Modern America 1914 - present

I) Definition

II) Who stutters?

III) What causes stuttering?

• Folk myths
• Physical aspects
• Neurological aspects
• Psychological aspects
• Genetic aspects

V) Problems that people who stutter have

V) Therapies and approaches for remedy

VI) What do people think about people who stutter? How do they intract with them?

VII) How should one interact with people who stutter?
 
 
 
 
 
 

Terms:

• dysfluency (interruption of and problems with fluency)
• secondary behavior
• repetitions
• prologations
• blockings
• interjections
• circumlocutions
• non-avoidance

Bibliography:

•           Cooper, E.B., and Cooper, C.S. Multicultural considerations in the assessment of stuttering. Communication Disorders in Multicultural Populations. (2nd ed.). Boston: Butterworth-Heinemann, 1998
•      Engelken, Marianne. Successful Stuttering Management Program. June 2001. Sept.2001. <www.logopaedie.de>
•      Kassler-Stottertherapie. August 2001. <www.kassler-stottertherapie .de>
•      Rauschan, Werner. Stottern. Institut fuer kommunikative Stottertherapie. April 2001. Sept. 2001. <www.logopaedie.de/therapie bereiche/artikel/rauschan.htm>
•      Schwarz, Martin. Stutter No More. New York: Simon & Schuster, 1991. 
•      Starkweather, Woodruff C., and Janet Givens-Ackerman. Stuttering. Pro-Ed Studies in Communicative Disorders.        Austin, Texas: Pro-Ed, Inc, 1997
•      The Australian Stuttering Research Centre. Youren, L. The Camperdown Program. July 2001. Sept.2001. <www.cchs.usyd.edu.au/asrc/ treatment/camperdown.htm>
•      Theories Of Stuttering Development. October 2001. <www.marshall.edu>
•      The Stuttering Homepage Minnesota State University, Mankato. Folk Myths about Stuttering. June 1998. Sept. 2001. <www.mankato.msus.edu/dept/ comdis/kuster/Infostuttering/ folkmyths.html>
•      The Stuttering Homepage Minnesota State University, Mankato. Harrison, John. Thirteen Observations About People Who Stutter. June 1998. Sept. 2001. <www.mankato.msus.edu/ dept/ comdis/ kuster/ Infostuttering / 13observations.html >
•      The Stuttering Homepage Minnesota State University, Mankato. Hermann Christmann. Stuttering and Communication. Aug. 1997. Sept.2001. <www.mankato.msus.edu/dept/ comdis/isad/papers/christman. html>
•      The Stuttering Homepage Minnesota State University, Mankato. Ramig, Peter. Various Paths to Long-Term recovery From Stuttering. June 1998. Sept.2001. <www.mankato.msus.edu>
•      Van Riper, Charles. The Nature Of Stuttering. New Jersey: Prentice-Hall, Inc., Englewood Cliffs: 1971.
•      Viswanath, Nagalapura, and Rosenfield, David. Stuttering. Elsevier’s Encyclopedia of Neuroscience (2nd enlarged and revised edition). Ed. George Adelman, Barry H. Smith. 1999 ed.

     Stuttering is the interruption of speech in its fluency. Continued repetitions, prolongations, audible or silent blockings, interjections and circumlocutions are factors that contribute to this involuntary dysfluency. People who stutter often produce words with additional tension of speech- and other musculature in order to try to conceal their problem. Often fear, excitement, stress or pressures of different nature play a role in intensifying the disruptions of speech.
 

II) Who stutters?

    In all cultures of the world there are people with speech dysfluencies. The way people stutter, however, often varies dependent on the language they speak since each language has its unique phonetic and phonological system. Some sounds often create more problems for a speaker than others. Therefore bilingual speakers might have stuttering problems in one language but not (or maybe not as severe) in the second language. An article on http://web.nmsu.edu reports that according to Cooper and Cooper “Bilingual Spanish- and English speaking subjects often have greater frequency of dysfluencies in Spanish than English, possibly due to the frequency of the occurrence of vowel- initiated words in Spanish.”
The Stuttering Foundation of America (SFA) states that three million Americans stutter while three to four times as many males are affected by this speech problem as females. The SFA also reports that about 25 % of all children show signs of stuttering at some point in the development of their language acquisition. This phase might continue for six months or more for about 4% of them. Viswanath, N.S. & Rosenfield, D.B. (1962) affirm that while children often recover spontaneously from stuttering adults have a much harder time to leave their dysfluency behind. The stuttering problem remains for one percent of all adults.
 

