrigel's book:

Zen is the "everyday mind," as was proclaimed by Baso (died 788); this "everyday mind" is no more than "sleeping when tired, eating when hungry." As soon as we reflect, deliberate, and conceptualize, the original unconsciousness is lost and a thought interferes. We no longer eat while eating, we no longer sleep while sleeping. The arrow is off the string but does not fly straight to the target…Calculation which is miscalculation sets in…The archer's confused mind betrays itself in every direction and every field of activity.

Wendell Johnson said, "Stuttering is what you do trying not to stutter again."

Malcolm Fraser (founder of NAPA Auto Parts and the Stuttering Foundation of America said, "Stuttering is largely what the stutterer does trying not to stutter."

The goal of stuttering therapy is spontaneous fluent speech. The goal of Zen is to do life activities without self-conscious calculating and thinking.

Non-stutterers usually talk without self-conscious calculating and thinking. But sometimes they are self-conscious about their speech. Fear of public speaking is common. And non-stutterers are self-conscious about asking the boss for a raise, or asking someone out on a date, or when discussing a difficult subject. Speech pathologists call this pragmatics—the mental effort of calculating the listener's reaction to your speech. In the Zen framework, pragmatics is the calculation that is miscalculation.

The goal of stuttering therapy should be to become a "Zen master of speech," just as other Zen masters are archers or swordsmen or calligraphers. To make an analogy to Baso, you sleep when tired, eat when hungry, and talk when you need to communicate. You don't worry about the listener's reaction. You don't fear embarrassment. If the listener doesn't do what you want or expect, you don't get upset.

You also talk fluently—but let's define fluency as if we're learning a foreign language. You need vocabulary to express your thoughts, grammar so your meaning isn't misconstrued, and accent and articulation to be understood. Mild stuttering may be OK, if your listener understands you, and you don't fear or avoid speaking. Van Riper called this "fluent stuttering," and a Zen master might call it "fluency which is not fluency."

Like speech, archery is a combination of motor skills. You tense and relax certain muscles, with split-second timing. Like fluency for a stutterer, these motor skills are not easy or obvious. Like many stutterers working on their speech, Herrigel worked six years before he considered himself an archer.

Why did Herrigel study archery to learn Zen philosophy? Most Zen students read books, take classes, and talk with Zen masters. How could learning a set of motor skills teach you a philosophy? Herrigel was told that to learn Zen he must begin "by learning one of the Japanese arts associated with Zen."

Master Kenzo Awa's first lesson was drawing the bow, letting "only your two hands do the work, while your arm and shoulder muscles remain relaxed, as though they looked on impassively."

This step is like stuttering therapy, with the goal of speaking while keeping your speech-production muscles relaxed.

Herrigel couldn't do this first step. He would "start trembling after a few moments, and my breathing became more and more labored." Sounds like stuttering!

He was trying to draw a six-foot bow held above his head, which requires great strength. But somehow the Master did this effortlessly.

…he called out to me to "Relax! Relax!"…the day came when…I lost patience and brought myself to admit that I absolutely could not draw the bow in the manner prescribed.

"You cannot do it," explained the Master, "because you do not breathe right."

Sounds like stuttering therapy! The Master continued,

"Press your breath down gently after breathing in, so that the abdominal wall is tightly stretched, and hold it there for a while. Then breathe out as slowly and evenly as possible, and after a short pause, draw a quick breath of air again—out and in continually, in a rhythm, that will gradually settle itself. If it is done properly, you will feel the shooting becoming easier every day. For through this breathing you will not only discover the source of all spiritual strength but will also cause this source to flow more abundantly, and to pour more easily through your limbs the more relaxed you are."

And as if to prove it, he drew his strong bow and invited me to step behind him and feel his arm muscles. They were indeed quite relaxed, as though they were doing no work at all.

The new way of breathing was practiced, without bow and arrow at first, until it came naturally. The slight feeling of discomfort noticeable in the beginning was quickly overcome. The Master attached so much importance to breathing out as slowly and steadily as possible to the very end, that, for better practice and control, he made us combine it with a humming note.

First relaxed breathing, and now vocal fold vibration!

I cannot think back to those days without recalling, over and over again, how difficult I found it, in the beginning, to get my breathing to work out right…

When, to excuse myself, I once remarked that I was conscientiously making an effort to keep relaxed, he replied: "That's just the trouble, you make an effort to think about it. Concentrate entirely on your breathing, as if you had nothing else to do!"

I've heard stuttering therapists say the same thing…

It took me considerable time before I succeeded in doing what the Master wanted. But—I succeeded. I learned to lose myself so effortlessly in the breathing that I sometimes had the feeling that I myself was not breathing but—strange as this may sound—being breathed. And even when, in hours of thoughtful reflection, I struggled against this bold idea, I could no longer doubt that the breathing held out all that the Master had promised.

Learning to draw the bow took a year. Perhaps stuttering therapies are unsuccessful because we expect results too quickly. Stuttering therapy could start with a year of breathing exercises.

Then Herrigel learned to loose the arrow. This was even more difficult than drawing the bow. Herrigel kept jerking his hand at the moment of release, resulting in "visible shaking of my whole body and affected the bow and arrow as well." This caused the arrow to "wobble."

The Master told Herrigel, "Don't think of what you have to do, don't consider how to carry it out! You mustn't open the right hand on purpose."

Herrigel told the Master that after drawing the bow, "unless the shot comes at once I shan't be able to endure the tension…I can't wait any longer."

The Master replied that Herrigel's inability to wait was because, "You do not wait for fulfillment, but brace yourself for failure."

Herrigel spent three years learning to release the arrow. The Master kept saying to release the arrow without tension, like a bamboo leaf holding snow, bending lower and lower until the snow slips off. The bamboo leaf waits without effort until the snow falls off.

In stuttering therapy, the first word of a phrase should be without effort, rolling off your vocal folds like the snow sliding off the bamboo leaf. You shouldn't intend to say the first word, as the archer doesn't open his hand on purpose. The word should say itself, without your planning or calculating or trying.

Herrigel's three years practice releasing the arrow suggests that learning to release the first word of a phrase may also take three years, and be the hardest part of stuttering therapy.

Herrigel was dedicated to his practice, but he couldn't release the arrow smoothly. The Master kept telling Herrigel to become "truly egoless." Herrigel became dejected, and planned to discontinue the archery lessons, concluding that, "all my efforts of the last few years had become meaningless."

Then, one day, after a shot, the Master made a deep bow and broke off the lesson. "Just then 'It' shot!" he cried.

"It" meant that Herrigel had loosed a shot without loosing the shot. "It" had loosed the shot, not Herrigel. The Master could not say anymore what "It" was, just that "It" can only be known through experience.

Only after considerable time did more right shots occasionally come off, which the Master signalized by a deep bow. How it happened that they loosed themselves without my doing anything, how it came about that my tightly closed right hand suddenly flew back wide open, I could not explain then and I cannot explain today…I got to the point of being able to distinguish, on my own, the right shots from the failures. The qualitative difference is so great that it cannot be overlooked once it has been experienced.

In stuttering therapy, the difference between your relaxed, fluent voice and your tense, stuttering voice is as obvious as night and day—after you learn relaxed, fluent speech. Until then it seems impossible.

The Master then began training Herrigel to shoot at a target, adding, "He who has a hundred miles to walk should reckon ninety as half the journey."

The Master refused to teach Herrigel to aim, insisting that the target was not the goal, and the goal cannot be aimed at, and that the goal doesn't have a name, except maybe "enlightenment".

But even though the Master did not aim, all of his shots lodged in the black center of the target, from sixty feet away.

At first Herrigel tried to shoot without caring if the arrows hit the target. But he couldn't do this, and "I confessed to him that I was at the end of my tether."

The Master replied:

You worry yourself unnecessarily. Put the thought of hitting right out of your mind! You can be a Master even if every shot does not hit.

You can be a Zen master of speech even if you still stutter. Mild disfluencies don't matter, if you communicate well.

When the Master said he sees "the goal as though I don't see it," Herrigel replied that the Master should then be able to shoot blindfolded. The Master then had Herrigel set up the target in darkness, except for one candle. Herrigel could not see the target at all, but the Master shot two arrows. When Herrigel turned on the lights, he saw that not only had both arrows hit the bulls-eye, but the second arrow had hit the first and splintered it!

Herrigel describes the following months as the hardest yet, of trying to hit the target yet not trying to hit the target. He gradually came to see the value of this training:

It destroyed the last traces of any preoccupation with myself and the fluctuations of my mood.

Finally, the Master had Herrigel shoot in front of spectators, and awarded him a diploma, "inscribed with the degree of mastery." Before Herrigel returned to Europe, the Master added,

I must only warn you of one thing. You have become a different person in the course of these years. For this is what the art of archery means: a profound and far-reaching contest of the archer with himself. Perhaps you have hardly noticed it yet, but you will feel it very strongly when you meet your friends and acquaintances again…You will see with other eyes and measure with other measures.

[edit] Response Selection under Stress

[edit] Stuttering Reduces Stress

Speech-Language Pathology/Stuttering/Response Selection Under Stress/Stuttering Reduces Stress

[edit] Speech-Related Fears and Anxieties

Introducing yourself to an attractive person. Raising your hand to answer a teacher's question. Ordering in a restaurant. Calling a store to ask if they have what you want. Making a toast at your best friend's wedding reception. Calling to order a pizza. Leaving a voicemail.

Do any of these make you nervous? Any that you never, ever do? Everyone is nervous about some speaking situations. Public speaking is humanity's most common fear, greater than the fear of death. Few women will introduce themselves to a man to ask for a date, or call a man who's given his telephone number and asked for a date. Ordering in a French restaurant is scarier than ordering at McDonald's.

The Predator Approach

Rent the video Predator, starring Arnold Schwarzenegger and Jesse Ventura. Settle down with a bowl of popcorn to watch the governor of California and the governor of Minnesota discuss school funding and property tax reform. Just joking. Back in 1987, Schwarzenegger and Ventura were action movie heroes. In Predator the men shoot a variety of large weapons, including an M-134 7.62mm minigun and an M-79 grenade launcher.

Now write down a list of speaking tasks that you don't do, that non-stutterers don't think twice about doing. Let's say that you're afraid to leave voicemails on answering machines. Write down all the speech therapy tools you can use in this situation. Imagine yourself as Schwarzenegger and Ventura making a list of weapons to bring. But instead of arming yourself with a minigun and a grenade launcher, your weapons for voicemail could include:

• Practicing your message before you call.
• Fluency skills, such as slow speech with stretched vowels, relaxing your breathing, or relaxing your vocal folds.
• Using a DAF/FAF anti-stuttering device.
• A hierarchy of stress, beginning with calling your own answering machine, then calling your speech-language pathologist's answering machine, then calling a friend's answering machine, then calling a business's answering machine (e.g., calling restaurants before they open asking if they have banquet facilities), and finally calling that attractive person of the opposite sex.

