theoretical perspective of stuttering.pdf / kunnampallil gejo john

7/27/2019 Theoretical perspective of stuttering.pdf / KUNNAMPALLIL GEJO JOHN

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Theoretical perspective of

stuttering

KUNNAMPALLIL GEJOJOHN ,MASLP

KUNNAMPALLIL GEJO JOHN,BASLP, MASLP


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What are theories??

Theories-- putting together the bits and

pieces of what is known about something

to understand it better.

A theory puts together findings in a

systematic way,

past phenomenon-- explainedfuture-- is predicted.



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A complete theory explains why

one person stutters on some words and not

others

In some situations and not others

*When a theory explains these things well, it can

lead to effective treatment



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Scientists --theory a formal set ofhypotheses -- explains the important causal

relationships in a phenomenon.

These hypotheses are then tested, and the

theory may be thrown out, improved or

confirmed as a result.



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The field of stuttering research and treatmenthasnt developed far enough to have a formaltheory of stuttering

There are a number of informal theories thatmight be called as theoretical perspectives ortheoretical models.



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Bloodstein (1973)groups theories as

belonging to 3 types Theories of the etiology of stutteringwhich

offer an account of the etiology, or onset ofstuttering.

e.g., Johnsons diagnosogenic theory (1942).Orton-Travis theory (1927; 1931).

Theories of the moment of stuttering, whichare concerned with the nature of discrete

instances of stuttering behaviors.e.g., Wests (1958), Eisensons (1958) andGlaubers (1958) concepts.



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Theories that shifts the frame ofreference,whose basic contribution lies in aa reformulation of a [previous theory, either of

the etiology or of the moment of stuttering, interms of a new frame of reference.

E.g., cybernetic models of stuttering (Mysak,

1960; Lee 1951) & learning theoryinterpretations (Wischner, 1950; Brutten &

Shoemaker, 1967; & others).



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5 main Perspectives of stuttering

Stuttering as anticipatory struggle behavior.

Stuttering as a learned behavior.

Stuttering as a prosodic behavior.

Stuttering as timing and sequencing disorder.

Stuttering as a temporal disorder.



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I. Stuttering as an anticipatory

struggle behavior:



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The anticipatory struggle hypothesis:-

These hypotheses view the moment of stuttering

as learned behavior that is some how precipitated

by it being anticipated and feared.

They indicate that what maintains the disorder is

anticipating stuttering and struggling to avoid it.

Some of those who advocate such hypothesesrefer to the moment of stuttering as struggle

behavior.



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Theoretically, if a person who had the disorderstopped fearing and desiring to avoid stuttering,he/she would become more fluent, evennormally fluent.

If such a person could be made to want tostutter, he or she would be even more likely toexperience increased fluency.



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Many stutters knowledgeable about stutteringagree that anticipation of stuttering contributes to

both precipitating moments of stuttering and

maintaining the disorder

There is no general agreement on the nature of

the mechanism by which this occur.



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Stutteres interfere in some manner with the waythey are talking because of their belief in the

difficulty of speech.

This idea, termed -- the anticipatory struggle

hypothesis, -- in one or another of its forms, one

of the most widely employed explanations of the

moment of stuttering and has a strong influence

on theory, treatment and research.



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Early formulations:

The early literature on speech disorderscontains numerous references to stuttering as

stammering from fear, doubt, or anticipation

of speech difficulty.

Boome & Richardson (1931) and Gifford

(1940) inferred that stuttering as an

expectancy neurosis.

Others referred to it as an anxiety neurosis, or

speech phobia.



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Failure of automaticity:

A distinctive hypotheses --that stuttering resulted

from the attempt to exercise conscious control

over the automatic processes of speech.

West in more refined form stated that stutterers

tend to create difficulty for themselves by

voluntarily producing individual speech

movements rather than by initiating

automatic serial responses.



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Anticipatory avoidance:

The anticipatory struggle concept is best knownin the special form in which Johnson developedit in a series of writings spanning three decades.

In accordance with this view, the very thingsstutterers do in order not to stutter are theirstuttering.

Stuttering is then, anticipatory, apprehensive,

hypertonic avoidance reaction.



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That is --it is what happens when a personanticipates stuttering and becomes tense in theattempt to avoid it.