III) What causes stuttering?

1.) Folk myths about stuttering:

     Stuttering is a problem that most likely exists ever since people use language as a means of communication. Since humans are born with a need for communication this problem is very striking for the one who has it and it is also highly evident to the one who is involved in a dialogue with a person who stutters. Humans are also born with a certain curiosity and they seem to feel the need to explore the unknown and the urge of finding answers to any problem that concerns them directly. (This is due to our most important tool that has helped us to survive through the course of evolution: intelligence.) And stuttering is one of those problems that do concern us directly. The consequence is that people from all over the world have had (and still have even though they might now be modified by scientific knowledge) their own theories about what evokes stuttering.
     In the following I would like to share some information regarding myths about stuttering provided by The Stuttering Homepage Minnesota State University, Mankato.

• African American myths say that stuttering is caused by a mother eating improper foods when breast feeding the infant or seeing a snake during her pregnancy, if an infant is allowed to look in a mirror, is tickled too much, if the hair is cut before a child has uttered its first words, or if the child got scared as a baby
• South African beliefs about the causes of stuttering include leaving the baby out in the rain, failing to inform ancestors of imminent birth or if the child’s tongue is too short.
• Icelandic myths say stuttering comes from a mother drinking from a cracked cup in her pregnancy.

     It is evident that different cultures have different ideas and theories about this very common problem. Scientists working in the fields of biology, psychology, neurology and linguistics got involved in various research projects to find answers to the question: What is it that causes stuttering? Some approaches were more or less successful in understanding aspects of the development and process of stuttering. Still, there is no definite answer found.

     In the following I would like to introduce various approaches to this topic based on different aspects in the fields of biology, neuroscience, linguistics, psychology and genetic research:

A) Physical aspects:

     The production of speech involves different motor coordination processes and various muscular activities. Therefore it seems obvious that if one part of the process cannot be performed accurately it might result in dysfluency of speech. Starkweather and Givens-Ackerman (90) point out that the coordination of contracted and relaxed muscles (which complement each other in “antagonistic sets” (ibid)) involved in speech production might cause a problem for people who stutter (stiffness of muscles resulting in tremor or swinging) especially when speech has to be produced quickly or in stressful environment.
     Viswanath and Rosenfield emphasize the fact that stuttering in some cases can be connected with hearing problems. If a fluent person hears his/her speech delayed he/she might develop a stutter. Individuals who become deaf also show changes in their quality of speech. It also shouldn’t be neglected that many people who stutter become fluent when they do not hear their speech while it is concealed by noise (1962).
     According to different sources of research, including Dr. Martin F. Schwartz, the vocal cords indicate the origin of stuttering.  He observed that with people who stutter the vocal cords, instead of being “brought together by several pairs of muscles so that [the vocal cords] touch each other very gently” (14) constrict in a rather unnatural and forceful way. The consequence is that the air pressure that has built up cannot be released. With normal speech the airflow which causes the vibrating of the vocal cords, however, provides the “raw material for speech production” (14). If there are difficulties with the “raw material” (ibid) it seems almost natural that problems with the transformation of it into utterance will occur even if all other muscles of lips, tongue, jaws, cheeks and palate that help to shape a specific sound work right. As stated by the National Institute on Deafness and other Communication Disorders more than 100 muscles are occupied with the process of speech production.
     With both, the muscles and the vocal cords, tension and release play the most important role in vocalization of utterances. In conversations with people who stutter, however, behaviors involving the contraction of muscles that are not naturally used for speaking or the exaggerated contraction of muscles that are, can be observed.
     Examples of these secondary behaviors as indicated by Starkweather are: odd movements of the jaw or cheek muscles, rolling of the eyes, making fists, rocking back and fro, with children sometimes jumping up and down or squeezing cheeks to get the words out, alteration of pitch, vocal quality and/or loudness, slower or faster speech. Secondary behavior depends partly on the severity of the dysfluency problem and varies individually (30/31, 69/70)
     The question might occur, why people who stutter show this kind of behavior. In ancient times it was interpreted as behavior of feebleminded or obsessed people. The truth is far from that: Firstly, people who stutter usually are of either equally or even higher intelligence than the average fluent individual. Secondly, it is in the nature of all humans to find ways and/or tools that make life easier. Individuals, who stutter, as mentioned above, are restricted in many ways by their problem, including an issue very important to all humans: communication. Naturally they seek to find ways to overcome their difficulties. They might apply a certain behavior unconsciously and find out that it helps them to articulate what they want to say – as a consequence this behavior will most probably be reused in a similar situation. I would like to introduce an example that illustrates this kind of behavior as follows:
     If somebody wants to play the piano and finds all keys but one working and if he really wanted to or had to play he would try and find a way: Either would he press harder on this specific key or he would start to avoid this note by looking for other ways of playing the song. While the latter goes parallel with avoidance behavior or circumlocutions that many people who shutter perform, the first alternative refers to the secondary behavior mentioned above. The pianist might want to use this instrument again and- of course again finds a specific key broken. Now, that he already knows about the problem he pushes harder right away to get the string to swing and to produce a sound. This behavior seems only natural. But – does it fix the actual problem? The answer is obviously “no”. Whereas a piano with technical difficulties can be repaired by somebody in the required profession this project is much more complex with stuttering. The core problem is that despite of modern research and interdisciplinary scientific approaches no universal cause or remedy has been found. The main reason for that is that all clients have their own history of language acquisition and that the development and causes of this speech disorder varies individually.
     Still, there are some main features of dysfluencies that people who stutter share, including the ones mentioned above. Most problems in utterance of words and phrases lie within the “transition of one sound to another” state Viswanath& Rosenfield (1962). This often results in prolongations of one sound until the next sound can be produced. A person who has trouble with a sound or a feared word often copes with it the same way the pianist described above would do with a broken key. An interesting observation is that most difficulties occur at the beginning of words and sentences. This is also true for fluent speakers. The fast speed of speech contributes to ‘natural’ tongue slips or to stammering.
 