Don't stop listing your arsenal until you look at the list and laugh at how you'll blow away that poor little voicemail. Then think of one more weapon to add to your list. You're ready when you're confident that you won't stutter.

Let's say that your message is, "You're the most wonderful person I've ever met. I can't wait to see you again." Using all of your fluency weapons, pick up the phone and call your own answering machine. Check your messages. Pretty good, huh?

Now call yourself again. This time, reduce or throw away one of your weapons. If you used one-second stretched syllables on the first call, call yourself using half-second stretch. Then go to quarter-second "slow normal" speech.

If you used an anti-stuttering device on the first call, don't use the device for your next call.

If you practiced the message on the first call, say something spontaneous on your next call.

Step by step, throw away your weapons, until you can call your own voicemail fluently, without effort or fear.

OK, if you're a non-violent person, think of this as a multifactoral approach to stuttering therapy. Instead of relying on one fluency skill, take one item from the auditory processing category, e.g., an anti-stuttering device; one item from the speech motor control category, e.g., relaxed vocal folds; one item from the stress control category, e.g., using a hierarchy of stress; one item from the neurotransmitters category, e.g., medication, etc. Don't select all your fluency skills from one category, e.g., gentle onsets, diaphragmatic breathing, relaxed vocal folds, etc.

Make a Stress Hierarchy

Now take a step up the stress hierarchy. Call your speech-language pathologist and leave a message. (If you're not in speech therapy, call a friend or relative.) Begin with your full arsenal of fluency weapons, then call back, using fewer fluency weapons. Then work your way up your stress hierarchy. If you feel any twinge of fear on a call, take a step back until you feel confident again.

Approaching feared speaking situations can be like fighting a grizzly bear armed only with a pocket knife. Scary speaking situations combine to look like a ten-foot-tall bear. Most speech therapy programs give you only one weapon.

Divide your general fear of speaking into specific fears. The giant bear becomes many small bears. Now create a stress hierarchy, with a small bear on one end, and a bunny rabbit on the other end. And instead of having one weapon, which your speech-language pathologist (or the expert who trained her back at the university) assured you was the One True treatment for stuttering, you now have a variety of fluency skills.

You're armed like Arnold Schwarzenegger, you're hunting bunny rabbits, and you're in a pet shop before Easter. Armed to the teeth with speech therapy skills, there's no possibility of stuttering in your feared situation. Heck, it isn't even a feared situation anymore!

You now see why this chapter follows the auditory processing chapter and the speech motor learning and control chapter. The previous chapters gave you many weapons for your fluency arsenal. Now that you have many fluency skills you have no reason to fear speaking situations. Work your way down your list of feared speaking situations until you have no more speech-related fears and anxieties than an average non-stutterer.

Further Reducing Fears and Anxieties

When you run out speech-related fears and anxieties that non-stutterers aren't scared of, make a list of speaking situations that scare non-stutterers. Remember when I said that your speech can be better than non-stutterers? When you're ready, move on to these areas:

• Walk up to strangers at parties. If you're single, pick attractive persons of the opposite sex. Say that your speech therapist wants you to talk to strangers and ask if you can talk to this person. If you have an anti-stuttering device, ask if it's OK to use it. No one is going to say no. I met one of my ex-girlfriends this way.
• Join Toastmasters International to learn public speaking skills.
• Sign up for a beginning acting class at a university or community theater. Acting classes are the most fun you've had since sixth grade.
• Put together some funny stories and sign up to do stand-up comedy on amateur night at a nightclub.
• Sign up for voice lessons. Amaze people by singing at social occasions.
• Learn a foreign language. Talk to cab drivers in their native language.

Stress Is the Absence of Choices

We experience stress when our plans are thwarted. We try to reach a goal, and some little thing stops us. For stutterers, that little thing often is an inability to communicate.

E.g., you go to a fast-food restaurant to buy a cheeseburger. You can see the cheeseburgers behind the counter. You can smell the cheeseburgers. You even have correct change in your hand. All you have to do is say, "Cheeseburger"—but stuttering stops you.

Instead of thinking of stress as thwarted plans, think about your choices. You could point at the cheeseburgers. You could write "cheeseburger" on a note. You always have choices.

If you focus only on reaching your goal, you miss opportunities that may be better than your goal. E.g., you miss the salmon pesto salad the restaurant just added to the menu.

Or you pantomime "cheeseburger" as if you were playing charades. You feel ridiculous, and people in the line laugh at you. Then a movie producer offers you a million dollars to star in his new "stupid and stupider" movie.

OK, that's unlikely. Just realize that you always have choices. As you imagine your choices, you'll feel your stress going away. Your insurmountable problem now looks like a variety of choices (see the section Personal Construct Therapy.

Use a Partner to Center Your Emotions

When you feel stressed, find a partner who expresses the opposite emotion.

E.g., if you're fired from your job. You come home feeling like a failure and you'll never succeed. You don't want a partner who agrees with you.

Instead, you want a partner who'll tell you that you're smart and hardworking, and you'll soon find a better job.

Picture your emotions like a car with a manual transmission. To shift from one gear to another gear, you have to shift through neutral gear. Similarly, to shift from feeling stressed to another emotion, first seek your emotional center.

Reduce Your Child's Stress

No studies have tested whether reducing stress affects children's stuttering. But you can try and observe whether this helps your child's speech.

Don't demand that your child confess guilt (fear of punishment). When your child experiences overwhelming emotions, e.g., is afraid to do something, don't demand that your child explain why he or she feels overwhelmed. Emotions are in a deeper, older brain area. Language is a higher, new brain function. An emotionally overwhelmed child may be unable to speak.

Don't insist that your child talk in an unfamiliar situation, e.g., at a new day care center (uncertain what to say, fear of embarrassment, uncertainty of status with new children). Situations that feel comfortable to you may be stressful to your child. Try to see stress from your child's point of view.

Reduce Your Listener's Stress

Stuttering is a rare disorder. Many people have never met a stutterer. I've had listeners ask if I was having a medical emergency, or ask if I was cold (apparently I looked like I was shivering). I have no doubt that other listeners thought that I was mentally retarded or psychotic, perhaps dangerous. Reduce their fears by saying that you stutter.

Some listeners think that they did something to make you stutter. Other listeners wish there were something they could do to help you. Tell them that you stutter. If they have any questions about stuttering, they'll ask you.

Make a joke about stuttering. Or you could put stuttering on your business card, perhaps describing you as chapter leader of your local stuttering support group.

Better, tell listeners that you're using speech therapy skills. Ask if your fluency skills sound weird, then do what your speech-language pathologist wants you to do (e.g., breathe with your diaphragm, relax your vocal folds, slow down your speaking rate). Ask if your stuttering therapy speech sounds better than your stuttering.

Ask the listener to remind you when you miss a speech motor control target. You could ask listeners to remind you when you stutter, but they'll be uncomfortable doing this, and you'll feel embarrassed if you don't have good control over your stuttering. Instead, ask listeners to remind you when you miss targets, e.g., you talk too fast. You should have better control over that.

If you're doing speech therapy, tell listeners you'll pay $1 for each missed target they point out (see my Romantic Disaster of 1996).

Lastly, if you use an anti-stuttering device, show it to your listener and ask if she minds if you use it. This is perhaps the best way to tell listeners that you stutter. Listeners invariably ask questions about the devices. In contrast, listeners rarely ask questions about speech therapy, e.g., vocal fold relaxation isn't of great interest to the general population. But everyone wants to know how anti-stuttering devices work. Suggest that the listener try on the device, and adjust it to make the listener stutter (by maximizing the delay, or moving the pitch shift up and down). When I do this, other people come over to see what's making their friend trip over his or her words. They give me positive feedback about my stuttering, laugh at their own failure to talk, and experience for a few minutes what it feels like to stutter.

Alternative Ways to Reduce Stress

If stuttering is the only way you know to reduce stress, you'll always stutter in stressful situations. Instead, learn alternative ways to reduce stress. Take a stress reduction class. Read books about handling stress.

One of the best ways to reduce stress is to relax your breathing. Stress reduction classes teach this. Or take a meditation or yoga class. Relaxed breathing not only reduces stress, it helps stutterers talk fluently.

Look for Stuttering-Reducers

Imagine a stutterer reading a projected PowerPoint presentation aloud to an audience. He scans the slides for feared words. Sure enough, there's a p-word. And an s-word! He scans the prodigious thesaurus in his brain, looking for words he can substitute. But the audience is reading the slides projected on the screen. Will they think he's illiterate if he substitutes or skips words? But what if he blocks and the audience discovers that he stutters! What can he do?

He's looking for stuttering-increasers. I.e., he's looking for ways to stutter. And, sure enough, stuttering-increasers—difficult sounds, feared words, judgmental listeners—abound, if you know where to find them.

Imagine another stutterer, also reading aloud to an audience. Instead of looking for stuttering-increasers, she looks for stuttering-reducers:

• With her text prepared for her, she can focus on using her speech therapy skills instead of thinking about what she's saying.
• She can pretend to be a robot reading machine. The robot has no emotions, it just sees words, moves its mouth, and words come out.
• She can wear an anti-stuttering device and the audience will think it's a microphone for the PA system.
• When she introduces herself she can say that she stutters. Audiences love presentations that start with a joke, so she could start with a joke about her stuttering.

You'll recognize this as a variation of the Predator approach.

Increasing or Decreasing Stress in Therapy

Stuttering therapy typically begins with a stutterer learning closed-loop speech motor control in a low-stress environment, e.g., chatting with the speech-language pathologist, or alone practicing word lists.

The stutterer gradually moves from closed-loop speech motor control to open-loop speech motor control. When he achieves fluent open-loop speech motor control, the speech-language pathologist takes him to a shopping mall for "transfer" practice. Then they're finished with speech therapy and he's on his own.

The result is fluent open-loop speech in low-stress environments, and relapse to open-loop stuttering in high-stress environments. The relapse shake the stutterer's self-confidence. Or the stress de-myelinates (weakens) fluent speech motor programs. A single high-stress, dysfluent experience might destroy weeks of low-stress practice.

Or both. The stutterer then gets into a vicious cycle of stress and relapse leading to more stress and more relapse.

A better plan would be to train a stutterer to recognize stressful situations, and consciously switch to closed-loop speech motor control (i.e., very slow speech) in high-stress environments. When he feels his stress diminishing he can switch to open-loop speech motor control (i.e., normal-sounding speech).