In a phrase stuttering is what the speaker doeswhile trying not to stutter again.

stuttering is not a symptom of a constitutionalabnormality or an emotional disorder, but a

consequence of certain inappropriateperceptual and evaluative reactionswithregard to speechthat a speaker has learnedfrom the social environment.



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Approach - avoidance conflict:

Stuttering may be-- the resultant of a conflictbetween opposing wishes to speak and to keepsilent.

This view was developed extensively by Sheehan(1953; 1958) in a learning theory context to beconsidered further on.

From a practical standpoint the conflict hypothesis -

-stuttering results from the desire to avoid speech.

In contrast to Johnsons view of stuttering as theavoidance of stuttering, then the conflict theorydepicts it is as the avoidance of speaking.



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Preparatory set:

Van riper (1937; 1954) developed his concept ofthe role of the preparatory set in stutteringprimarily as a therapeutic tool and has notappeared to place much emphasis on its

theoretical implications.

Van riper--, in advance of the attempt on a wordperceived as difficult or feared, stutterers tend toplace themselves in a characteristic muscular

and psychological set which determines theform of the subsequent stuttering block.


Thi t h ti ll


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This set has essentially

3 identifiable features.

1. Stutteres establish an abnormal focus oftension in their speech organs.

2. They prepare themselves to say the first

sound of the difficult word as a fixedarticulatory posture rather than as a normalmovement blending with the rest of the word.

3. They may adopt this unnatural posture of thespeech organs appreciably before initiatingvoice or airflow, resulting in a silentpreformation of the sound



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Having done all of these things

because of their anticipation of

difficulty on the word, it is apparent

that they have effectivelydestroyed their chances of saying

it normally.



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Tension and fragmentation:

practically all of the integral features of stuttering

behavior are reducible to the surface effects of

two underlying forms of behaviortension &

fragmentation.

In stuttering the underlying tension produces

prolongations and hard attacks.

The repetition of stuttering may be interpreted as

a fragmentation of rehearsing the initial part of

their throw.



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Such an interpretation is useful in

explaining why it is almost always

the first sound of the word that the

stutterer repeats, as well as certainother puzzling features of its

distribution in the speech sequence.



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Anticipatorystruggle theories:

The moment of stuttering in which -- stutteresinterfere with the way they speak because of theirbelief in the difficulty of speech and theiranticipation of speech failure.

The explanations to account for this and differ inthe respect that they consider the causative factorof central importance to be

1. The childs excessive hesitations and repetitions(primarily stuttering)

2. The parents high standards of fluency(diagnosogenic theory)

3. Communicative failure or pressures, broadlyviewed



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People who stutter are frequently

viewed as more anxious than non

stutterers and as being depressed.

A strong and pervasive stereotype is

held by non stutterers that people

who stutter are guarded, nervous,

and tense.



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The Relationship Between Communication

Attitude, Anxiety, and Depression in

Stutterers and Non stutterers

Susan Miller,Ben C.Watson;

Journal of Speech and Hearing Research

Vol.35 789-798 August 1992)



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This study examined self-perceptions ofgeneral state and trait anxiety, depression, andcommunication attitude in matched groups ofstutterers and non stutterers.

Results refute the assertion that people whostutter are more anxious or depressed thanthose who do not.

Anxiety and depression are not related to self-ratings of stuttering severity.



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Communication attitude is negative for this groupof people who stutter and becomes increasinglynegative as self-ratings of stuttering become

more severe.

People who stutter, grouped by severity rating,differed in the strength of the relation betweenmeasures of communication attitude, anxiety, and

depression.

Findings suggest that the anxiety of people whostutter is restricted to their attitude towardscommunication situations and that it is a rational

response to negative communicationexperiences.



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Theories of anticipatory

struggle hypothesis

1. Theory of primary and secondary

stuttering

2. Diagnosogenic theory

3. Theory of communication pressure



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1.Theory of primary and

secondary stuttering:



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stuttering as a developed disorder arises as a

reaction to unusual but relatively simplerepetitions in a childs speech, termed primarystuttering.

According to Froeschels and Bluemel, stuttering

first appears in the form of speech repetitionsthat occur without effort or awareness on thepart of the child.

This stage of the disorder was held to be

essentially a phenomenon of early childhoodand one which tends to disappear is speakingdifferently.