B) Neurological aspects

     Since it is known that certain areas of the brain are concerned with language processing, assumptions are made that stuttering may originate from a neurological defect. Different cases indicate that brain damage (e.g. after illness or accident) can evoke speech disorders and stuttering. However, many people who stutter do not suffer from brain damage and still have trouble with their speech. Recent research by the German Kassler Stottertherapie (KST) is concerned with the activation of the brain during speech in order to find ways of monitoring therapy effects for stuttering clients (Results of experiments carried out by the KST concerning brain activity (involving 20 fluent and 21 stuttering speakers) demonstrate that the first show “consistent activation in speech related and motor areas (of the brain)” while the latter show irregularities: The hemisphere for language processing indicates decreased activation, the motor systems show increased activation and additionally there are diffuse activities in regions of the brain that don’t have anything to do with language processing.
     Some linguists argue that stuttering might also result from problems with cognitive language processing, i.e. that a person might know what he or she wants to say but that he/she has difficulties with transforming this concepts into utterance. If one thinks of examples of daily life he has to admit that this is true also for fluent speakers. Sometimes we have an idea of what we want to say but it might be very complex at points and we have to rethink the idea while speaking. If  the language processing is not fast enough at this point, even a usually fluent and eloquent speaker will find him/herself repeating sounds or words, he/she might seem to ‘be stuck’ in his/her utterance.
 

C) Psychological aspects:

     In addition to physiological and neurological observations a different perspective on this topic should be taken into consideration: Humans are not only physically defined entities that function due to a sophisticated regulation system, the brain. A very important dimension that contributes to humanity is the individual psyche. Very often in the modern world people suffer from depression, diseases or other disorders due to stress. Stress is a factor that has always been there, in its various forms and degrees. Since stress, stimulus from outside as well as from within the organism, affects all living systems, it naturally affects all of us. Stress is a factor that often contributes negatively to our life because it influences our bodies as well as our psyche in a disadvantageous way. People cope individually with different situations, stimuli or information. The German KST assumes that some people who are susceptible to stuttering might develop a stutter only if they are exposed to certain stresses. 
     Dr. Martin F. Schwarz defines eight basic stresses that contribute to a person’s stuttering. He points out that the combination of some or even all of these stresses can result in the locking of the vocal cords:

- Stressful speaking situations: e.g. telephone, big audience
- Feared words or sounds
- Authority figures: parents, supervisor, teacher, official etc.
- Uncertainty: due to new or unfamiliar situation, uncertainty of proper behavior, uncertainty about the pronunciation of a word etc.
- Fatigue/Illness: lack of sleep, disease
- External factors: “bad news” (25)
- Speed stress: is often responsible for the onset of stuttering in children
- Base-level stress: Tension is always present in the 16 muscles in and around the vocal cords, but the magnitude of it varies. The variance is due to two major factors, first brain hormones and second persistent subconscious conflicts (23ff).