For example, I used to meet strangers and say, "My speech-language pathologist wants me to talk to strangers. May I talk to you?" I would then use very slow closed-loop speech motor control. After we had a friendly conversation going and my fears and anxieties diminished, I'd use the "slow-normal" speaking rate that mixes open- and closed-loop speech motor control.

In other words, with traditional therapy the stutterer switches between stuttering and fluent speech, as situations change between high-stress and low-stress. Instead, I switched between closed-loop and open-loop speech motor control, as stress changed. The result was that I constantly myelinated (strengthened) the fluent speech motor programs in my brain. Most important, I strengthened my brain's connection between stressful situations and closed-loop speech motor control. Switching to closed-loop speech motor control in a stressful situation should be as habitual as remembering to count to ten before punching someone.

You might object that severe stutterers may be unable to produce even two-second stretch closed-loop speech motor control in stressful situations. I.e., their fluent speech completely breaks down under stress. So use the Predator approach.

Or you might object that closed-loop speech motor control sounds "weird," and stressful situations are where you most want to sound normal. When I said to strangers, "My speech-language pathologist wants me to talk to strangers…#133;" no one ever refused. Most people then asked me questions about stuttering therapy. As long as the stutterer tells listeners that he is using special "speech therapy speech," sounding "weird" isn't an issue.

References

1. ^ Nippold, M., Rudzinski, M. "Parents' Speech and Children's Stuttering: A Critique of the Literature," Journal of Speech and Hearing Research, 38:5, October 1995.

• Next section: Personal Construct Therapy: You Always Have Choices

• Back to Table of Contents

[edit] Personal Construct Therapy: You Always Have Choices

No one needs to be completely hemmed in by circumstances; no one needs to be the victim of his biography.

— George Kelly, The Psychology of Personal Constructs (1955)

In every situation, you always have a choice of how to react. This insight is the basis of personal construct therapy (PCT). The goal of PCT is to develop awareness of your choices in every situation. The antithesis is to always react the same way to stressful situations.

If you make the same speech choices in high-stress situations, no amount of practice in a low-stress speech clinic will change your speech. E.g., if you always substitute words "when the going gets tough," you're not going to use gentle onsets in a difficult situations, even after practicing 5,000 gentle onsets in the speech clinic.

To develop awareness of your choices, describe a situation in which you stuttered. Imagine different ways you could have responded to the situation.

Role-play the scene with your speech-languge pathologist or in your support group. When someone sees a choice that hasn't been played, switch roles, for that person to play the new choice. E.g., the situation is answering the telephone at work. One person pretends to be a caller, and the other pretends to be the employee answering at Pasquale's Pizza. The employee uses slow speech. But another choice might be to switch to voiced consonants, i.e., answering the phone Basdahllee's Bizza. You should be able to think of a half-dozen other possibilities. Role play every choice and see what feels best.

Slow Down by Not Interrupting

Conscious choice requires slow reactions. In a fast reaction to environmental stimuli, your brain will select the most myelinated (habitual) open-loop motor program. Interrupting people, or responding quickly in a conversation, is a fast reaction.

Let people finish their sentences. Wait two seconds. Then start talking. Your fluency will improve.

Verbal Aikido

[w:Aikido|Aikido] is a Japanese martial art. Combatants focus not on punching or kicking opponents, but rather on using their own energy to gain control of them or to throw them away from you.

Verbal aikido is the art of not arguing, but instead agreeing with someone who is verbally attacking you. Then you help the assailant attack you, until—surprise—he realizes that he's just been made to look like a fool.

E.g., a middle-aged, overweight woman owned a chain of women-only health clubs. Middle-aged, overweight women could work out in these health clubs without feeling intimidated by young male bodybuilders.

A "shock jock" radio host invited the health club owner onto his show. He described her physical appearance, then asked why anyone would want to work out at a health club owned by a fat, ugly old lady.

She responded, "So we don't have to work out with boorish meatheads like you."

This silenced the radio host long enough for her to say that overweight, middle-aged ladies have to exercise too, and the radio host was a perfect example of the men she didn't want to have to be around when she exercised.

My example of the parents responding to their teenagers' four-letter words is another example of verbal aikido.

Use verbal aikido to turn around the stress. E.g., a highway patrol officer pulls you over for speeding. Instead of trying to hide your stuttering, you make a joke: "I stutter, so I'm not going to try to talk you out of giving me a ticket." Maybe this will put the officer in a good mood and let you go with a warning.

Changing Self-Descriptions

Many stutterers improve their speech, yet continue to believe that their speech is worse than non-stutterers. Graduates of fluency shaping therapy programs sometimes have beautiful, clear speech that is easier and more pleasant to listen to than non-stutterers' speech. Yet they continue to believe that they can't do certain things, such as public speaking.^[14]

Conversely, stutterers who improve their speech attitudes have better speech a year after completing therapy, as compared to stutterers who maintain poor attitudes.^[15]

Write a description of yourself, and then describe who you expects to be in five years. Look for items that are opposite in the two descriptions. E.g., now you're now single, but in five years you hope to be married.

Then write a description of yourself as a stutterer, and then describe who you'd be if you didn't stutter. E.g., assertive vs. shy, or popular vs. lonely. These descriptions are your personal constructs.

Work on changing your personal constructs. Again, imagine specific situations for each personal construct. E.g., if you wrote that you'd be assertive instead of shy, describe a recent situation in which you weren't assertive. Now role-play the scene with your speech-language pathologist or your support group. Imagine different ways to react in the situation and switch roles.

"Who Would I Be If I Didn't Stutter?"

This is a favorite conversation topic at stuttering support groups. People initially say, "I'd be more successful at work," "I'd be more assertive with my husband and family," and other negative aspects of stuttering.

After fifteen minutes, people start saying, "If I didn't stutter, I'd be less compassionate," or "I would never have developed my musical talent." People realize that they chose a career in a "helping profession" (e.g., nursing or teaching), or they developed non-verbal skills, such as athletics or painting, because they stutter. They realize positive aspects of stuttering. They see that stuttering can be a gift.

In contrast, a stutterer completed a speech therapy program, but refused to speak fluently. He said that his co-workers had listened to his stuttering for 20 years. He asked, "What would they think if I came to work speaking fluently?"

Another stutterer was earning $25,000/year as a computer programmer. His supervisor left, and the company wanted to promote the stutterer. He would receive a salary of $55,000/year. The management position required talking to clients on the telephone. The company offered to pay for speech therapy and an anti-stuttering device. The stutterer refused the promotion, saying that he didn't want to talk to anyone. The company instead hired a less-qualified manager from outside the company.

For these stutterers, the psychological issues surrounding stuttering are more disabling than their disfluencies.

Change Your Lifestyle

As your improve your fluency, ask your supervisor for tasks that require talking. Do social activities that involve talking.

Training a new motor skill requires about three million repetitions. To say three million words, you must talk at least four hours a day for at least six months.

Take an acting class. Take singing lessons. You'll have fun, and meet new people. You'll get over your speech-related fears.

You'll find some things other people can easily do that you can't, but you'll also find things you can easily do that other people can't. E.g., I took a public speaking course. I was able to project your voice, when other students are afraid to raise their voices. I was able to switch emotions (anger, sadness) easily and convincingly, when other students couldn't. And there were simple presentations that you couldn't understand a word I said.

Volunteer to read to blind or elderly individuals. Volunteer at a hospital directing visitors where to go. Volunteer with your public radio station answering pledge week calls.

Or moonlight at a job that requires talking. Find a job that requires being charming and friendly.

Join social clubs that requires talking. Put Toastmasters at the top of your list. Members give a series of ten speeches, usually one speech per month. The speeches are four to ten minutes long. Each of the ten speeches teaches you a new skill, such as using gestures and body language, or being persuasive on a controversial topic. Judges always point out things you did well—and award lots of ribbons—as well as ways you can improve. You'll find that even if you stutter severely, you're better than non-stutterers at some aspects of public speaking.

The National Stuttering Association has its own public speaking training program, which is quite different from Toastmasters. Ask for the "Speaking Circles" video.

References

1. ^ Andrews, G., Cutler, J. "Stuttering Therapy: The relation between changes in symptom level and attitudes." Journal of Speech and Hearing Disorders, 39, 312-319, 1974.
2. ^ Guitar, B. & Bass, C. (1978). "Stuttering therapy: The relation between attitude change and long-term outcome." Journal of Speech and Hearing Disorders, 43, 392-400.

[edit] Genes and Neurotransmitters

Speech-Language Pathology/Stuttering/Genes and Neurotransmitters

[edit] Psychological Issues

Experts have proposed dozens of psychological causes for stuttering. Then they use psychological tests to test their hypotheses. And, every time, the tests prove the "experts" wrong. But this doesn't stop the experts from writing books promoting their theories.

In 1928, a Freudian psychologist advanced a theory that stuttering was an attempt to satisfy unresolved oral-erotic needs.^[16] If this were true, there would stuttering phone sex lines. Imagine finding ads in the back of Playboy magazine with scantily-dressed women saying, "Call me! I stutter!"

A 1939 personality test study found that stutterers were more neurotic, more introverted, less dominant, less self-confident, and less sociable than non-stutterers.^[17] Examination of the personality test found sixteen speech-related questions, including "If you are dining out do you prefer someone else to order dinner for you?" The psychologists had interpreted stutterers' reluctance to order in restaurants as evidence of neuroses, rather than as difficulty talking.

A 1952 study of hostility and aggression found stutterers more likely to turn hostility inward. A 1953 study found the opposite.^[18]

Other psychological studies found no difference between stutterers and non-stutterers for self-concept, levels of aspiration, body images, role perception, handwriting, social maturity, birth order, exaggerated fears, sleep disturbances, hyperactivity, temper tantrums, thumb sucking, and nail biting.^[19]

Stutterers are, on average, psychologically normal, except for fears and anxieties around talking. We generally have the same speech-related fears and anxieties as non-stutterers, such as fear of talking to strangers and fear of speaking to an audience, but these fears are greater in stutterers.

Freedom to Speak—Badly

From the book How to Learn Any Language:

Americans, however, hold one high card that too frequently goes unplayed. We're gregarious. We're extroverts. Some say it contemptuously. Some say it admiringly. But those who know us best agree that we Americans are the only people in the world who enjoy speaking another language badly!

Most people in the world are shy, embarrassed, even paralyzed when it comes to letting themselves be heard in languages they speak less than fluently. An American may master a foreign language to the point where he considers himself fluent. A European, however, who speaks a language equally well and no better will often deny he speaks it at all!

