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< Speech-Language Pathology | Stuttering
Stuttering modification therapy is primarily associated with Charles Van Riper.
The goal of stuttering modification therapy is not to eliminate stuttering. Instead, the goals are:
Modify your moments of stuttering, so that your stuttering is less severe.
Reduce your fear of stuttering, and eliminate avoidance behaviors associated with this fear.
Four Phases of Stuttering Modification Therapy[edit]
The therapy has four phases: identification, desensitization, modification, and stabilization.
Identification[edit]
You begin by identifying the core behaviors, secondary behaviors, and feelings and attitudes that characterize your stuttering.
Your speech-language pathologist points out your 'easy or effortless stuttering.' You learn to identify when you do these behaviors. The goal is to improve your awareness of what you do when you stutter.
Next, your speech pathologist trains you to identify and become aware of your avoidance behaviors, postponement behaviors, starting behaviors, word and sound fears, situation fears, core stuttering behaviors, and escape behaviors.
Finally, you identify feelings of frustration, shame, and hostility associated with your speech.
At first, identifying these behaviors is done in the speech clinic. Later, your speech pathologist takes you out of the clinic, to identify what you do in everyday conversations.
Desensitization[edit]
Van Riper called this 'toughening the stutterer to his stuttering.' You do this in three stages:
Confrontation, or accepting that you stutter. You're expected to tell people that you stutter, and talk about what you are doing in therapy to change your stuttering.
Freeze your core behaviors—repetitions, prolongations, and blocks. When you stutter, your speech pathologist raises a finger. You hold what you are doing, until she drops her finger. For example, if you were repeating a syllable, you have to continue to repeat that syllable. Your speech pathologist will make you freeze these core behaviors for longer and longer periods. The goal is for you to become less emotional or more tolerant of these behaviors.
Voluntary stuttering, or stuttering on purpose. This helps you remain calm when you stutter.
Modification[edit]
This is where you learn 'easy stuttering' or 'fluent stuttering,' in 3 stages:
Cancellations. When you stutter, you stop, pause for a few moments, and say the word again. You say the word slowly, with reduced articulatory pressure, and blending the sounds together.
Pull-outs. After you master freezing and cancellations, you use your 'easy stuttering' while you are in a stutter, to pull yourself out of the stutter and say the word fluently.
Preparatory sets. After mastering pull-outs, you look ahead for words you're going to stutter on, and you use 'easy stuttering' on those words.
Stabilization[edit]
The last stage of stuttering modification therapy seeks to stabilize or solidify your speech gains. This is accomplished through sub-goals:
The first is for you to become your own speech therapist. You take responsibility for making your own assignments and prescribed therapy activities.
Another sub-goal is 'the automatization of preparatory sets and pull-outs.'
The last subgoal is for you to change your self-concept from being a person who stutters to being a person who speaks fluently most of the time but who occasionally stutters mildly.
Efficacy Studies[edit]
A study indicated that naïve or nonprofessional listeners responded less well to stuttering combined with stuttering modification techniques than they did to stuttering (only).[1] In other words, listeners may prefer to listen to untreated stuttering than to listen to a stutterer using stuttering modification therapy techniques.
Nineteen adult stutterers participated in the 3.5-week Successful Stuttering Management Program (SSMP, developed by Dorvan Breitenfeldt) program. Immediately post-treatment their speech had improved 10%. Six months later this modest gain had all but disappeared. Several measures of anxiety found a 10-15% psychological improvement. The researchers cautioned that six months isn't a long follow-up, and that this psychological improvement might not last, given the absence of improved speech. The researchers concluded, '…the SSMP appears to be ineffective in producing durable improvements in stuttering behaviors.'[2]
Stuttering Modification Programs[edit]
Approach-Avoidance Therapy (Joseph Sheehan)[edit]
In the 1940s, behavioral psychologist Neal Miller tied strings to rats, and sent them scampering down a runway towards food. He measured how hard the rats pulled on the strings to get to the food. He called this force the 'gradient of force.'
He then put an electric shock at the end of the runway, instead of food. The rats scampered away from the electric shock, and Miller called this the 'gradient of avoidance.'
He put the food and the electric shock together at the end of the runway. The rats wanted to scamper to the food, but away from the electric shock. They ended up running back and forth in a narrow space somewhere in the middle of the runway. This was called the 'approach-avoidance conflict.'
This reminded psychologist Joseph Sheehan of stutterers' repetitions and prolongations. In 1953, Sheehan developed the theory that stutterers want to say a word, but also want to avoid the word.
Why would stutterers wish to avoid saying words? Sheehan suggested that stutterers dislike the listener, or fear certain words, or fear certain situations, or feel guilt or anxiety about the emotional content of our message.
Sheehan believed that 'stuttering is not a speech disorder, but a conflict revolving around self and role, an identity problem.' He based this view on the fact that most stutterers have difficulty saying their names, and that many stutterers are fluent when acting (Sheehan, 1970).