     In addition to stress emotions play an important role with stuttering. According to interviews I have taken with relatives or friends of people who stutter, the communication problem often evolves from and later reinforces a lack of self-confidence, difficulties in social life, anxiety, and shame. Also the feeling of helplessness and frustration feeds the development of stuttering. In many cases stuttering originates in the feeling of rejection, suppression and being dominated or belittled by people who are considered as important, e.g. teachers, parents, or supervisors.
     Charles Van Riper mentions that stuttering can often have its cause in traumatic experiences that result in anxiety and a “self role conflict” (270). All people have the urge to communicate. However, which often is due to the social feedback a stuttering person gets, he/she finds himself/herself between the “two drives to speak and to keep silent”(ibid). Thus, stammering and difficulties with utterances mirror this internal conflict to the outside world.
     Another factor that contributes to this language problem is the feeling of guilt. If a person experiences the feeling of guilt, especially in early ages, this can result in fear. Fear again nourishes the drive to keep silent, which, as just mentioned, is against the natural urge to talk. According to Van Riper fear and the experience of communicative and social failure can develop into a neurosis. Some people who stutter are aware of the fact that their dysfluency might be distressing to their partners of conversation, which in return makes them feel guilty.  However, I should like to stress that this does not mean that all people who stutter are neurotic. Schwarz argues that personality tests prove that most people who stutter do not show major differences in personality if compared with people who do not have this type of fluency disorder (20).
 

D) Genetic aspects:

     Research of the German KST resulted in the following conclusion: Stuttering occurs more frequently in families that have a history of stuttering than in families that do not. With twins in families that have dysfluent speakers one twin is likely to develop a stutter with a probability of 60% if the other twin also stutters. Chances for other siblings to also stammer are about 25% if one of their brothers or sisters does. The rate of probability shows that stuttering cannot be of entirely genetic cause; since the DNA of twins is identical and only in 60% of the cases do actually both twins develop a difficulty in fluency. In some cases only one family member turns out to develop a stutter even though no other cases of stuttering occur in his/her family history. Pure genetic inheritance of stuttering is obviously questionable. It seems that influences and environmental stresses play an important role in the development of this speech disorder. The KST assumes that a genetic predisposition of stuttering can be inherited but other factors are “necessary” to actually lead to the problem.
     The National Institute of Health in Washington currently works on the identification of the genes that might be responsible for stuttering.
 

IV) The development of stuttering

     Before I will describe the different stages of stuttering I would like to mention that two types of stuttering are to be distinguished. First, acquired stuttering, and second, developmental stuttering, which I will describe more detailed in the subsequent passage.
     Acquired stuttering shows dysfluencies throughout sentences while in developmental stuttering the problem shows primarily in word initiation. The former, according to Viswanath and Rosenfield may be caused by neurological disease or psychogenic disturbance while genetic and environmental reasons contribute to the development of the latter. The authors also mention that acquired stuttering usually occurs with adults. Those are often not, unlike developmental stutterers, bothered by their abnormal speech (1962).

     Language acquisition is a highly complex process that humans start to go through already as infants. Especially in the first years, when a child goes through many different stages of development the process of language acquisition might be interrupted or slowed down. Parents should be careful to not put pressure on their child, since all individuals develop at different rates. The combination of too much pressure and genetic disadvantage could support the development of anxiety and therefore a problem in fluency. A language rich environment, in contrast, can support language learning and also literacy. As mentioned above, many children go through a phase where they show signs of stuttering. However, only a small percentage actually develops this difficulty in fluency. The following passage will give more insight into the phases of stuttering.

Phase I

     Development of stuttering: The child’s fluency is interrupted at regular intervals by repetitions, which occur usually at the beginning of sentences. Only small parts of the speech are affected. Pressure, being upset or the fact that the child has a lot to say may lead to this kind of interruption about which the child is usually not aware or concerned.

Phase II

     Stuttering worsens: Major parts of the speech are chronically affected by the child’s fluency problems. Stuttering usually occurs if the child talks under stress, in excitement, or very rapidly. The individual now is aware of his stuttering but still shows little concern.