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Many primary stutteres are urged to thinkbefore they speak, to take a deep breath or to

stop and start over so often that they becomeguilty and apprehensive about their mild speechinterruptions.

The more serious form of disorder was then

believed to develop from the childs efforts toavoid primary stuttering.

This advanced form, marked by strenuous

blockages, fear, embarrassment, and variousconcomitant symptoms of effort and emotion,was characterized as secondary stuttering.



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According to this theory of the development ofstuttering , is only some time after its onset, insecondary stage, that it becomes an anticipatory

struggle behavior as children begin to react withanticipation, fear and avoidance to their primarystuttering

Primary stuttering is type of disintegration orbreakdown, and both genetic and environmentalfactors were suggested as its chief cause.

Van riper stated that in some instances the etiology

was primarily constitutional, in others neurotic, and instill others from a home environment marked byfrequent interruption, unresponsive listeners, demandsto confess guilt orally, or other fluency disruptors.



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The theory of Weiss (1964) regarding therelationship between stuttering and cluttering, in

view of Weisss identification of cluttering withprimary stuttering.

Cluttering,is a disorder of fluency marked by

monotonous, rapid, jerky, repetitive, indistinctutterance with frequent telescoping of words,unaccompanied by fear, anticipation, any senseof difficulty with specific words or sounds or evena detailed awareness of speaking abnormally.

It has long been noted that stuttering andcluttering frequently appear in the same person.



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Weiss in 1934 advanced the hypothesis thatstuttering essentially always has its onset as areaction of effort or struggle for the purpose ofovercoming cluttering.

Later in 1964 he employed a broader definitionof cluttering than is usual, reflected that thedifference between cluttering and Blumelsprimary stuttering was largely one of

nomenclature



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2.Diagnosogenic theory



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According to this theory the disorder is usually

caused by a parents diagnosis of normaldysfluencies in childs speech as stuttering.

Bluemel, Froschels and others Developed

stuttering, reaction relatively simple repetitionsin young stutterers.

Froschels, noted the similarity of these

repetitions to those of many normal childrenduring the early years of speech development



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According to Johnsons theory, it was notexcessive hesitancy that usually caused a child to

develop anticipatory reactions of struggle or

avoidance, but abnormal parental reactions to

this hesitancy.

Others had termed primary stuttering was not a

disorder to be treated. It was a normal attribute of

speech that was to be prevented from giving riseto stuttering by alerting the parents evaluation of

it.



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Johnson (1934) found that majority of the

descriptions offered were confined to

-- brief, effortless repetitions of syllables, words,

and phrases of which the child was unaware,

He inferred that these descriptions were similar

to speech hesitations of most ordinary children



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Johnsons findings, may stand as a formal

statement of his theory:

Practically every case of stuttering was

originally diagnosed as such, not by a speech

expert, but by a layman- usually one, or both of

the childs parents.

What these laymen had diagnosed as stuttering

was, by and large indistinguishable from the

hesitations and repetitions known to be

characteristic of normal speech of young

children. Stuttering as a definite disorder was found to

occur, not before being diagnosed, but after

being diagnosed (Johnson, 1944).



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According to Johnson, stuttering

generally began not in the

childs mouth but in the

parents ear.

This was not, however, because the

parents were necessarily as

aberrant in their perceptions of

reality as this might seem to imply.



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Evidence show that most young children arerelatively disfluent and that parents of stutterersoften tend to be dominating, overanxious, or

perfectionisic.

But Johnson's basic premise that on the date oforiginal diagnosis, stuttering children may speakin a manner that is not always to be clearlydifferentiated from that of other children of likeage who have not been diagnosed as stutteresis difficult to verify by means of an objectivescientific test.

Attempts to confirm it, based upon intensiveinterviewing of parents in case of recent onset ofthe problem.

KUNNAMPALLIL GEJO JOHN

,BASLP, MASLP


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3.Theory of

communication pressure


,BASLP, MASLP


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If stuttering is based upon the childs beliefin the difficulty of speech, there would

appear on the surface that there might not

be other sources from which stuttering

might stem.

scattered references in the literature on

stuttering for this kind to the problem of

the onset of stuttering was made by

Bloodstein (1958; 1975) on the basis of a

clinical study of 108 stuttering children.


