Stuttering 55performed. Walter was prescribed muscle relaxants, but they did not help him talk more fluently;
they simply caused him to be lethargic and were stopped. Fi nally, in a special conference with his
parents, teachers, case man ag ers, and social workers, it was agreed that a decision was needed on
whether Walter would ever talk normally.
You have been authorized to make that determination, by which every one involved in Walter’s
stuttering will abide. You have 1 week to make this impor tant decision.
You conduct a series of evaluations. Walter is pleasant and cooperative as you try dif fer ent
therapies. You discover that he is unable to achieve any type of fluent speech for more than a few
seconds. Try as he may, he simply cannot modify his speech consistently to reduce or eliminate the
dysf luencies. You reward easy contacts, slower rates of speech, and even speaking with a Southern
drawl. You show Walter how to relax his speech muscles and how to make each sound easily and
gently. But it is to no avail; Walter is incapable of a minimum of f luent speech even in a controlled
clinical setting. No therapy can create the necessary level of f luency to be rewarded, expanded,
and, hopefully, generalized.
Fi nally, in a last- ditch attempt, you set up a delayed auditory feedback (DAF) device. This
instrument has settings allowing the speaker’s auditory feedback to be delayed by a fraction of
a second. You place the earphones over Walter’s ears, set the delay to maximum, and have him
discuss story pictures. DAF causes normal speakers to be dysfluent; they have more repetitions,
hesitations, and prolongations, and the longer the delay, the more dysf luent they are. Walter also
displays increased dysf luencies because of the maximum delay. (You are disappointed that he does
not have near- f luent speech, as do some persons who stutter under the conditions of DAF.) After
allowing him to discuss the story pictures with the maximum DAF, you gradually reduce the delay,
hoping that Walter will have adjusted and consequently will be more fluent. Then, gradually, you
can reduce the delay to real time. If the theory works with Walter, you will have the necessary
f luent speech be hav iors to reward. You have found that persons with low intelligence quotients
respond better to be hav ior modification than to many other types of stuttering therapy, which
require high levels of psychological and intellectual participation that are beyond the reach of
many individuals with intellectual disability. Using be hav ior modification, you can gradually get
Walter to be more and more f luent in controlled situations, and hopefully over time, generalize the
be hav ior to all speaking situations.
Unfortunately, Walter is unable to achieve the level of f luency necessary for operant condition-
ing. Although he becomes more f luent by gradually reducing the DAF, it is not enough, nor can he
maintain it, even when rewards are given for each f luent utterance. You try several variations of
delaying the auditory feedback, but they, too, are unsuccessful. It appears that you, like the many
previous clinicians, cannot make meaningful and per sis tent gains in Walter’s speech fluency. You
and Walter discuss your belief that stuttering therapy should be terminated permanently, and you
find that he agrees. In your report, you state that the time has come for Walter to learn to accept
his stuttering rather than trying futilely to overcome it.