Sheehan developed a stuttering modification therapy program based the reduction of avoidance.first, in the 'self-acceptance' phase, you are trained to accept yourself as a stutterer. You are encouraged to maintain eye contact with listeners, and discuss your stuttering with friends and acquaintances.
In the 'monitoring' phase, you improve your awareness of what you do when you stutter.
In the 'initiation' phase, you seek out feared situations, and feared words, and stutter openly.
In the 'modification' phase, you stutter openly and easily. You let the listener know that you are having trouble with a word. You do a prolongation on thefirst sound of the word. You do a 'smooth release' onto the next sound.
Lastly, in the 'safety margin' phase, you develop a tolerance for disfluency.
Sheehan did not believe that stutterers could or should speak fluently. In his therapy, 'No practicing of special techniques for achieving fluency are involved—only openness and honesty and a changing role of self-acceptance as a stutterer will lead to overcoming the tyranny of stuttering.'[3]
Sheehan's stuttering therapy is practiced at the University of California—Los Angeles (UCLA).
Successful Stuttering Management Program (Breitenfeldt and Lorenz)[edit]
The 'Successful Stuttering Management Program' (SSMP) is practiced by Dorvan Breitenfeldt and Dolores Rustad Lorenz at Eastern Washington University in Spokane, Washington. It's a three-week, intensive, residential group therapy program. The program is mainly stuttering modification therapy, emphasizing avoidance reduction.
The program begins with 'confrontation of stuttering.' The aim is to develop awareness of your stuttering, reduce use of avoidance techniques, and eliminate word and situation fears. The techniques are voluntary stuttering and stuttering surveys.
In a 'stuttering survey,' you go to a shopping mall, stop strangers, and ask them questions about their reactions to your stuttering. You stutter on purpose. You do 200-300 stuttering surveys in the program.
In the second phase, you learn the stuttering modification techniques: preparatory sets, cancellations, and pull-outs. This differs from other stuttering modification therapies, in which preparatory sets are learned after cancellations and pull-outs.
The second phase also includes changing your self-concept and lifestyle.
You also substitute continuents for plosives. You substitute /w/ for /b/, /s/ for /t/, and /z/ for /d/. For example, you say 'wank' instead of 'bank,' and 'zollar' instead of 'dollar.' You also add sounds with prolongations. For example, 'water' becomes 'oowater.'
Other speech pathologists are skeptical of this technique:[4]
This type of substitution behavior seems to go against the original philosophy of nonavoidance…the idea of teaching stutterers to substitute…strikes us as [an avoidance 'trick']…it may even strengthen clients' tendencies to scan ahead in anticipation of sounds that are feared and should be avoided.
In the third phase, you transfer your new skills to face-to-face and telephone conversations. You are also encouraged to do voluntary stuttering.
'Self-Therapy for the Stutterer' (Malcolm Fraser)[edit]
The book 'Self-Therapy For The Stutterer,' by Malcolm Fraser, shows how to do stuttering modification can be done as self-therapy, as opposed to going to a speech clinic. The book is published by the Stuttering Foundation of America.
Critiques of Stuttering Modification Therapy[edit]
Assumptions[edit]
Stuttering modification therapy assumes that stutterers will never be able to talk fluently, and so the best a stutterer can hope for is to be a better communicator while still stuttering. The effectiveness of other, more recently developed stuttering therapies for producing fluent speech makes this assumption questionable.
Identification Critiques[edit]
Improving self-awareness of stuttering behaviors, as well as psychological effects, is an excellent foundation for any speech therapy. The problem with this stage of stuttering modification therapy is that it was developed before the invention of video camcorders and biofeedback devices. Current technology can help you do this stage better and faster.
Desensitization Critiques[edit]
Telling people that you stutter is good. But freezing core behaviors and voluntary stuttering could strengthen the neural pathways for these behaviors, making these undesirable motor programs even harder to change.
Modification Critiques[edit]
'Cancellations' and 'pull-outs' don't work if you have poor awareness of your stuttering. By the time you realize that you are stuttering your speech may be out of control. If stutterers' auditory processing underactivity results in poor awareness of one's speech, then stutterers who have a this neurological abnormality strongly can't be expected to modify their speech.
'Preparatory sets' teach stutterers to 'scan ahead' for feared words, i.e., teach you another secondary behavior. In fact, the entire 'modification' stage is arguably teaching you more secondary behaviors.
If modified stuttering sounds worse to listeners than untreated stuttering, increased listener discomfort may cause stress in the stutterer using stuttering modification techniques.
Stabilization Critiques[edit]
But 'becoming your own speech pathologist' doesn't mean reading books about stuttering, taking a class, going to conventions, or learning about new research and therapies. 'Becoming your own speech pathologist' means motivating yourself to do therapy activities indefinitely. You wouldn't do these therapy activities on your own, because you don't perceive resulting benefits. You need a speech pathologist to get you to do the activities.
Another goal is 'the automatization of preparatory sets and pull-outs.' But you're just told you to practice, and not taught techniques or practice schedules to maximize autonomous motor learning.