Phase III

     Stuttering becomes severe: The child or early adolescent has trouble with particular sounds, syllables and words. Stuttering, which is now accompanied by circumlocutions or word substitutions occurs depended on different situations. The person does not avoid conversations but shows embarrassment and becomes irritated with the disruption of his/her own speech.

Phase IV

     The person is considered a stutterer: The adolescent or adult starts to avoid speaking-situations due to fear of words, sounds, and syllables. Many circumlocutions are used and the problem causes embarrassment to the person.
 
 

V) Problems that people who stutter have

     According to a study carried out by the Stuttering Information Center of Denmark people who stutter are definitely discriminated against in the labor market even though it is proven that stuttering is not a matter of intelligence and ability. It is interesting that in contrast to employers who have at least one stutterer as their employee and therefore share a more positive attitude towards people with fluency problems, employers who don’t have experience with stuttering people are more likely to stigmatize and show signs of discrimination. If an employer has the choice between two applicants of which one is a fluent person and the other a person who stutters, he/she in many cases decides for the former one. Employers argue that people with difficulties in fluency seem more nervous, might not be able to express him/herself clearly and unmistakably and that he/she might make customers feel insecure and uncomfortable. The study also reveals that people who stutter pose limitations onto themselves because they have learned from their environment that their problem discriminates them in more ways than only language wise from people who speak with fluency according to the norm.
     This of course has social consequences. A person who has not been taken seriously for a significant period of time in his/her life and who has gotten negative feedback from his/her social environment is likely to feel insecure and frustrated. In some cases this results in the growth of social anxiety. People who stutter are very concerned about the way other people think about them and about what they say, are more careful about the words they use or just keep silent.
     As a consequence the image of their selves and their self-confidence is in many cases affected in a negative way. John Harrison who himself stutters published thirteen observations he had made about people with dysfluencies. On the web page http://www.mankato.edu/dept/comdis/kuster/infostuttering/13observations.html he states that people who stutter ….
1) …have difficulty in letting go in what one feels and is willing to risk
2) …do not have a strong sense of who they are because they are too concerned with other people’s opinion about them
3) …are overly concerned with pleasing others
4) …have a narrow self-image
5) …lack of self-assertiveness
6) …have a misconception of what constitutes acceptable speaking behavior
7) …see themselves as powerless and helpless
8) …understand life as a performance
9) …are afraid of making mistakes and being judged
10) …are afraid of responsibility and making decisions because they are afraid of making mistakes
11) …tend to blame most of their problems on their imperfect speech
12) …see themselves as different from other people
13) All of what is mentioned above contributes to the lack of positive speaking experiences.
 

VI) Therapies and approaches for remedy
 

     First of all it should be mentioned that THE remedy for stuttering does not exist. Part of it is that despite of recent research still many features about stuttering are unknown. Another factor that cannot be neglected is that THE cause for stuttering does not exist, either: The causes for stuttering often vary individually. It therefore seems obvious that a therapy might help one individual while the fluency problem of another person is not diminished. However, today many approaches for remedy are taken and various therapies are offered.
     Attempts have been made to cure this dysfluency with drugs. The main focus lies on tranquilizing drugs and antidepressants. The effects, however, are only of partial success and of temporary quality. Despite of ongoing research and experiments there is not enough knowledge about potential side effects. Therefore a drug therapy should not be preferred to alternative possibilities and should, if chosen by a client, only be applied in combination with a speech therapy. Nevertheless, the placebo effect actually helped some clients to overcome their fluency problem or at least to improve their speech. Speech clinicians therefore rather recommend speech therapies, as mentioned above.
     All therapies have the same general goals which are firstly, the prevention of the development, and secondly the reduction and a potentially successful cure of the fluency problem. According to Werner Rauschan indirect approaches can be distinguished from direct ones. The former train changes on levels of communication that are indirectly related to the client’s stuttering (like breathing, rhythm, motor skills etc.). An entirely new way of speaking is learned and finally covers the stuttering. It therefore allows the clients to be more or less fluent within a rather short period of time. However, observations show that they remain helpless when facing recurring sequences of stuttering.
     The direct approaches aim at the awareness of specific features of stuttering and also put emphasis on a holistic procedure. They see a close connection between the system of communication and the different levels of emotion, thoughts, kinesthetic awareness, and social role. The client is to learn how to change his/her negative self-image, and to concentrate primarily on the content of the utterance instead of its form. In contrast to the approach mentioned first this one does not build on the idea of creating artificial fluency but instead works directly with various features of stuttering and tries to modify it in a way that it no longer conveys a problem for the client and his/her partners of conversation.