Are you an American—happy to talk even when your speech isn't good? Or are you a European—"shy, embarrassed, even paralyzed" when you can't speak fluently?

Or are you Chinese? In China, stutterers are expected to keep their mouths shut because stuttering will embarrass their families. You don't want the neighbors to find out that your brother stutters, so you find him work that doesn't require speech, and he stays at home the rest of the time.

If that doesn't sound fair to you, stick an American flag pin in your lapel. Then go out and speak English—badly, if you have to.

The First Amendment to our Constitution is freedom of speech. Our ancestors believed that talking is the most basic human right. If you don't want to talk, are you throwing away the fundamental freedom that previous generations fought for?

Change Your Lifestyle to Talk More

Ask your supervisor to give you work requiring talking. This could be talking to customers, or calling suppliers, or training other employees.

Or change careers to a job that requires talking. A man bought an anti-stuttering device, quit his job as a back room accountant at a bank, then worked at the Chicago Board of Trade, yelling orders to buy or sell soybean futures.

Or find a volunteer service requiring talking. Hospitals have information booths where volunteers direct visitors to their floors. Public television stations need volunteers to answer the phones during pledge drives.

Political groups need canvassers to collect signatures on petitions. Pick a cause you believe in. Imagine yourself standing on a busy street corner, talking to passerby about an important issue. Can you picture anything more American?

Complimenting People

Here's another way to make the world a better place. Make eye contact, smile, and then compliment a person.

Don't limit this to attractive, single persons of the opposite sex. Make everyone you meet feel good about themselves. Compliment old men, women pushing strollers in the park, the person behind you in the supermarket line, and your in-laws.

Here are a few compliments you can make about anyone:

• Compliment the person's smile. Then smile. This will make the person smile. Add a little joke such as, "Give my compliments to your orthodontist."
• Compliment the person's eyes. This reminds you to make eye contact. Look into the person's eyes long enough to mentally note his or her eye color. A friend broke up with her boyfriend when, wearing sunglasses, she asked him what color her eyes were. He didn't know.
• Compliment the person's name. This helps you remember the person's name. Associate the person's name with an interesting fact, e.g., ask how his or her name is spelled (e.g., Rebecca vs. Rebekah), the ethnic origin, or the meaning of the name. (I got a date with a woman named Alethea because I knew that alethea is Greek for truth). Ask if the person is related to a celebrity with the same last name. Read a history of your area to learn the names of local heroes and historical figures.
• Compare the person to a celebrity. (A friend writing a personal ad asked if she looked like Natalie Merchant or Neve Campbell. I replied that she reminded me more of a young Tommy Lee Jones.)
• Listen for extraordinary things people have done, then reflect this back to them. Everyone thinks that their lives are ordinary. E.g., a man who flies jet fighters thinks of himself as an ordinary fighter pilot.

Tell Stuttering Jokes

A stutterer goes away to a two-week intensive speech therapy course on the East Coast. When he returns, his friends ask how it went.

The stutterer pauses, takes a deep breath, and slowly says, "Peter Piper picked a peck of pickled peppers."

His friends are amazed. "You said that completely fluently!" they say.

The stutterer says, "Y-y-yeah b-b-but it's, it's h-h-hard t-t-to w-w-work th-that in-t-to a, a c-c-conversation."

Add more stuttering jokes!

Inward Anger vs. Outward Anger

Stuttering, like any frustrating experience, causes anger. Some individuals direct these feelings inward (i.e., they hate themselves). This leads to a vicious cycle or "self-fulfilling prophecy" of failure.

But other stutterers direct these feelings outward. These individuals feel anger at other people. Their relationships at work or socially go poorly, again creating a vicious cycle of failure.

How do you feel when people disrepect you when you stutter? Do you feel anger at yourself for stuttering? Or do you feel anger at the person who treated you poorly?

When you're angry, do you do nothing, but get angrier inside? That's inner-directed self-hatred.

Or do you take action to "send a message" nonverbally—which the other person is certain to misunderstand? I once "sent a message" to my housemates that it was their turn to buy toilet paper. Don't ask me what I did! They didn't get the message. They just got angry back at me. That didn't lead to domestic bliss.

If you're doing fluency shaping therapy use slow, stretched syllables when telemarketers call. Do you look forward to annoying telemarketers? If so, your anger is directed outward. But if you refuse to annoy telemarketers, your anger is directed inward.

Outer-directed anger is easier to outgrow than inner-directed anger. E.g., you can't wait for telemarketers to call. You have your DAF device plugged into your telephone. You sit down to dinner, and the phone rings. It's the Munificent Police Protective Association. You happily draw out a forty-five minute conversation. Your dinner gets cold but your speech gets better. Then a friend calls, and you speak fluently at a slow-normal rate. You feel good about yourself and your anger drops away.

In contrast, if your anger is inner-directed and a telemarketer calls, you decide not to practice your speech therapy, you stutter a "No, thank you" to the telemarketer and hang up. Your speech doesn't improve and your self-hatred continues.

If practicing speech therapy with a telemarketer scares you, have your speech-language pathologist pretend to call you. She'll try to sell you slow pitch bats, slow blow fuses, stainless steel slow cookers, and slow jam CDs. If you can't think of anything to say, ask, "How slow are the slow pitch bats?"

Then call her, reversing roles. Convince her that your slow blow fuses are the slowest, and that no one makes a slower slow cooker. Practice this until you're willing to practice therapy skills with a telemarketer.

Denial Is a Bigger Problem Than What You're Denying

I had a neighbor with schizophenia. He went to a dentist for a root canal, and the CIA put a radio into his tooth. The government was broadcasting messages to his brain.

Like 40% of schizophrenics, he denied that he had the disorder. He'd lost his job as a chemical engineer, and now worked as a minimum-wage security guard. He had no friends other than me.

My neighbor enjoyed reading French and Italian newspapers at a university library. He'd take the newspapers to the basement where no one would hear him repeating obscenities to annoy the CIA agents listening to his thoughts. One day security guards asked him to leave. To get away from them he ran into traffic in a busy street. He wasn't allowed to use the library after that.

Consider what would have happened if he'd told a librarian that he had a mental illness that made him talk to himself, and asked if there was somewhere he could read the newspapers without disturbing anyone. The librarian would have unlocked a conference room for him to use.

Denying that he had schizophrenia took a lot of effort. His life would have been simpler if he admitted that he had the disorder. If you put more effort into denying that you have a disorder than the treatment would demand, then you have a denial problem.

He'd ask me whether I thought he was crazy. I'd say, "You're crazy if you deny that you have a mental illness. If you admit it, then you're not crazy."

Avoidance is Denial

Denial can look like avoidance. Many stutterers will spend two hours driving to a store to see if the store has an item, instead of spending two minutes calling the store (and experiencing the embarrassment of stuttering).

Many stutterers substitute words. E.g., saying "the great American pastime" instead of "baseball." That's eight syllables instead of two, and some listeners won't know what you're talking about.

When avoiding stuttering takes more effort than stuttering, you're denying how much effort avoiding stuttering takes.

Here's an extreme example of avoidance. A woman called me, inquiring about stuttering treatments. Her husband was a computer software engineer. He'd stopped talking. He'd requested a demotion at work to a position in which he never spoke to anyone. He sat in his cubicle, communicating by e-mail. At home he no longer spoke to his wife or children. He stopped participating in social activities or friendships. His wife was considering divorce. But first she was learning everything she could about stuttering, in hopes of finding something that would enable him to speak.

Did this man have a stuttering problem? Or did he have a denial problem? He thought he could make his life easier by not talking. But the effort required to not talk (e.g., an unhappy marriage) outweighed the effort of talking (e.g., to his wife, who already knew and accepted that he stuttered).

"I Can Do It Without Help" Is Denial

A friend lives in a state that provides anti-stuttering telephones free (see State Special Telephone Equipment Programs). He stutters moderately to severely. I suggested that he fill out the application to get an anti-stuttering device. He said no, he'd been to a good speech therapy program, and he knew what he had to do. He was determined to improve his speech without electronic devices, medications, or other help.

It's been five years since he went to that speech therapy program. He still stutters. He's denying that the speech therapy program wasn't helpful. He's denying that he doesn't know what to do to improve his speech. He's denying that he needs help.

In contrast, a stutterer not in denial will use whatever's avail-able to improve his speech. If your state wants to give you a telephone that helps you talk fluently, why not take it?

"But I’ve Tried Speech Therapy" Is Denial

Consider why crazy weight loss diets attract customers. People try the "pizza and ice cream" diet, it doesn't work, and then they can say that they tried to lose weight but the diet didn't work. Therefore no diet, exercise plan, or anything else will ever work. Therefore they have an excuse to be overweight. These people chose the "pizza and ice cream" diet instead of the salads and running ten miles a day diet. They chose a fad diet because they knew it wouldn't work.

Similarly, some stutterers go to one speech therapy program, it doesn't help, and then write articles saying that "achieving fluency…is nearly impossible" and "stuttering is a physical impediment for which little can be done."^[20] That's also denial. The person avoids effective treatments, by denying that effective treatments exist.

Denying the Most Important Thing in Your Life

I was unaware how severely I stuttered (see My Life in Stuttering). I thought that I had a minor speech problem. I tried to do everything that everyone else does. When I consistently failed at things most people seemed to effortlessly achieve (e.g., finding a job, finding a girlfriend) I didn't realize it was because talking to me was an excruciating experience for listeners. No one told me that. They just avoided me.

Did I have a denial problem? Yes—but let me tell you about an accountant I had dinner with. He worked for the local government. He kept pen and paper next to his bed because he'd wake up with ideas of how to solve accounting problems at work.

My first thought was, this guy needs a life! He dreams about accounting!

Then I thought, he thinks about accounting 24/7. He must be a good accountant. When I need an accountant I'll hire him.

My speech improved after I was 30, when I made stuttering the center of my life. I thought about stuttering 24/7. I'd wake up with ideas for how to solve speech problems. Speech therapy changed from something I did two hours a week in speech clinics, to what I did all the time.

My denial problem wasn't that I didn't admit that I stuttered. My denial problem was that I didn't admit that stuttering was the most important thing I did. I'd pushed it to the side and focused on other things.

Whatever you focus on, you can achieve. It may take years of persistence but you will succeed. But you can only think about one thing 24/7. You don't want to spend your life climbing a mountain, get to the top, then see that you climbed the wrong mountain.

Miracles Happen

Miracles happen when you focus on the most important thing in your life, and then everything else falls into place, effortlessly. E.g., you improve your speech, then your boss gives you a promotion. Then the pretty blonde at the photo store wants to be your girlfriend. It happened to me, and it'll happen to you. To read about more miracles, see the appendix Famous People Who Stutter.

