Fluency and its Disorders.

Unit 2(a,b,c)

Unit 2(A): Definition and Causes of

Stuttering:
DEFINITION
FLUENCY: Effortless flow of speech

Stuttering is a developmental disorder characterised by frequent

and protracted sound prolongations, sound, syllable, word and
phrase repetitions and silent blocks that interfere with the efficient
production of speech (Bloodstein, 1995; Guitar, 2014).

Wingate (1964) gave a standard definition of stuttering as

disruption in the fluency of verbal expression, which is
characterised by involuntary, audible or silent, repetition or
prolongation in the utterance of short speech elements and words
of one syllable.

CAUSES OF STUTTERING
Theories of stuttering etiology:
These theories describe the conditions under which stuttering first
develops (Bloodstein, 1995).
Five main theories under this category are (1) Theory of Cerebral
Dominance (2) Diagnosogenic Theory (3) Genetic Disorder
Theory (4) Demands and Capacities Theory and (5) Covert Repair
Hypothesis.
(i)Theory of Cerebral Dominance –Travis (1931) proposed this
theory. According to this theory, stuttering may be considered as
an inability to co-ordinate the messages sent from both cerebral
hemispheres for the movement of speech musculature. It also
proposes that one hemisphere is dominant in controlling for the
synchronisation of messages. Hence, in the absence of one
hemisphere dominance, the two hemispheres would function
independently, which may cause poorly coordinated timing of
speech movements and stuttering may be manifested. As this
theory makes a link between cerebral dominance, handedness and
stuttering, it is also sometimes known as the “handedness theory”.
According to Travis (1931), society’s pressure for children to use
the right hand in many activities, ultimately attempted to change
left-handed children’s cerebral dominance, which might lead to
problems like stuttering.

(ii)Diagnosogenic Theory – This theory of stuttering was

proposed by Wendell Johnson in 1942. This theory explains
stuttering as a result of attempting to avoid stuttering (Bloodstein,
1984). Johnson (1959) suggested that the attempt to avoid
stuttering was caused by parent’s misdiagnosing normal
disfluencies as stuttering.The parents attempted to correct these
disfluencies, or showed adverse reactions to disfluencies and these
attempt created feelings of anxiety in the child leading to the child
believing that he/she was really disfluent and therefore became so.
Johnson proposed that the disfluency noted in very young
stuttering children was no different to normal childhood
disfluency (Bloodstein, 1984). This statement highlights the
importance of differential diagnosis in very young children, which
continues to receive research attention today (Ambrose & Yairi,
1995).
(iii)Genetic Disorder theory –
This theory suggests that stuttering has a genetic basis and it is
based on the observation that stuttering runs in families. Generally
person’s inherited susceptibility along with environmental factors
eventually leads to the development of stuttering (Yairi &
Ambrose, 1996). Further, it is also proposed that genetics may also
play a role in the persistence or recovery of stuttering (Ambrose,
Cox, & Yairi, 1997).

(iv)Demands and Capacities Theory (DCT) – This theory was

proposed by Starkweather (1987).This theory is based on the
premise that stuttering is caused when a person’s capacity for
speech is inadequate to meet the demands placed on the person
(Adams, 1990). People could have a reduced capacity in cognitive,
linguistic, motoric and/or emotional areas. There may be different
sources of demands, including environmental, communication
partners and/or the stutterer’s own demands (Adams, 1990).
Few stuttering therapy approaches are based on DCT. For
example, parents are asked to slow down their rate of speech when
talking with their child with stuttering so that the demands being
placed on the child to reply with a similar rate of speech will get
reduced (Costello & Ingham, 1984).

(v)Covert Repair Hypothesis (CRH) –

This theory proposes that stuttering occurs due to disruption in the
process of transforming thoughts into speech.
Further it states that instances of disfluency are self repairs which
reflect a person’s impaired ability to phonologically encode, and
their attempts to adapt for this (Postma & Kolk, 1993).
When they attempt to activate sounds at a faster rate than their
phonological encoding system is capable of doing, it leads to
increase in the chance of an error occurring in the sounds selected.
When the speaker detects these errors they may attempt to correct
it mid speech which results in the perception of a stutter (Postma
& Kolk, 1993).

Unit 2(b): Characteristics of Stuttering:

Core Behaviours (Van Riper 1971, 1982):
Stuttering is associated with core behaviours, which include
repetitions, prolongations and blocks. These stuttering behaviours
seem involuntary to the stutterers.
REPETITIONS: Repetitions are typically first core behaviour to
develop. These are simply a sound, syllable or single syllable
word repeated several times. The speaker is apparently “stuck” on
a sound and continues repeating it until the following sound can
be produced.(Yairi and Lewis,1984)
PROLONGATION: Prolongation of sounds may develop
somewhat later than repetitions. In prolongation the sound or
airflow continues, but movement of one or more articulators is
stopped. Prolongations as short as half a second may be perceived
as abnormal.(Van Riper,1982)
BLOCKS: Blocks are typically the last core behaviour to develop.
They occur when the stutterer inappropriately stops the flow of air
or the voice and often the movement of articulators as well.