     Rauschan talks of different forms of therapy that are offered:

· Individual treatment where counselor either works once a week with one person or a small group of clients. This form has the advantage that individual need can be taken into consideration. However, the risk of stagnation in therapy has often been observed since dealing with rather personal matters tends to overshadow the actual stuttering problem.
· Groups meet in institutions for several weeks where their behavior is being observed, treated and modified in cooperation with therapists who work in the field of logaoedics. The meetings are usually successful. Regardless, the clients face difficulties if they return to their “normal” social environment.
· Therapies that are based on intervals work with small groups for a few days. After that the clients go through a phase of individual autonomous work in the environment that they are used to. The next phase offers intensive work in the same small groups mentioned above. That way the clients can share their experience, learn from therapeutic suggestions and from one another and finally apply the knowledge they have gained in their every day lives. The dynamic of this approach is of great advantage.

     In the following I will introduce three different programs for the improvement of fluency: Firstly, the Successful Stuttering Management Program (SSMP) which was developed by Dorvan Breitenfeld and Dolores Rustad Lorenz and is carried out at the Eastern Washington University in Cheney, USA; secondly, the Camperdown Program, developed by researchers at the Australian Stuttering Research Center, in Camperdown, a suburb of Sydney, Australia and finally the biofeedback-therapy of the KST, developed and carried out by A. Wolff von Gudenberg and H.A.Euler since 1996 in Kassel, Germany.

     1.) The SSMP is based on Van Riper’s Non-Avoidance Therapy which is a method of confronting the client with his disorder, of teaching about its nature and of supporting and encouraging the person with dysfluency to develop a less effortful way of stuttering. An important factor for the clients is to accept their problem as incurable and at the same time to learn to cope with it in a natural and self-confident way. Breitenfeld stresses that the attempt to cover up the weakness results in a growth of tension and therefore makes a fluent conversation almost impossible. He offers a technique called “Advertising” which helps people who stutter to learn how to take pressure and tension away in order to enable a pleasant conversation. It basically says that the person concerned has to tell him/herself and others “I am a stutterer”. This confession often is very hard and has to be practiced. In group- and partner-work the participants are encouraged to advertise themselves and talk regardless of their stuttering. A crucial aspect in this program is on the one hand the mutual encouragement and support of the participants and on the other hand the autonomous work in their “field experience” where they have to apply what they have learned and practiced.

     2.)The Camperdown Program (1999) aims at the prospect of speaking fluently. It is based on the technique of prolonged speech, which stretches the words to a rather unnatural length. The participants are instructed to use their speech patterns at a very slow rate to then increase it in a systematic way until a natural rate is reconstructed. After the clients have learned to speak without stuttering in the clinic they are encouraged to use their newly acquired patterns in the outside world. The manual for the program says: “Clients learn the technique by watching and imitating a standard prolonged speech video, accompanied by written text. The video demonstrates prolonged speech in a slow and exaggerated manner in connected speech.” The program consists of four components, which are:
· Individual Teaching Sessions, which teach basic behaviors required for the program.
· Group Practice that supports the acquisition of consistent control over their stuttering, now applying a natural sounding rate of speech. The client also learns to develop a balance between controlled stuttering and natural sounding speech.
· Individual Problem Solving Sessions, which reinforces the development of strategies for generalizing stutter-free speech.
· A maintenance phase where the client has to apply his achievements in his/her natural environment.

     3.)The Kassler Stottertherapie is based on the combination of the non-avoidance method, fluency shaping and other approaches. This therapy consists of a diagnostic part, an intensive program, which lasts for three weeks, and finally a structured aftercare, which is provided for the period of at least one year’s time. The first part evaluates the clients’ motivation, expectations and qualification for this program. In addition to that samples of the person’s speech are taken in various situations and questionnaires about communication skills are to be filled in. The second part includes three crucial elements:
 

•  Modification by extending syllables, practice of diaphragm breathing and gentle speech. Decrease in the speed of speech also is an important component. In the first days of therapy each syllable is systematically prolonged for two seconds each.
• Reinforcement/Deepening by the means of gentle speech. The speed of speech is increased to one and then to ½ second for each syllable. Therapists support the participants in getting used to the new speech patterns.
• The Phase of Application reinforces the transfer of the learned speech patterns that again have been increased in their speed to normal sounding, however still slow, speech. Participants first practice their newly learned patterns on telephone conversations. Then they are encouraged to apply their speech in everyday situations, outside the therapy-community. These activities are reinforced by role-plays and group discussions that are recorded on videotape. The analysis of the tapes is an important factor in this phase. 