But before your miracles can happen, think about my question. Is stuttering the most important thing you do? If you're a severe stutterer, as I was, the answer may be yes. Miracles aren't going to happen in your life until you think about stuttering 24/7. If your child stutters, you may have to focus on your child's treatment, rather than leaving it to the school's speech-language pathologist.

But if you're a mild stutterer, stuttering might be the wrong mountain for you to climb. You might be focusing your energy on avoiding stuttering, when listeners don't care whether you stutter. They might even like hearing you stutter occasionally. Maybe you should put your energy somewhere else.

References

1. ^ Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.
2. ^  Yeoman, Barry. Wrestling with Words, Psychology Today, November/December, 1998.

[edit] You're Not Alone: Join a Support Group

Likely you've never met another stutterer. You've never seen a book about stuttering in a bookstore. You may be the first stutterer that your speech-language pathologist has met. You might feel that you're the only person in the world with this problem.

Your speech-language pathologist printed a webpage for you with the time and place of stuttering support group. You put it off the first month, but this month you drive there. You drive by the house. You see a group of people in the living room. You sit in your car, not sure if you have the courage to walk into the house.

Let's back up to how you find a stuttering support group. The National Stuttering Association(http://www.nsastutter.org/) (800 364-1677) has more than 70 local support groups across the United States. Many stutterers say that the annual NSA convention is the best experience of their lives.

Speak Easy International has stuttering support groups in the New York-New Jersey area. Call Bob Gathman, at (201) 262-0895.

The National Association of Young People Who Stutter(http://www.friendswhostutter.org/) (866 866-8335) has support groups for children and teenagers who stutter.

Many speech clinics have their own stuttering support groups. These are often for practicing therapy. Practicing in a group is better than practicing alone because we learn best by seeing other people make mistakes and then improving. In contrast, seeing a speech-language pathologist (who likely doesn't stutter) perfectly executing a speech motor skill can make you feel like she has a gift you'll never have.

If you're outside the United States, find a stuttering support organization in your country by visiting the International Stuttering Association (http://www.stutterisa.org) website.

Then there are the online support groups. Yahoo Groups lists more than seventy stuttering e-mail lists, the most prominent and largest of these is Stuttering Chat, which has over 3000 members. The Usenet discussion group is alt.support.stuttering.

The online support groups tend to be a few individuals who do 90% of the chatting, and hundreds of people who don't write anything. I remember when one individual used several e-mail addresses and fake names to have long arguments with himself.

Benefits of Support Groups

A support group will help you learn what works for other people. You'll get feedback on what you're doing. A group of people will generate new ideas that no individual would have thought of.

In a support group, you'll find that you've solved problems that other people face. Other people may have solved problems you face. Stuttering will no longer seem like one big problem, but rather will become a set of small problems.

A support group improves your emotional state. Hearing other people's experiences improves your perspective. Your setbacks don't seem so bad. Sharing positive experiences makes everyone in the group feel good.

When you feel frustrated or depressed, you have no idea what to do. Talking to individuals who've been in the same situation will help you see that you have choices (see the section Personal Construct Therapy).

[edit] Support Group Activities

Talking About Your Stuttering

Mild stutterers may be able to successfully hide stuttering, but listeners figure out that they're hiding something. Listeners may not know what the stutterer is hiding, but he'll come across as "phony" or dishonest.

Listeners have a different message for severe stutterers. Severe stuttering disturbs listeners. They don't understand stuttering. They want to know if there's anything they can do to help you. But they're too polite to ask you about your disability. They want you to educate them. They don't want the proverbial "elephant in the living room" that no one will talk about.

The Disability Hierarchy

The least respected disabilities are non-physical and non-visible. Stutterers look normal, until we talk. Listeners feel shock seeing you go from normal behavior one moment to head jerks, facial spasms, stuck in repeating dysfluencies the next moment.

But you can move up the disability hierarchy. You can change your stuttering into a visible, non-physical disability:

• Tell people that you stutter.

• In contrast, hiding your stuttering throws away the respect and support that people would otherwise give you.

  [edit] Heading needed

  The chapter is divided into sections because it exceeds the 32K limit of some browsers.

  • Singers and Actors
  • Athletes
  • Writers and Photographers
  • Political and Business Leaders
  • Other Professions
  • British Royals and Commoners
  • More Stutterers in History
  • Serial Killers
  • In the Ancient World

  [edit] Famous People Who Stutter

  I am 21 years old. I graduated from my third college course and still no job. Interviews come by the dozens but job offers are none! I am a Pharmacy Assistant Health Care Aide plus a medical transcriptionist, but after all the years in school and all the money spent on education, I am still unable to find work! Am I to live in poverty because people only see me at my worst?

  Interviews for me are a horrid experience. I've had people pick up a newspaper and start reading it, waiting for me to get out of a block. All the interviewers act as if I'm wasting their time. It's more like they're wasting mine.

  If people could only see me when I am fluent I'm sure I would have a job. On interviews I find myself apologizing for my speech…but why do I?

  Is there anyone out there who is experiencing the same problems? I need help to cope.^[21]

  —————

  I am an embedded software engineer, and today I was faced with a situation that I have not ran into yet in my pursuit of employment. Like many of you I have had the phone hung up on me by recruiters, or they rudely and quickly end the phone conversation. I had a personal phone interview with Motorola. First, the interview was designed to be very high stress. Second, the questions were given to me in advance which only made the situation worse. Of course it being a phone interview made it worst. I was unable to form sentences and completely locked up on the interview and was eliminated from the running for this software engineering position. Can I do anything? According to the recruiter I'm a great fit for the position, god this frustrating.

  —————

  Graduate students in my stuttering class [surveyed employers, who] indicated that they would prefer to hire someone who was deaf or someone with moderate cerebral palsy rather than someone who stuttered. Interestingly, several of the employers who said they would not hire a stutterer had one or more stutterers already working for them.

  When we probed to understand the WHY behind the employers' responses, we learned that essentially they thought they "understood" deafness and cerebral palsy, but stuttering was strange—and they assumed that persons who stutter were strange.^[22]

  Ten months after completing a stuttering therapy program, 44% of stutterers had received a promotion. 40% had changed jobs, 36% reporting that the change was for the better. Combining these, about 60% had improved employment after stuttering therapy. The study also found that 88% of the stutterers had maintained their fluency.

  Their employers reported a 20% improvement in "communication effectiveness" for the stutterers completing therapy.^[23]

  Stutterers earn approximately $7200 less per year than non-stutterers.^[24] Two groups of 25 persons were examined. The groups were matched for age, sex, IQ, race, education, and socioeconomic background. The subjects were contacted ten years after graduating from college. They were asked a number of questions relating to levels of achievement. The difference did not appear to be the result of employer discrimination. Rather, the stutterers were reluctant to accept promotions that involved making presentations to groups of people:

  I have refused (or went "kicking") different projects at my job, which may/may not lead to promotions. Most recently, I went kicking on co-facilitating a corporate-wide quality workshop initiative. My partner in facilitation, after much coaxing by me, took the majority of the speaking sections, while I became her assistant. (Please be aware that I have not discussed my disorder with my co-workers, I am a mild stutter that can usually "pass" for a fluent speaker.) I am now interested in changing careers and am looking for careers that focus on "behind the scenes" work…i.e., technical writing. I have considered such careers as Law, but have veered away from them.^[25]

  [edit] Talk About Your Stuttering

  Another interview lasted about two minutes. The interviewer (another personnel director—they seem to be the worst problem) found an excuse to say I was not qualified for the job—so good-bye. I protested, asked for the technical interview and was asked to leave. As his excuse was plainly made up—this was also probably a case of discrimination.^[26]

  Begin the interview by talking about your stuttering. You may only get two minutes if you don't!

  Take a copy of Stuttering: Answers for Employers by the Stuttering Foundation of America with you to the interview. You can download a PDF of the brochure from the web site at www.stutteringhelp.org.

  Whether you're looking for a job or already have a job, talk about your stuttering. Many people feel uncomfortable talking to a person who stutters. Educate them about stuttering to make them feel comfortable.

  Some people make incorrect assumptions about individuals who stutter. E.g., some people think that individuals who stutter are mentally retarded—even if you have a Ph.D.!

  "Excellent communication skills" is the #1 qualification employers look for. Regardless of whether the help-wanted ad included this, say that you have excellent communication skills. Give concrete examples:

  • If you're in a speech therapy program, discuss your progress and the techniques or strategies you use.
  • If you learned nonavoidance skills in speech therapy, explain that although you stutter, you've overcome your fears of talking to strangers, etc.
  • "I can say a phrase fluently if I say it a lot. In my last job, I pretty much said the same things to customers all day, and my speech was fine." This should be acceptable for retail jobs, etc.
  • If you use an electronic anti-stuttering device, show it to the interviewer and explain how it works.

  If the job requires making presentations, say that you can't say as much as non-stutterers so you prepare your remarks in advance and get right to the main points, unlike people who ramble on for half an hour.

  Membership in Toastmasters proves that you have excellent communication skills. Toastmasters gives out lots of prizes, so mention if you won a blue ribbon for one of your speeches.

  Communication is a two-way street. Say that you may not speak as well as other people, but you listen more carefully. Demonstrate that by not interrupting the interviewer, and by rephrasing and repeating back his questions. Ask the interviewer whether listening or speaking is more important in the job—they'll always say that listening is more important.

  The interview for the job that I currently have was one of the few interviews in which I discussed in depth the nature of my stuttering problem. I spent about a half-hour discussing my speech, and I think that it was very helpful for the interviewer in understanding how well I could work around my handicap.^[27]

  [edit] The Americans With Disabilities Act

  In 1992, the Americans with Disabilities Act (ADA) outlawed employment discrimination against individuals with disabilities. Speaking was defined as a "major life activity" that the inability to do is disabling.

  The central point of the ADA is that individuals with a disability can ask their employer (or potential employer) for a reasonable accommodation. A reasonable accommodation is a change to the job that will enable the individual to do the job. E.g., a stutterer might ask that he not have to answer the telephone. Or he might ask that the employer buy an anti-stuttering telephone.

  When an individual with a disability requests a reasonable accommodation, the employer must make the accommodation. The individual must make the request. If the individual doesn't make such a request, the employer is not obligated to suggest an accommodation, or to hire the individual.

  Employers aren't allowed to ask employees (or potential employees) about disabilities. It is essential that stutterers talk to employers about their speech. In a job interview, say that you stutter. Then ask whether your speech will interfere with the job. If you don't ask, winning a lawsuit will be difficult or impossible.