,BASLP, MASLP


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It usually begins as a response of tension and

fragmentation in speech, not sharply different

from certain types of normal disfluency, and is

brought about largely by the provocation pf

continued or severe communicative failure in thepresence of communicative pressure.

This hypothesis finds its most significant

elaboration with reference to the variety offactors that may contribute to a childs conviction

that speech demands unusual effort or

precautions.KUNNAMPALLIL GEJO JOHN

,BASLP, MASLP


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This theory can be summarized by thestatement that stuttering is caused by

communicative failure as perceived by the child.

From certain stand point it may be seen as a

generalization of the two anticipatory struggle

theories which are described previously.

It differs from them, however, in denying that

either a diagnosis of stuttering or the occurrence

of excessive repetitions in a childs speech isnecessary in order for anticipatory struggle

reactions to develop.


,BASLP, MASLP


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Stuttering as an learned

behavior


,BASLP, MASLP


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According to this point of view, stuttering has its

origin in the early fumbling and hesitancies and

interruptions which seem to be a natural and

common phase of the speech learning process.

Rather he/she does a form of maladaptive

behavior that is somehow learned.


,BASLP, MASLP


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These learning theories have lent themselves to

a number of systematic statements about

stuttering.

In general, the aim of such statements has been

to make use of the relatively precise language of

behavior science in order to try to define the

process by which stuttering is learned and

maintained by identifying the motivationalfactors, stimulus variables and reinforcing

conditions


,BASLP, MASLP


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1.Stuttering as an

instrumental avoidance act


,BASLP, MASLP


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proposed by Wischner (1947; 1952).

Wishner based his formulations on twoobservations that had been the subject of

considerable earlier research.

One of these was the adaptation effect and theother phenomenon of expectancy or anticipation,

which he equated with anxiety.

Drawing an analogy between the tendency forstuttering to decrease with successive readings

of the same passage (adaptation) and

experimental extinction of a learned response.


,BASLP, MASLP


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One of the best documented facts aboutstuttering is that, as a group, individuals who

stutter show a decrease in stuttering frequency

of approximately 50% across five repeated

readings of the same material- a phenomenon

known as the adaptation effect

(Johnson; Brown; Curtis; Edney & Keaster, 1967;

Johnson & Knott, 1937; Van riper & Hull, 1955).


,BASLP, MASLP


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Frank & Bloodstein (1971) reported thatstuttering frequency during a solo readingfollowing 5 unison readings was not significantly

different from that during the last reading of a

conventional adaptation procedure with six solo

readings.

Their finding, that the relatively fluent unison

readings and the more disfluent solo readings

resulted in similar reductions of stuttering

frequency, demonstrated that overt stuttering is

not later required for adaptation to occur.


,BASLP, MASLP


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The proposed motor learning hypothesis ofstuttering adaptation maintains that reductions instuttering frequency during repeated oralreadings can be attributed to improvements inspeech motor skill resulting from repeatedpractice of the same sequences of articulatory

and phonatory movements.

The increase in the speed of performance duringmotor learning is an interesting phenomenonthat may prove useful as a first test of Max et

als (1997) motor learning hypothesis ofstuttering adaptation.


,BASLP, MASLP


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This reasoning is based on the fact that the

increase in speed of performance duringimprovements in non speech motor behaviorrepresents change in the opposite direction ofthe changes that are known to be associatedwith many conditions of reduced stuttering.

Increase in fluency as a result of various typesof stuttering treatment also have been reportedto be associated with a decrease in speech orarticulation rate (Story; Alfonso; & Harris, 1996)or an increase in the duration of acoustically orkinematically defined segments (Mallard & Westbook, 1985; Mc clean, Kroll & Lofrus, 1990).


,BASLP, MASLP


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Adaptation Of Stuttering Frequency

During repeated Readings: Associated

Changes In Acoustic Parameters OfPerceptually Fluent Speech

Authors:Ludo max & Anthony J Caruso

JSLHR; Vol:41; Dec98


,BASLP, MASLP

Study was conducted 8 individuals who stutter


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Study was conducted 8 individuals who stutter

It revealed that speech adjustments occurringduring adaptation differ from those reported forother fluency enhancing conditions or stutteringtreatment.