The last goal is for you to change your self-concept from being a person who stutters to being a person who speaks fluently most of the time but who occasionally stutters mildly. This would be a good goal if stuttering modification therapy trained you to be a person who stutters mildly. But if stuttering modification therapy '…appears to be ineffective in producing durable improvements in stuttering behaviors.' then this self-concept may be difficult to maintain.
Personal Experiences with Stuttering Modification Therapy[edit]
Please read Speech-Language Pathology/Stuttering/How to Participate in this Wikibook before adding material.
References[edit]
^ Manning, W. H., Burlison, A. E., & Thaxton, D., (1999) 'Listener response to stuttering modification techniques,' Journal of Fluency Disorders, 24, 267-280.
^ Blomgren, M., Roy, N., Callister, T., Merrill, R. 'Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes,' Journal of Speech and Hearing Research, 48:509-523, June 2005.
^ Culatta, R., Goldberg, S. Stuttering Therapy: An Integrated Approach to Theory and Practice. Boston: Allyn and Bacon, 1995.
^ DeNi, L., Kroll, R., & Ham, R. 'Therapy Review,' Journal of Fluency Disorders, 21, 1996, pages 61-67.
Retrieved from 'https://en.wikibooks.org/w/index.php?title=Speech-Language_Pathology/Stuttering/Stuttering_Modification&oldid=3545065'
Stuttering is a speech disorder. It’s also called stammering or diffluent speech.
Stuttering is characterized by:
repeated words, sounds, or syllables
halting speech production
uneven rate of speech
According to the National Institute of Deafness and Other Communication Disorders (NIDCD), stuttering affects about 5 to 10 percent of all children at some point, most often occurring between ages 2 to 6.
Most children won’t continue to stutter in adulthood. Typically, as your child’s development progresses, the stuttering will stop. Early intervention can also help prevent stuttering in adulthood.
Although most children outgrow stuttering, the NIDCD states that up to 25 percent of children who don’t recover from stuttering will continue to stutter as adults.
There are three types of stuttering:
Developmental. Most common in children younger than 5 years old, particularly males, this type occurs as they develop their speech and language abilities. It usually resolves without treatment.
Neurogenic. Signal abnormalities between the brain and nerves or muscles cause this type.
Psychogenic. This type originates in the part of the brain that governs thinking and reasoning.
Stuttering is characterized by repeated words, sounds, or syllables and disruptions in the normal rate of speech.
For example, a person may repeat the same consonant, like “K,” “G,” or “T.” They may have difficulty uttering certain sounds or starting a sentence.
The stress caused by stuttering may show up in the following symptoms:
physical changes like facial tics, lip tremors, excessive eye blinking, and tension in the face and upper body
frustration when attempting to communicate
hesitation or pausing before starting to speak
refusal to speak
interjections of extra sounds or words into sentences, such as “uh” or “um”
repetition of words or phrases
tension in the voice
rearrangement of words in a sentence
making long sounds with words, such as “My name is Amaaaaaaanda”
Some children may not be aware that they stutter.
Social settings and high-stress environments can increase the likelihood that a person will stutter. Public speaking can be challenging for those who stutter.
There are multiple possible causes of stuttering. Some include:
family history of stuttering
family dynamics
neurophysiology
development during childhood
Brain injuries from a stroke can cause neurogenic stuttering. Severe emotional trauma can cause psychogenic stuttering.
Stuttering may run in families because of an inherited abnormality in the part of the brain that governs language. If you or your parents stuttered, your children may also stutter.
A speech language pathologist can help diagnose stuttering. No invasive testing is necessary.
Typically, you or your child can describe stuttering symptoms, and a speech language pathologist can evaluate the degree to which you or your child stutters.
Not all children who stutter will require treatment because developmental stuttering usually resolves with time. Speech therapy is an option for some children.
Speech therapy
Speech therapy can reduce interruptions in speech and improve your child’s self-esteem. Therapy often focuses on controlling speech patterns by encouraging your child to monitor their rate of speech, breath support, and laryngeal tension.
The best candidates for speech therapy include those who:
have stuttered for three to six months
have pronounced stuttering
struggle with stuttering or experience emotional difficulties because of stuttering
have a family history of stuttering
Parents can also use therapeutic techniques to help their child feel less self-conscious about stuttering. Listening patiently is important, as is setting aside the time for talking.
A speech therapist can help parents learn when it’s appropriate to correct a child’s stuttering.
Other treatments
Electronic devices may be used to treat stuttering. One type encourages children to speak more slowly by playing back an altered recording of their voice when they speak quickly. Other devices are worn, like hearing aids, and they can create distracting background noise that’s known to help reduce stuttering.
There are no medications that have yet been proven to reduce stuttering episodes. Although not proven, recent research suggests there is hyperactivity of the muscles affecting speech and medications to slow the hyperactivity may be helpful.
Alternative therapies like acupuncture, electric brain stimulation, and breathing techniques have been researched but don’t appear to be effective.
Whether or not you decide to seek treatment, creating a low-stress environment can help reduce stuttering. Support groups for you and your child are also available.