  If you employer (or potential employer) tells you that "good communication skills" are necessary for the job, talk about the specifics. As noted above, you can explain that you have excellent communication skills. You can also ask for reasonable accommodations as necessary.

  Stutterers rarely talk to their employers about their speech. The few stutterers who've told me that they talked about their stuttering with their employer reported 100% successful results of the conversation. In every case, the employer wanted to help the stutterer, but didn't know what to do. Every request was a reasonable accommodation has been granted, as far as I've heard.

  The 99% of stutterers who don't talk about their speech with their employers are treated badly, in one way or another. When they feel they've been discriminated against, they don't win ADA lawsuits because neither they nor their employer ever said anything about their speech.

  For more information about the ADA, visit the Equal Employment Opportunity Commission website or http://www.justice.gov/disabilities.htm. If you need to hire an attorney experienced with discrimination against stutterers, call the National Stuttering Association.

  The ADA does not apply to the federal government, including the military services. The ADA covers only employment discrimination. If you experience discrimination or harassment outside of work, you will have to rely on other federal or state laws.

  [edit] Vocational Rehabilitation

  If you're looking for a job, make an appointment with a vocational rehabilitation counselor. Look in your telephone directory's blue (government) pages under your state's department of labor (or department of education in some states).

  Voc rehab counselors want you to succeed. They'll get you whatever therapy, devices, or job training you need. I've heard many good reports from stutterers about voc rehab counselors.

  A stutterer complained that, after paying for stuttering therapy and an electronic device, the counselor also wanted to pay for his CPA certification. The stutterer insisted he would pay for his own certification.

  [edit] References

  1. ^ Giret, Karen. Letting GO, National Stuttering Association newsletter, July/August 1996.
  2. ^ Freeman, Frances. 1993. University of Texas, personal correspondence.
  3. ^ Craig, A., Calver, P. "Following Up on Treated Stutterers: Studies of Perceptions of Fluency and Job Status." Journal of Speech and Hearing Research, 34, 279-284, April 1991.
  4. ^ Schwartz, Martin, 1996, Stutterers Earn Significantly Less 10 Years After Graduating College.
  5. ^ Personal e-mail.
  6. ^ David Bertollo, e-mail.
  7. ^ Tom Morrow, e-mail.
  8. ^ Fraser, Jane. Stuttering: Answers for Employers, The Stuttering Foundation of America. June 2006

  [edit] High School Science Projects

  Altered Auditory Feedback

  High school students can build an altered auditory feedback device for a science project. Several alternatives are also possible:

  • Find a DAF kit by doing a websearch for "delay echo reverb kit."
  • Find a FAF kit by doing a websearch for "voice changer kit." Or rewire a voice changer toy (about $20) to use headphones instead of a speaker.
  • Find a MAF kit by doing a websearch for "function generator kit." MAF uses a 105 Hz sine wave.
  • Guitar effects processors usually have both reverb (DAF) and frequency-shift (FAF) effects.
  • Writing your own DAF software is easy. FAF software is harder, as it requires a fast Fourier transformation (FFT) for octave-scale FAF. DAF/FAF software can be downloaded for about $30 from http://www.artefactsoft.com.
  • Set up a computer to measure and display your vocal amplitude and frequency. Use a Radio Shack multimeter with a frequency counter and computer output. With a microphone the total cost should be $100-150. Or look for audio recording software with frequency analysis.

  You can do the following experiments on yourself, or find volunteer subjects in your stuttering support group. Ask your speech-language pathologist to help you find a support group, or call the National Stuttering Association at (800) 364-1677. Experiments to do:

  • Tape record a stutterer's speech at fast and slow speaking rates, without the device; and then with DAF set at 50 ms, 100 ms, and 200 ms. Count the number of disfluencies per minute, and the number of syllables per minute. Graph the relationship between fluency and speaking rate.
  • Do you agree with speech-language pathologist Janice Costello-Ingham, Ph.D., that "the functional variable in regard to the reduction of stuttering is not DAF, but prolonged speech, and the latter can be produced without reliance on a DAF machine"^[28] or do you agree with speech-language pathologist Joseph Kalinowski, Ph.D., that "a slowed rate of speech is not a necessary antecedent for fluency improvement under conditions of altered auditory feedback."^[29] I.e., does DAF improve speech only when the stutterer talks slower, or does DAF improve speech at normal speaking rates?
  • Math and physics: measure and calibrate the delay control of a DAF device. You'll need a frequency generator, frequency counter, and a dual-trace oscilloscope. Feed a sine wave into the DAF device. Set up the oscilloscope to display the input and output of the DAF device. At what frequencies do the two waves match? Find at least three matching frequencies for each DAF setting. Divide one by the differences between the matching frequencies to get the delay length, in milliseconds. Explain why this works.
  • Use the DAF device on a person who does not stutter, at different delay settings. How is the DAF effect different on individuals who don't stutter, and persons who stutter?
  • Tape record a stutterer speaking (without DAF) for at least three minutes. Then have the person speak with DAF for ten minutes. Take off the device and record another three minutes of speech. Does DAF cause carryover fluency (after removing the device)?
  • Show how to use a vocal amplitude display to help you do gentle onsets. Show how vocal frequency is a surrogate for vocal fold tension, i.e., relaxed vocal folds produce a low vocal frequency, and tense vocal folds produce a high vocal frequency.
  • Find out if any of your relatives stutter. Draw a family tree showing your relationship to the person. Present evidence that stuttering has a genetic cause, and evidence that stuttering is not genetic.
  • Find a speech clinic that has a speech biofeedback system. Write a report about what the biofeedback system does.
  • Repeat Wendell Johnson's 1937 studies of adaptation and anticipation. These studies are described in A Handbook on Stuttering, by Oliver Bloodstein.

  History

  • Write a report on the history of stuttering therapy, using Stuttering: The Search for a Cause and Cure by Oliver Bloodstein.
  • Write a report about a famous person who stutters.

  Community

  • Interview a speech pathologist about the cause of and treatments for stuttering. Describe the techniques and goals of two therapies. Ask your school district if they have a speech pathologist specializing in stuttering, or call the Stuttering Foundation of America at (800) 992-9392 to find a stuttering specialist.
  • Help your school's speech pathologist organize a "Youth Day," with the help of Friends Who Stutter or the National Stuttering Association. This is a weekend workshop in which a childhood stuttering specialist trains school speech-language pathologists and parents to treat stuttering. At the same time, the children play speech therapy games and meet each other.
  • Observe a speech pathologist treating a preschool child who stutters. Write a report about this, answering these questions: What games did the speech pathologist play with the child? What was the purpose of the game? What did the speech pathologist talk about with the child's parents?
  • Interview a successful adult who stutters. This could be an accountant, a lawyer, or a teacher. You can find such a person by calling a local stuttering support group. Ask how stuttering affected the person's childhood and high school years; adult life; choice of career; and marriage or relationships. What stuttering therapy has the person had? How severely did the person stutter when he or she was younger? Are there situations in which he or she stutters more, or stutters less? Are there are speaking situations he or she fears or avoids because of stuttering?
  • Does another student have a disability? Compare yourself to a student with a physical disability, and to a student with a non-physical disability (e.g., mental, emotional, or learning disability). See The Disability Hierarchy.

  References

  1. ^ Costello-Ingham, J. Journal of Fluency Disorders, 18, 1993, page 30.
  2. ^ Kalinowski, J. European Journal of Disorders of Communication, 31, 1996, page 259.

  [edit] Audience Reaction Video

  Speech-Language Pathology/Stuttering/Audience Reaction Video

  [edit] States That Provide Anti-Stuttering Telephone Devices

  Speech-Language Pathology/Stuttering/State Special Telephone Equipment Programs

  [edit] Other Fluency Disorders

  See also:

  • Cluttering
  • Parkinson's speech
  • Essential tremor
  • Spasmodic dysphonia
  • Social anxiety
  • Broca's aphasia

  Head injuries and strokes

  Head injuries and strokes can cause repetitions, prolongations, and blocks - some cases being the result of Broca's aphasia, and others being an acquired disorder of neurogenically-based stuttering. Neurogenic stutterers lack the same types of struggle behavior, and the fears and anxieties of developmental stuttering.

  Developmental stutterers can fluently speak certain memorized phrases, such as the "Pledge of Allegiance." Neurogenic stutterers are disfluent on everything. Developmental stutterers can speak fluently in certain (typically low-stress) situations. Neurogenic stutterers are disfluent everywhere.

  Stuttering therapy techniques and devices help some individuals with neurogenic speech disorders, but don't help others. Because different people have different areas of their brains injured, a treatment that's effective for one person may not be effective for another person.

  Psychogenic stuttering

  Rarely, traumatic experiences caused an adult to stutter. Psychogenic stuttering typically involves rapid, effortless repetitions of initial sounds, without struggle behavior.

  [edit] Heading needed

  Speech-Language Pathology/Stuttering/Long-Term Studies of Stuttering Therapy

  [edit] Long-Term Studies of Stuttering Therapy

  These 357 words include every combination of consonant and vowel in the English language.