During the last 6 repeated readings, a statisticallysignificant increase in articulation rate wasobserved, together with a decrease in wordduration, vowel duration, & consonant- vowel (CV)transition extent.

Other adjustments showing relatively consistenttrends across individual subjects includeddecreased CV transition rate & duration, &increased variability of both CV transition extentand vowel duration.


,BASLP, MASLP


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One of the central problems in the application of

learning principles to stuttering is to explain the

nature of the reinforcement that causes it to

persist in the face of repeated punishment.

Wischner posited that this reinforcement

consisted of a reduction in the stutterers anxiety

following the block.

Prior to the moment of stuttering there was a

building up of expectancy, or fear.KUNNAMPALLIL GEJO JOHN

,BASLP, MASLP


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The immediate effect of stuttering was a

reduction of this tension.

Although the block had punishing

consequences, Wischner pointed out that these

did not follow as immediately on the termination

of the block as did anxiety reduction.

Consequently, the stuttering behavior was

reinforced rather that extinguished


,BASLP, MASLP


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Wischners main analysis clearly consisted inpart of a reformulation of Johnsons concept ofthe moment of stuttering as an anxiety motivatedavoidance reaction.

He referred to Johnsons diagnosogenic theoryas tenable instigators to anxiety in the stutterermight be found in parental disapproval of normaldisfluency


,BASLP, MASLP


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2.stuttering as approach

avoidance conflict


,BASLP, MASLP


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Sheehan (1953; 1958) viewed stuttering

primarily as the resultant of a conflict between

opposing drives to speak and to hold back from

speaking and developed an interpretation of the

moment of stuttering based on Neal E millersresearch and theoretical formulations on

approachavoidance conflict in animals.


,BASLP, MASLP


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Miller (1944) showed that as a hungry ratapproaches a food trough at the end of a runwayits motivation to reach the food steadilyincreases.

It is possible to measure the strength of itsapproach drive and to show by means of asloping line precisely it increases with nearnessto the goal.

If electric shock is substituted for the food the ratflees. The farther it gets from the feared object,the weaker becomes its motivation to avoid it


,BASLP, MASLP


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This declining avoidance drive may also berepresented by a sloping line, or gradient.

If electric shock & food are combined, together

with the appropriate cuestimuli by which therat may recognize their presence, the element ofconflict is introduced.

In such a situation the approach and avoidancedrive are present together, and it is possible torepresent this by showing both gradientssuperimposed on the same field.


,BASLP, MASLP


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The gradient of avoidance is steeper than thegradient of approach.

As a result, if the opposing drives are of about

the same average strength, at a certain distancefrom the goal the two gradients will intersect.

This fact has some rather significantimplications. Before the point of intersectionreached, the approach gradient is higher thanthe avoidance gradient, and the rat could beexpected to run toward the goal.


,BASLP, MASLP


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He stated that stuttering was basically anapproachavoidance conflict.

Whenever stutterers urge to speak was

distinctly stronger than their desire to avoidspeech, they spoke fluently.

When avoidance of speaking was the clearlydominant drive, they were silent. But when theirapproach and avoidance drives were in relativeequilibrium, so that the gradients crossed, theystuttered


,BASLP, MASLP


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Sheehan offered the hypothesis that once theblocking had begun to take place the fear thathad elicited it became reduced, the avoidancedrive was consequently decreased, and so theconflict was temporarily resolved.

He theorized further that the stutterersconflicting feelings of approach and avoidancetoward speech tended to be complicated by

similar attitudes toward silence, and he pointedout that this, too, had its counterpart in thelaboratory which Miller termed double approach

avoidance conflict.


,BASLP, MASLP

Sheehan postulated 5 distinct levels on which


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Sheehan postulated 5 distinct levels on whichspeech avoidance drives might operate. Hestated that these drives might emanate from

Reaction to specific words, resulting principallyfrom past conditioning to phonetic factors.

Reaction to threatening speech situations.

Guilt & anxiety concerning the emotional content

of speech. Feelings of anxiety in the stutterers relationships

with listeners, especially when these are seen asauthority figures, and

The egodefensive need to avoid competitiveendeavors posing threat of failure or threat ofsuccess.


