50 Chapter 3
Treatment of Stuttering
Several methods of evaluating and treating stuttering exist. Some clinicians separate stuttering
into core and accessory features. The core features are the repetitions, prolongations, and blocks
in speech, and the accessory or secondary features are eye squints, hand slaps, head jerks, and
the like. Other clinicians evaluate and treat overt and covert symptoms of the disorder. The overt
symptoms are the disruptions in speech f luency, and the covert features are the anxiety reactions,
embarrassment, shame, and guilt that many persons experience while stuttering. In children, true
stuttering is often differentiated from normal nonf luencies and incipient stuttering. One way of
eva luating and treating stuttering is to separate t he sy mptoms of t he disorder into (1) what is heard;
(2) what is seen; (3) what is felt by the person before, during, and after the moment of stuttering;
and (4) the effects of the disorder on the person’s personality (Tanner, 1994, 1999b, 2003c; Tanner
et al., 1995). Each of these symptoms provides a framework for evaluation and treatment of this
complex communication disorder. This eclectic treatment approach incorporates several popu lar
therapies, including be hav ior modification, f luent stuttering, desensitization, and counseling.
Stuttering: What Is Heard
The audible symptoms of stuttering are repetitions, prolongations, and blocks. Repetitions
occur on sounds, syllables, and words. For example, a stuttering person may say, “s, s, s, Susan” or
“Please pass the coff, coff, coff ” or “I want, want, want.” Repetitions can also occur on phrases, for
example, “I want to, I want to, I want to go outside.” Prolongation is the “stretching out” of certain
speech sounds, usually continuants. For example, the word “soup” might be said as “ssssssssss-
soup.” Blocks are silent gaps or pauses between or within words, such as, “May I [pause] have some
pop [pause] corn?” Many persons who stutter have a combination of repetitions, prolongations,
and blocks.
There are several techniques for managing the audible symptoms of stuttering. The f luent
stuttering approach and the Van Riper approach are widely used. The goal of f luent stuttering is
to have the person who stutters do so less abnormally. Early in the treatment of stuttering, it was
found that if persons who stutter are admonished for the be hav ior and attempt not to stutter, often
the result is an increase in the frequency and severity of the disorder. In f luent stuttering therapy,
the person is permitted to stutter but is taught to do so unobtrusively. According to Hedge (2001),
Van Riper’s approach is “[a]n extensive, early, and inf luential treatment program for stuttering;
also described as stuttering modification therapy; [the] goal is to teach less abnormal, socially
more acceptable stuttering, not necessarily normal f luency” (p. 487). When persons who stutter
become proficient in this technique, many can modify their stuttering to the extent that the audi-
ence is unaware of the audible symptoms of stuttering.
Stuttering: What Is Seen
The vis i ble features of stuttering are highly individualized avoidance and escape be hav iors.
They are used by the person who stutters to avoid the moment of stuttering or to escape from it
once it occurs. As noted earlier, they can include head jerks, inappropriate eye blinks, lack of eye
contact, hand slaps, inappropriate articulatory gestures, biting the lips, turning the head, twisting
the trunk, and others. Many of these be hav iors are learned over time and become integral parts
of the stuttering pattern. In many persons who stutter, as the stutter increases in severity, they
activate more avoidance and escape be hav iors. These be hav iors also ref lect the order in which they
were learned; the first- learned be hav iors are activated first, the second- learned ones are activated
next, and so forth.
The vis i ble features of stuttering can be changed through be hav ior modification. In adults,
often it is only necessary to bring negative vis i ble be hav iors to their attention. This can be done
by videotaping speech segments or by having them observe their face and upper body in a mirror