  Word List 1

  able

  baby

  chainsaw

  dateline

  famous

  gatepost

  halo

  jaywalk

  cable

  label

  mailbag

  nadir

  pacer

  rabies

  saber

  shapeless

  table

  they

  vacant

  weightless

  whale

  zany

  Word List 2

  abbey       (a monastery)

  baboon

  dancer

  famine

  gadget

  hacksaw

  jasmine

  cabin

  ladder

  macro

  knapsack

  package

  rabbit

  saddle

  shadow

  tactile

  than

  thankful

  vanish

  wacky

  Word List 3

  achoo

  baa

  cha-cha

  
  

  father

  
  

  hah

  calf

  launch

  macho

  
  

  pasta

  Word List 4

  alarm

  balloon

  macaw

  patrol

  salon

  taboo

  Word List 5

  eager

  beachfront

  cheap

  dealer

  feature

  geese

  healer

  genius

  kiwi

  legion

  meager

  kneecap

  peaceful

  react

  cease-fire

  sheepdog

  teak

  thee

  theme

  V-eight

  weasel

  wheel

  yeast

  zeal

  Word List 6

  any

  bedtime

  checkbook

  dentist

  felon

  guest

  health

  gentle

  kettle

  leather

  meadow

  nephew

  peck

  redwood

  self-talk

  shepherd

  ten-speed

  them

  theft

  vent

  wealthy

  whether

  yell

  zest

  
  

  Word List 7

  aisle

  byte

  child

  diamond

  fiber

  guide

  height

  jive

  cayenne

  lion

  micro

  knife

  pie

  rhino

  cyclist

  shiner

  thyme

  thy

  thigh

  vibrant

  wildcat

  whitefish

  yipe

  xylan       (plant substance)

  
  

  Word List 8

  image

  bemoan

  chipmunk

  divide

  fishbowl

  gift-wrap

  hitchhike

  ginger

  kibbutz

  lily

  midcourse

  nimble

  picture

  rebel

  system

  shiftless

  ticket

  this

  thicket

  vicar

  wizard

  whimsy

  yip

  zigzag

  
  

  Word List 9

  oaken

  boastful

  choke

  domain

  focus

  ghost

  hoagie       (sandwich)

  joke

  coleslaw

  locust

  motion

  noble

  pollster

  romance

  soapstone

  chauffer

  toaster

  those

  thole       (endure)

  vogue

  woven

  yolk

  zonal

  
  

  Word List 10

  otter

  bobcat

  chocolate

  docile

  foggy

  goblin

  hobby

  jogger

  cobbler

  lobster

  model

  knockout

  pocket

  robin

  soccer

  shocker

  toddler

  volley

  waffle

  whopper

  yacht

  
  

  Word List 11

  alder

  bald

  chalk

  daughter

  fallen

  gauntlet

  hallmark

  jaunt

  caller

  laundry

  mossy

  gnaw

  pause

  raucous

  salted

  shawl

  talking

  thoughtful

  vault

  walker

  yawn

  
  

  Word List 12

  oil

  boil

  choice

  doily       (small napkin)

  foible

  goiter

  hoist

  join

  coin

  loin

  moist

  noise

  poignant

  royal

  soil

  toil

  voice

  yoicks       (cry to encourage foxhounds)

  
  

  Word List 13

  ouster

  bough

  chow

  downbeat       (conductor's downstroke on first beat of a measure)

  foul

  gauss       (measure of magnetism)

  hound

  jounce       (bounce, jolt)

  couch

  loud

  mountain

  noun

  pouch

  round

  sow

  shout

  tout       (extravagant praise)

  thou

  thousand

  vouch

  wound       (as in string, not as in injury)

  yowl       (cry of distress)

  zounds       (a mild oath)

  
  

  Word List 14

  oops       (mild surprise or apology)

  boomer

  chew

  deuce

  food

  goober       (peanut)

  hoop

  juice

  coolant

  lunar

  moon

  nougat

  poodle

  rupee

  sewage

  shoe

  tomb

  woo

  whoosh

  U-boat

  zoo

  
  

  Word List 15

  butte

  deuce

  feudal

  gewgaw       (showy trifle, bauble)

  hewn

  coupon

  mule

  neutral

  pewter

  tuba

  view

  whew

  Word List 16

  oomph

  butcher

  football

  good

  hoof

  cookbook

  lookout

  nook

  pudding

  roof

  soot

  shook

  took

  wolf

  whoops

  
  

  Word List 17

  onion

  bubble

  chubby

  doesn't

  fungus

  govern

  hovel

  judge

  color

  love

  money

  knuckle

  pump

  rough

  someday

  shutter

  touchdown

  thus

  thumbnail

  vulgar

  once

  what

  youngster

  • Next chapter: Recommended Books
  • Back to Table of Contents

  [edit] Recommended Books

  Fun With Fluency: Direct Therapy with the Young Child, by Patty Walton, MA-SLP, and Mary Wallace, MA-SLP (1998; ISBN 1883315395) is the best book I've read about treating children ages two to seven years old. It's all about direct stuttering therapy (as opposed to the old, ineffective indirect methods. A hierarchical progression of therapy begins with easy, stretchy speech; making direct requests for easy speech; modeling self-corrections; play speech games; contrast easy speech with hard speech; and embracing the speech villains.

  Motor Control and Learning: A Behavioral Emphasis, by Richard Schmidt, Tim Lee (2005; ISBN 073604258X) will tell you more about stuttering therapy, especially fluency shaping therapy, than any other book—even though this book never mentions stuttering. This book is about how our brains learn and execute complex motor (muscle) skills. Fluent speech is our most complex motor skill. If the stuttering "experts" were to read this book, stuttering therapy would advance fifty years.

  Stuttering: An Integrated Approach to Its Nature and Treatment, by Barry Guitar (1998). This is the best book I've read about stuttering. The first part of the book presents the essentials of stuttering research. The second part of the book differentiates stuttering modification therapy from fluency shaping therapy, and then shows how to integrate the two therapies. The writing is clear and understandable to undergraduate speech-language pathology students or even non-speech-language pathologists.

  Smart Moves: Why Learning Is Not All in Your Head, by Carla Hannaford (1995; ISBN 0915556278) is yet another book that isn’t about stuttering. This book shows how (and why) to use cross-lateral exercises to enhance learning. When we learn one thing in one area of our brain, and learn something else in another area, sometimes the different areas of the brain fail to communi-cate and we don’t seem to have learned. This is clear with learning-disabled children who can learn numbers, learn the words for numbers, and learn pictures of a number of objects (e.g., 7, seven, and seven apples) but fail to connect these concepts. Cross-lateral exercises involve moving your left hand or foot to the right side of your body, and your right hand or foot to the left side of your body (crossing your midline). Such exercises require commu-nication between your brain’s left and right hemispheres and seem to enhance learning. Because stutterers have more activity in their right hemispheres during speech, when non-stutterers have more activity in their left hemispheres during speech, cross-lateral exercises might enhance stuttering therapy.

  Stuttering: A Life Bound Up In Words, by Marty Jezer (1997). Jezer was a talented and entertaining writer, and author of biographies of Abbie Hoffman, Rachel Carson, and other books. This is Jezer's autobiography, and stuttering affected everything in his life. You learn much about stuttering and especially stuttering therapies, because Jezer went gone through just about every therapy program (and still stuttered).

  Knotted Tongues, by Benson Bobrick (1996). Bobrick is a historian, and the bulk of the book is about historical and literary persons who stuttered. These include Moses, Charles I, Lewis Carroll, Henry James, W. Somerset Maugham, Winston Churchill, and Marilyn Monroe. Bobrick also covers the history of stuttering treatments. Knotted Tongues is written for non-professionals. The book also has a thirty-page overview of stuttering science, and a twenty-page overview of stuttering therapies.

  The Mary Marony series of books, by Suzy Kline, portrays a seven-year-old girl who stutters. She is supported by her parents, speech pathologist, and teacher. In Mary Marony Hides Out (1996), Mary's favorite author comes to talk to her school. She is torn between her desire to talk to the author and her fear of speaking in the school assembly. When she gets up the courage to speak, a classmate makes fun of her, and Mary hides in the bathroom. The author stuttered growing up.

  The Loop, by Nicholas Evans (1998; ISBN 0440224624) Like Evans' first novel The Horse Whisperer, this book is set in Montana. The central characters are a successful rancher and Luke, the rancher's 18-year-old son. Luke stutters, and the father punishes him as if stuttering were a character flaw. The other teenagers ridicule Luke. His speech-language pathologist (who uses stuttering modification therapy) is sincere but ineffective. Luke decides not to go to college because he's afraid to talk. He's happy alone in the mountains, watching his father's cattle. Or so his father thinks. Luke is actually watching a family of wolves. When his father wants to kill the wolves, Luke courageously stands up to his father.

  
  

  [edit] External Links

  • http://www.mnsu.edu/comdis/kuster/stutter.html The Stuttering Homepage

  
  

  [edit] License

  [edit] GNU Free Documentation License

  Version 1.2, November 2002

  Copyright (C) 2000,2001,2002  Free Software Foundation, Inc.
  51 Franklin St, Fifth Floor, Boston, MA  02110-1301  USA
  Everyone is permitted to copy and distribute verbatim copies
  of this license document, but changing it is not allowed.
  
  

  0. PREAMBLE

  The purpose of this License is to make a manual, textbook, or other functional and useful document "free" in the sense of freedom: to assure everyone the effective freedom to copy and redistribute it, with or without modifying it, either commercially or noncommercially. Secondarily, this License preserves for the author and publisher a way to get credit for their work, while not being considered responsible for modifications made by others.

  This License is a kind of "copyleft", which means that derivative works of the document must themselves be free in the same sense. It complements the GNU General Public License, which is a copyleft license designed for free software.

  We have designed this License in order to use it for manuals for free software, because free software needs free documentation: a free program should come with manuals providing the same freedoms that the software does. But this License is not limited to software manuals; it can be used for any textual work, regardless of subject matter or whether it is published as a printed book. We recommend this License principally for works whose purpose is instruction or reference.

  1. APPLICABILITY AND DEFINITIONS

  This License applies to any manual or other work, in any medium, that contains a notice placed by the copyright holder saying it can be distributed under the terms of this License. Such a notice grants a world-wide, royalty-free license, unlimited in duration, to use that work under the conditions stated herein. The "Document", below, refers to any such manual or work. Any member of the public is a licensee, and is addressed as "you". You accept the license if you copy, modify or distribute the work in a way requiring permission under copyright law.

  A "Modified Version" of the Document means any work containing the Document or a portion of it, either copied verbatim, or with modifications and/or translated into another language.

  A "Secondary Section" is a named appendix or a front-matter section of the Document that deals exclusively with the relationship of the publishers or authors of the Document to the Document's overall subject (or to related matters) and contains nothing that could fall directly within that overall subject. (Thus, if the Document is in part a textbook of mathematics, a Secondary Section may not explain any mathematics.) The relationship could be a matter of historical connection with the subject or with related matters, or of legal, commercial, philosophical, ethical or political position regarding them.

  The "Invariant Sections" are certain Secondary Sections whose titles are designated, as being those of Invariant Sections, in the notice that says that the Document is released under this License. If a section does not fit the above definition of Secondary then it is not allowed to be designated as Invariant. The Document may contain zero Invariant Sections. If the Document does not identify any Invariant Sections then there are none.

  The "Cover Texts" are certain short passages of text that are listed, as Front-Cover Texts or Back-Cover Texts, in the notice that says that the Document is released under this License. A Front-Cover Text may be at most 5 words, and a Back-Cover Text may be at most 25 words.

  A "Transparent" copy of the Document means a machine-readable copy, represented in a format whose specification is available to the general public, that is suitable for revising the document straightforwardly with generic text editors or (for images composed of pixels) generic paint programs or (for drawings) some widely available drawing editor, and that is suitable for input to text formatters or for automatic translation to a variety of formats suitable for input to text formatters. A copy made in an otherwise Transparent file format whose markup, or absence of markup, has been arranged to thwart or discourage subsequent modification by readers is not Transparent. An image format is not Transparent if used for any substantial amount of text. A copy that is not "Transparent" is called "Opaque".