,BASLP, MASLP


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This clearly suggests that

stuttering may have its origin

both in the learning of speech

anxietiesand in unconsciousfactors of personality.


,BASLP, MASLP


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Perkins (1953) pointed out that the logicalimplication of the conflict hypothesis was that thestuttering block itself was not learned behavior.

Both Sheehan (1951) and perkins (1953)attempted to determine the effect on stuttering ofnon reinforcement, which they defined by aprocedure in which the subjects repeated eachstuttered word until they could say it normally,

and obtained somewhat conflicting results.


,BASLP, MASLP


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3. Stuttering as

operant behavior


,BASLP, MASLP


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Flanagan, Goldiamond & Azrin [1958 ]concluded that they had been able to reduce the

stuttering of three laboratory subjects.

These reports suggesting that stuttering andnormal disfluency could be brought under

operant control did much to arouse interest in

investigating these behaviors by applying the

conditioning principles of B.F skinner.


,BASLP, MASLP

I Ski t f b h i l l i


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In Skinners system of behavioral analysis, acentral role is played by the kind of response,termed an operant that is capable of being

increased or decreased through itsconsequences as they affect the organism.

Given behavior consists essentially of aspecification of the contingent consequencesserving to reinforce and maintain it as aresponse to certain occasioning stimuli.

This reinforcement is described as positive

when it consists of such a stimulus as a pellet offood or as negative when it consists of anaversive stimulus such as shock.


,BASLP, MASLP


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They hypothesized that when a childs nonfluent responses are punished the child may

respond by changing the form of nonfluency to

struggle or silence.

This changes reinforced by the termination of

the aversive stimuli of nonfluency (negative

reinforcement), but may occasion new

punishment are also occasioned by the fact thatstutteres tend to become their own listeners.


,BASLP, MASLP


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There are certain positive reinforcements forstuttering.

The child may gain attention or may use

stuttering as an excuse for failure or inadequacy.

This reinforcement is likely to be particularlystrong because of the variable schedule onwhich it is usually given, responses intermittentlyreinforced being particularly resistant toextinction.


,BASLP, MASLP


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Various other workers have made of the operantmodel in connection with stuttering.

For the most part, however, they have been less

concerned with etiological theories than withexperimental demonstrations of the operantnature of stuttering and disfluency.

The result has been a considerable amount ofresearch on punishment in relation to stuttering.


,BASLP, MASLP


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4. stuttering as conditioned

disintegration


,BASLP, MASLP


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Brutten & shoemaker (1967) theorized thatstuttering in its integral aspects is a failure ordisruption of fluency resulting from emotionalarousal that has become associated with speechand speech related stimuli through a process of

classical conditioning.

From this point of view the stuttering blocks notoperant, but respondent, behavior.


,BASLP, MASLP


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Most investigators of the learning processrecognize at least a rough distinction between 2kinds of learning, one based on operant orinstrumental conditioning and the other onrespondent or classical conditioning.

Classical conditioning is represented by the wellknown pavlovian experiment.

Classical conditioning plays a important part inthe learning of anxiety reactions or othermotivational states of automatic arousal.


,BASLP, MASLP

Cl i l diti i f th t tt i f th


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Classical conditioning for the stuttering from thepoint of view of Brutten & Shoemaker.

They based their theory on the observation thatin normal speakers stress may produceautomatic reactions capable of disruptingspeech fluency.

They suggested that a further, or advanced,stage of stuttering comes into being throughpenalties the child receives for abnormal speechbehavior.

As a result of such punishment, the act ofspeaking itself, or the words employed, come toelicit conditioned negative emotion, & in time theconditioned stimuli for fluency failure may for thisreason consist increasingly of speech

associated cuesKUNNAMPALLIL GEJO JOHN

,BASLP, MASLP


81/82

Other writers find it very difficult to accept theview that the initial fluency breaks are operantly

conditioned.

The very consistency of the core behaviorsstutteringthe syllabic repetitions and fixationsor prolongations that are found in all stutteresand that in young children seem to constitutemost of the abnormality seem to indicate thatthese are precipitated rather than learned.

Accordingly, Brutten & Shoemaker & others haveheld that this core behavior occurs as a result ofemotionally induced breakdown in coordination


,BASLP, MASLP


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theoretical perspective of stuttering.pdf / kunnampallil gejo john

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