Secondary Behaviours:
Persistent stuttering is associated with secondary characteristics
that define the disorder beyond the speech characteristics
described above. Stutterers learn these behaviours as a
consequence of their effort to finish the core behaviours quickly or
to their effort to avoid them. People who persist in stuttering into
the school age and adult years, often present with facial grimaces,
eye blinking, jaw and neck tension, reduced eye contact, hand
tapping or other extraneous body movements (Conture & Kelly).
These can be broadly classified into two categories:
“Escape behaviour”: occurs when the speaker is stuttering and
attempts to get out of stuttering and finish the word. Eg: eye blink,
head nods or interjection of extra sounds. These often are followed
by the termination of stuttering and are thus rewarded.
“Avoidance behaviour”: occurs when a speaker anticipates
stuttering and tries to keep from stuttering by changing the word,
using pause, or using an eye blink. These are rewarded because
they sometimes prevent a stutterer from stuttering.
Secondary behaviours interfere with the ability of stutterers to
communicate clearly and efficiently with their conversation
partners. People who stutter may also use circumlocution as a
strategy for avoiding speaking words that contain sounds that they
have developed a fear of over their lifetime (Bloodstein, 1995).

Feelings and Attitudes:

Feelings may be as much part of the disorder as the stuttering
behaviours.In children the positive feeling, like excitement and
negative feeling like fear may result in repetitive stutters that the
child may hardly notice but as he stutters frequently he may
become frustrated or ashamed of the stuttering behaviour and thus
these feelings increase effort and tension and impede fluent
speech. Feelings may also include fear of stuttering again, guilt
about not being able to help oneself, and hostility towards
listeners. Attitudes are feelings that have become a pervasive part
of a persons beliefs. Adults and adolescents who stutter have many
negative attitudes about themselves that are derived from years of
stuttering experiences.(Blood, Blood, Teil, Gable, 2001). A person
who stutters often projects his attitudes to the listener and
sometimes the listener may also contribute directly towards the
persons attitude by stereotyping them as tense, insecure, and
fearful. (Guitar&Hoffmann, 1978).
Unit 2 (c ): Development of Stuttering :
Bloodstein proposed Four phases in development of
stuttering (1960B)
Phase One: Pre-school period, Age 2- 6.
1. The difficulty has a distinct tendency to be episodic -
Appears for periods of weeks or months with long
interludes of normal speech. There is a high percentage
of spontaneous recovery in this phase.
2. The child stutters most when excited or upset, when
seeming to have a heart deal to say, or under other
communication pressures.
3. The dominant symptom is repetition.
4. There is marked tendency for stuttering to occur at the
beginning of the sentence, clause or phrases.
5. Interruptions occur not only on content words but also
on the functional words of speech. Frequent repetition
words as “like,” “but,” “and,” “so,” “he,” “i,” and
“with.”
6. Show little evidence of concern about the interruptions
in speech.
Phase Two: Elementary school age, Age range: 4 -
adulthood
1. The disorder is essentially chronic.
2. The child has a self-concept as a stutterer.
3. The stuttering occur chiefly on the major parts of
speech- nouns, verbs, adjectives and adverbs.
4. The chid usually evinces little or no concern about the
speech difficulty.
5. The stuttering is set to increase chiefly under conditions
of excitement or when the child is speaking rapidly.

Phase Three: Late childhood to early adolescence, Age

range: 8 - adulthood
1. The stuttering comes and goes largely in response to
specific situations.
2. Certain words or sounds are regarded as more difficult
than others.
3. In varying degrees, use is made of word substitutions
and circumlocutions.
4. There is essentially no avoidance of speech situations
and little or no evidence of fear or embarrassment.
Anticipation to stuttering as a highly conscious process
begins to develop in this stage. Reaction of irritation is
prominent than shame or anxiety.
Phase Four : Later adolescence and Adulthood, Age range:
as early as 10 years of age.
1. Vivid, fearful anticipations of stuttering.
2. Feared words, sounds and situations.
3. Very frequent word substitutions and circumlocution.
4. Avoidance of speech situations, and other evidence of
fear and embarrassment.
Stutterers may become acutely conscious of the reactions of
others to their speech and may be victimised by a tendency
to exaggerate and misinterpret these reactions.
They are likely to be unusually sensitive to the stigma
involved in being regarded as stutterer, to shrink from
discussing their speech difficulty with others, and to go to
extreme lengths to maintain a pretence as a normal speaker.
All of this, together with avoidance of speaking, tends to
impair their capacity for spontaneous and constructive
social relationships and in some cases may even serve to
isolate them to some extent from others.

REFERENCES:
I. Stuttering- An integrated Approach to its Nature and
Treatment. Barry Guitar. 4th Edition.
II.Stuttering and Related Disorders of Fluency. Edward
G.Conture, Richard E.Curlee. 3rd Edition.
III.A Handbook On Stuttering. Fifth Edition. Oliver
Bloodstein.