  Examples of suitable formats for Transparent copies include plain ASCII without markup, Texinfo input format, LaTeX input format, SGML or XML using a publicly available DTD, and standard-conforming simple HTML, PostScript or PDF designed for human modification. Examples of transparent image formats include PNG, XCF and JPG. Opaque formats include proprietary formats that can be read and edited only by proprietary word processors, SGML or XML for which the DTD and/or processing tools are not generally available, and the machine-generated HTML, PostScript or PDF produced by some word processors for output purposes only.

  The "Title Page" means, for a printed book, the title page itself, plus such following pages as are needed to hold, legibly, the material this License requires to appear in the title page. For works in formats which do not have any title page as such, "Title Page" means the text near the most prominent appearance of the work's title, preceding the beginning of the body of the text.

  A section "Entitled XYZ" means a named subunit of the Document whose title either is precisely XYZ or contains XYZ in parentheses following text that translates XYZ in another language. (Here XYZ stands for a specific section name mentioned below, such as "Acknowledgements", "Dedications", "Endorsements", or "History".) To "Preserve the Title" of such a section when you modify the Document means that it remains a section "Entitled XYZ" according to this definition.

  The Document may include Warranty Disclaimers next to the notice which states that this License applies to the Document. These Warranty Disclaimers are considered to be included by reference in this License, but only as regards disclaiming warranties: any other implication that these Warranty Disclaimers may have is void and has no effect on the meaning of this License.

  2. VERBATIM COPYING

  You may copy and distribute the Document in any medium, either commercially or noncommercially, provided that this License, the copyright notices, and the license notice saying this License applies to the Document are reproduced in all copies, and that you add no other conditions whatsoever to those of this License. You may not use technical measures to obstruct or control the reading or further copying of the copies you make or distribute. However, you may accept compensation in exchange for copies. If you distribute a large enough number of copies you must also follow the conditions in section 3.

  You may also lend copies, under the same conditions stated above, and you may publicly display copies.

  3. COPYING IN QUANTITY

  If you publish printed copies (or copies in media that commonly have printed covers) of the Document, numbering more than 100, and the Document's license notice requires Cover Texts, you must enclose the copies in covers that carry, clearly and legibly, all these Cover Texts: Front-Cover Texts on the front cover, and Back-Cover Texts on the back cover. Both covers must also clearly and legibly identify you as the publisher of these copies. The front cover must present the full title with all words of the title equally prominent and visible. You may add other material on the covers in addition. Copying with changes limited to the covers, as long as they preserve the title of the Document and satisfy these conditions, can be treated as verbatim copying in other respects.

  If the required texts for either cover are too voluminous to fit legibly, you should put the first ones listed (as many as fit reasonably) on the actual cover, and continue the rest onto adjacent pages.

  If you publish or distribute Opaque copies of the Document numbering more than 100, you must either include a machine-readable Transparent copy along with each Opaque copy, or state in or with each Opaque copy a computer-network location from which the general network-using public has access to download using public-standard network protocols a complete Transparent copy of the Document, free of added material. If you use the latter option, you must take reasonably prudent steps, when you begin distribution of Opaque copies in quantity, to ensure that this Transparent copy will remain thus accessible at the stated location until at least one year after the last time you distribute an Opaque copy (directly or through your agents or retailers) of that edition to the public.

  It is requested, but not required, that you contact the authors of the Document well before redistributing any large number of copies, to give them a chance to provide you with an updated version of the Document.

  4. MODIFICATIONS

  You may copy and distribute a Modified Version of the Document under the conditions of sections 2 and 3 above, provided that you release the Modified Version under precisely this License, with the Modified Version filling the role of the Document, thus licensing distribution and modification of the Modified Version to whoever possesses a copy of it. In addition, you must do these things in the Modified Version:

  A. Use in the Title Page (and on the covers, if any) a title distinct from that of the Document, and from those of previous versions (which should, if there were any, be listed in the History section of the Document). You may use the same title as a previous version if the original publisher of that version gives permission.

  B. List on the Title Page, as authors, one or more persons or entities responsible for authorship of the modifications in the Modified Version, together with at least five of the principal authors of the Document (all of its principal authors, if it has fewer than five), unless they release you from this requirement.

  C. State on the Title page the name of the publisher of the Modified Version, as the publisher.

  D. Preserve all the copyright notices of the Document.

  E. Add an appropriate copyright notice for your modifications adjacent to the other copyright notices.

  F. Include, immediately after the copyright notices, a license notice giving the public permission to use the Modified Version under the terms of this License, in the form shown in the Addendum below.

  G. Preserve in that license notice the full lists of Invariant Sections and required Cover Texts given in the Document's license notice.

  H. Include an unaltered copy of this License.

  I. Preserve the section Entitled "History", Preserve its Title, and add to it an item stating at least the title, year, new authors, and publisher of the Modified Version as given on the Title Page. If there is no section Entitled "History" in the Document, create one stating the title, year, authors, and publisher of the Document as given on its Title Page, then add an item describing the Modified Version as stated in the previous sentence.

  J. Preserve the network location, if any, given in the Document for public access to a Transparent copy of the Document, and likewise the network locations given in the Document for previous versions it was based on. These may be placed in the "History" section. You may omit a network location for a work that was published at least four years before the Document itself, or if the original publisher of the version it refers to gives permission.

  K. For any section Entitled "Acknowledgements" or "Dedications", Preserve the Title of the section, and preserve in the section all the substance and tone of each of the contributor acknowledgements and/or dedications given therein.

  L. Preserve all the Invariant Sections of the Document, unaltered in their text and in their titles. Section numbers or the equivalent are not considered part of the section titles.

  M. Delete any section Entitled "Endorsements". Such a section may not be included in the Modified Version.

  N. Do not retitle any existing section to be Entitled "Endorsements" or to conflict in title with any Invariant Section.

  O. Preserve any Warranty Disclaimers.

  If the Modified Version includes new front-matter sections or appendices that qualify as Secondary Sections and contain no material copied from the Document, you may at your option designate some or all of these sections as invariant. To do this, add their titles to the list of Invariant Sections in the Modified Version's license notice. These titles must be distinct from any other section titles.

  You may add a section Entitled "Endorsements", provided it contains nothing but endorsements of your Modified Version by various parties--for example, statements of peer review or that the text has been approved by an organization as the authoritative definition of a standard.

  You may add a passage of up to five words as a Front-Cover Text, and a passage of up to 25 words as a Back-Cover Text, to the end of the list of Cover Texts in the Modified Version. Only one passage of Front-Cover Text and one of Back-Cover Text may be added by (or through arrangements made by) any one entity. If the Document already includes a cover text for the same cover, previously added by you or by arrangement made by the same entity you are acting on behalf of, you may not add another; but you may replace the old one, on explicit permission from the previous publisher that added the old one.

  The author(s) and publisher(s) of the Document do not by this License give permission to use their names for publicity for or to assert or imply endorsement of any Modified Version.

  5. COMBINING DOCUMENTS

  You may combine the Document with other documents released under this License, under the terms defined in section 4 above for modified versions, provided that you include in the combination all of the Invariant Sections of all of the original documents, unmodified, and list them all as Invariant Sections of your combined work in its license notice, and that you preserve all their Warranty Disclaimers.

  The combined work need only contain one copy of this License, and multiple identical Invariant Sections may be replaced with a single copy. If there are multiple Invariant Sections with the same name but different contents, make the title of each such section unique by adding at the end of it, in parentheses, the name of the original author or publisher of that section if known, or else a unique number. Make the same adjustment to the section titles in the list of Invariant Sections in the license notice of the combined work.

  In the combination, you must combine any sections Entitled "History" in the various original documents, forming one section Entitled "History"; likewise combine any sections Entitled "Acknowledgements", and any sections Entitled "Dedications". You must delete all sections Entitled "Endorsements."

  6. COLLECTIONS OF DOCUMENTS

  You may make a collection consisting of the Document and other documents released under this License, and replace the individual copies of this License in the various documents with a single copy that is included in the collection, provided that you follow the rules of this License for verbatim copying of each of the documents in all other respects.

  You may extract a single document from such a collection, and distribute it individually under this License, provided you insert a copy of this License into the extracted document, and follow this License in all other respects regarding verbatim copying of that document.

  7. AGGREGATION WITH INDEPENDENT WORKS

  A compilation of the Document or its derivatives with other separate and independent documents or works, in or on a volume of a storage or distribution medium, is called an "aggregate" if the copyright resulting from the compilation is not used to limit the legal rights of the compilation's users beyond what the individual works permit. When the Document is included in an aggregate, this License does not apply to the other works in the aggregate which are not themselves derivative works of the Document.

  If the Cover Text requirement of section 3 is applicable to these copies of the Document, then if the Document is less than one half of the entire aggregate, the Document's Cover Texts may be placed on covers that bracket the Document within the aggregate, or the electronic equivalent of covers if the Document is in electronic form. Otherwise they must appear on printed covers that bracket the whole aggregate.

  8. TRANSLATION

  Translation is considered a kind of modification, so you may distribute translations of the Document under the terms of section 4. Replacing Invariant Sections with translations requires special permission from their copyright holders, but you may include translations of some or all Invariant Sections in addition to the original versions of these Invariant Sections. You may include a translation of this License, and all the license notices in the Document, and any Warranty Disclaimers, provided that you also include the original English version of this License and the original versions of those notices and disclaimers. In case of a disagreement between the translation and the original version of this License or a notice or disclaimer, the original version will prevail.

  If a section in the Document is Entitled "Acknowledgements", "Dedications", or "History", the requirement (section 4) to Preserve its Title (section 1) will typically require changing the actual title.

  9. TERMINATION

  You may not copy, modify, sublicense, or distribute the Document except as expressly provided for under this License. Any other attempt to copy, modify, sublicense or distribute the Document is void, and will automatically terminate your rights under this License. However, parties who have received copies, or rights, from you under this License will not have their licenses terminated so long as such parties remain in full compliance.

  10. FUTURE REVISIONS OF THIS LICENSE

  The Free Software Foundation may publish new, revised versions of the GNU Free Documentation License from time to time. Such new versions will be similar in spirit to the present version, but may differ in detail to address new problems or concerns. See http://www.gnu.org/copyleft/.

  Each version of the License is given a distinguishing version number. If the Document specifies that a particular numbered version of this License "or any later version" applies to it, you have the option of following the terms and conditions either of that specified version or of any later version that has been published (not as a draft) by the Free Software Foundation. If the Document does not specify a version number of this License, you may choose any version ever published (not as a draft) by the Free Software Foundation.