     It is proven that self-help also takes a significant role in the treatment of stuttering. Self-help groups often teach people who stutter that it is not necessary to deny the fact that they have difficulties with their speech. Participants often come to realize that their attempt to cover up the stuttering does not improve fluency but rather expands the tension. The feeling of being accepted is a very important feature in the process of improvement. It also is certainly uplifting to find out that other people have similar difficulties. Sometimes sole talking about the problem with people who understand and care can help and obviously motivate to initiate changes.

     In addition to the different therapies alternative approaches recommend Yoga and meditation to overcome stuttering. Relaxation techniques and “unlearning” the factors that contribute to ones dysfluency are the main idea of this method. It is not much known about the rate of success with this method.

     The approaches mentioned above only give a broad inside into all therapies offered. However they all have the main idea, to help people who stutter in common. To close the theme of remediable approaches I would like to give an example of how one individual who used to stutter reflected on his recovery. On the website http://www.mankato.msus.edu Peter R. Ramig, Ph.D., Professor at the University of Colorado presents eight factors that contributed to his own recovery from stuttering. These are:

· “Desperation/Motivation”
· “Caring, Supportive, Knowledgeable Speech Clinicians”
· “Confrontation and Modification of Stuttering”
· “Learning that Much Of My Hard Stuttering Resulted From My Attempts 
   Not To Stutter”
· “Learning To Monitor My Speech Via Proprioception”
· “Disclosing The Fact That I Am A Person Who Stutters”
· “Experiencing More Fluency And Controlled Stuttering In Situations I Once 
   Feared”
· “Don’t Ever Give Up”.
 

VII) What do people think about people who stutter? How do they interact with them?

     General Ideas about people who stutter include the assumptions that…
- …they think faster than they are able to express themselves,
- …that stuttering goes back to psychological problems or even to neurosis
- …that stuttering is always due to brain damage
- …that they are not as bright as people who speak fluently
- …that they are different in personality, especially more nervous

     If one has a conversation with a person who stutters, then insecurity can often be observed on both sides. Some people try to “help” by taking the words out of his/her mouth, and by giving advise like “slow down” or “start over”. Direct eye contact is often avoided; the attempt to deal with the problem is often not made.
 
 

VIII) How should one interact with people who stutter?

     Acceptance is a very important element when interacting with people who stutter. First of all it is crucial for the individual who stutters to feel accepted as a person and to be taken seriously. One element is the effort to keep eye contact. The acceptance of his/her stuttering takes away tension. If a person who stutters feels that it is okay to stutter, it in most cases diminishes or even disappears completely. Patience goes along with that. The individual concerned already has to struggle with his/her awareness of the dysfluency and the linked feeling of shame or embarrassment. Patience avoids putting more pressure from outside on the stuttering person. The attempt to help by making the utterance for the person with fluency problem is probably nicely meant, but it is far from actual help. On the contrary, it only feeds the stigma that people who stutter are less able and therefore need to be belittled. As many people interviewed stated appropriately, one should try to act normal, since people who stutter are just as normal. What’s normal anyway?!
 
 
 
 
 
 
 

Exercise:

Read the following sentences aloud. Then try to memorize them and say them again.
Try to do it as fast as you can.
Say the sentences while your partner tries to distract you.
Say those sentences in front of a group. Try to say them fast.

What do you notice?
Where/when did you have the most difficulties? Why?
 

1. Mr. Mummy mustn’t mess up Mrs. Mummy’s make up.

2. Tall traumatized tree trimmers are trained to trim the tallest trees.

3. Seven seriously silly stepsisters seek to sell sweaters to severely sweaty sauna sisters.

4. Which witch, Wanda wondered, would wish to wear a wrist watch?

5. Professional pumpkin pickers are prone to pick the plumpest pumpkin.

6. If big black bats could blow bubbles, how big of bubbles would big black bats blow?

7. Blaukraut bleibt Blaukraut und Brautkleid bleibt Brautkleid.

(German. Means: blue cabbage remains blue cabbage and a wedding dress remains a wedding dress)