48 Chapter 3
The treatment approaches for these operantly conditioned be hav iors consist of removing rewards
for stuttering and rewarding normally f luent speech patterns.
The classical conditioning theory suggests that stuttering is the result of disruptive effects of
anxiety during speech (Brutten & Shoemaker, 1967). According to this theory, anxiety disrupts the
fine motor functioning of speech muscles and causes dysf luencies. Because of classical (Pavlovian)
conditioning, the individual experiences anxiety in connection with certain sounds, words, situ-
ations, and persons. The anxiety is generated from within because of verbal impotence and from
the audience because of ridicule. Both external and internal sources of anxiety are paired with the
stuttering stimuli, and a vicious cycle of stuttering and anxiety is set in motion. According to the
classical conditioning theory, the therapy for stuttering consists of systematic desensitization in
much the same way that other anxiety- based disorders are treated.
These learning theories of stuttering have two major differences in their assumptions about
the disorder. First, they differ on the nature of the dysf luencies. The operant theory considers the
dysf luencies to be excessive normal disruptions of speech output. The classical theory believes
them to be abnormal dysf luencies resulting from the disruptive effects of anxiety and other nega-
tive emotions. Second, although classical models of stuttering acknowledge the effects of reinforce-
ment on be hav ior, they focus primarily on stimuli— the factors that prompt stuttering. Conversely,
although operant models acknowledge stuttering stimuli, they focus primarily on effects— the
rewards and punishments for episodes of stuttering.
Because no single theory about the etiology of stuttering has been accepted after nearly a
century of research, it is likely to have multiple causations. Some persons may develop stuttering
because of a psychological shock or trauma. For example, soldiers in combat sometimes develop
stuttering because of extreme stress. Other persons may have learned to stutter. For them, it is a
self- perpetuating bad habit that is difficult to break. There is prob ably a ge ne tic basis to stuttering,
and some children may be born with a predisposition to this disorder. In many patients, ge ne tics,
learning, and psychological prob lems may work together to cause stuttering. Stuttering is a com-
plex communication disorder, and so is the search for its cause or causes.
Diagnosing Stuttering in Children
Bloodstein (1995) reports that about 5% of the population has stuttered at some point in
their lives. According to the Stuttering Foundation of Amer i ca (2015), roughly 75% of children
who start to stutter become normally fluent by late childhood. Many more children than adults
go through periods of excessive dysf luencies but do not consider themselves to have a stutter.
Parents frequently become concerned that their children may be developing a stutter. For these
reasons, speech- language pathologists, particularly those working in educational settings, often
must screen and evaluate large numbers of children to see whether their dysf luencies are normal
or if they are developing a stutter. Diagnosing stuttering in children is a complex, impor tant, and
necessary professional responsibility and is part of the scope of practice for all speech- language
pathologists.
Although no clinician wants to make diagnostic mistakes, two types of errors can be made
when diagnosing stuttering in children. First, a clinician can make a false- positive diagnosis and
decide that a child is stuttering when, in fact, this is not so. The child may be going through a
period of excessive dysf luencies, and his or her parents and teachers may be concerned about them.
However, in real ity, the dysf luencies, although excessive, are normal and temporary. Eventually,
the child will outgrow them and display normal nonf luencies typical of all speakers. The second
type of mistake is the false- negative diagnosis in which the clinician believes that the child is
normally nonf luent and will eventually outgrow the excessive dysf luencies. In real ity, the child is
stuttering.