Friday, October 09, 2009

Should we ignore stuttering?

Should we ignore stuttering in treatment? I wrote about this approach before when introducing the ROPANA method by Roland Pauli. Let me go in more details.

Stutterers have fluent and stuttered speech. Fluent speech is most frequent when alone, not-thinking-about-speaking, calm and relaxed, reading, and speaking slowly. The two main approaches have the following weaknesses in my view:

1) Fluency shaping: learning motor code that is not part of natural speech, learning the new motor code, and keep practising so not to loose the new motor code. There is a great deal of resistance to acquiring and maintaining a new motor code.

2) Dysfluency shaping (Stuttering modification): learning to modify the motor codes associated to stuttered speech which means teaching yourself to change behaviours while stuttering. Stuttering events are as we all know dramatic events where our control of ourselves are dramatically reduced. And in such circumstances we need to learn what we are doing and trying to change it.

I give an example: avoiding eye contact. Under fluency shaping, you would learn a new way of speaking, which would lead to (more) fluent speech and you are naturally maintaining eye contact (or you can easily learn to maintain eye contact as you are not in an out-of-control stuttering situation.) Under dysfluency shaping, you would stutter, but try to stutter more easily and learn to maintain eye contact. The idea is to soften your stuttering, so you would still stutter but at least maintain eye contact. The argument is that changing behaviour like this might be more difficult but is long-lasting as you just modify an old way of speaking rather than learning a new way of speaking which might be unlearned.

Here is the third approach: dysfluency neglect/fluency enhancement. You completely ignore the stuttering event itself, and only work on when there is no stuttering. So the way to increase eye contact is to focus on good eye contact while fluent and to enhance the fluent periods. The advantage is: you work on eye contact while having control over yourself and so you can learn good eye contact easier, deeper, and establish good associations. The key is no attention to stuttering, don't legitimate it by working on parts of it. So better eye contact during stuttering might be a side effect because the learned behaviour during the fluent period is remembered by the brain (or there might be no effect). And better eye contact will primarily come from having more fluent periods where you have better eye contact anyway.

Here are other ways to work on stuttering without working on stuttering. After a stuttering event, you stop, take a break, and repeat over and over again in the fluent mode. The key is to associate the sentence/situation with fluency even when the first instance was stuttered. You want to flood your brain with memories of fluency to decrease the chance that the brain will find a trigger for stuttered speech. Or, you practise good breathing or body language while being fluent. You are learning in the fluent period. Or, you practise pausing in fluent speech to reduce the demand on the speech system. But you are not trying to reduce your speed because that is part of your natural way of speaking. Pauses are easier learned.

I am not saying this is a cure. What I am saying is that speech therapy is about changing behaviours, and this approach might be a more effictive less-resistance approach.

Let me know what you think!!

1 comment:

stuttering said...

It was really nice to go through the post focusing on stuttering. Stuttering is not a matter of negligence. It can be eradicated by proper treatment. Thank you for the tips for eradicating stuttering. They seems effective.