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THEORIES. $PEC1HC TH'ERAPlES AND
TECHNlQUES FOR USE iN
CASES OF STUTTERING

Thai: for the Degree oi M. A.
MICl-flGAN STATE COLLEGE

Lulu lohnsan Alonso
1950

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This .is to certify that the "

thesis entitled

THEORIES. SPECIFIC THERAPIES
AND TECHNIQUES FOR USE WITH
GASES 0F STUTTERING “.

has been accepted towards fulfillment
of the requirements for

u. A. degree in $289011

  

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presented by '
Lu1u= éohnsonmnnso

 

 

Major professor

; Date Aug. 12, 1950

 

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T3301 33, SPECIFI TTEEDAPIIBS AW) T‘ECIU’IQUES

FOR USE IT CASES OF STUTTERING

B‘J

Lulu Johnson Alonso

A THESIS

Submitted to the School of Graduate Studies of Tichigan
State College of Agriculture and Applied Science
in partial fulfillment of the requirements
for the degree of

R '1'? "I A . ma
quSTJh—I‘: C... “2.3

Department of Speech, Uramatics, and Radio Education

1950

1 c;

ACKI’ CTCL 339‘ 731’

The appreciation of the author must be
extended to "iss Lucia Torgan, who has patiently
guided and encouraged me throughout this study.

Special mention is due Dr. Charles Pedrey
and Dr. Donald Hayworth for their many valuable
suggestions.

Acknowledgment is herewith made to Dr.'flilson
F. Paul, who has been a constant source of inspira-
tion, and to ?rs. John Goodwin for her work in
typing the manuscript.

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CHAPTER . PAGE
I. T'mPLO'I TA’DDII‘ILICISCF TSLT'S USED............ 1
The Problemooooooooooooooooccoo-00.000000000000000 2

Statement of the problem....................... 2
Importance of the study........................ 2

jefinitiop-S Of tems usedOOOOOOOOOOOOOOOOOO0...... 2

Stuttering....................................o

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TheorieSOOOOOOOOOOOO0...OOOOOOOOOOOOOOOOOOOOOOC

Specific therapies and techniques..............

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Organization of the thesis........................ 3

Brief history and present status of the problem... 4

II. FETIEJ OF THE LITEZATTRE............................. 9
Literature on causes and treatment of stuttering.. 9

III. TEE TAT EEIALS F339 AND PKCCE JUEiS..................... 20
T'aterials and methods used........................ 20

IlettcrOQ000......0.0.0....00.00.000.00000000... 21

Questionnaire.................................. 22

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BIBLIOGRAPHYOOOOOOOOIOOO00......0......OOOOOOOIOOOOOOOOOOOOC 151

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APPmTDII-OOOOO00.000.00.000..00.0.0.000...OOOOOOOOOOOOOOOOCOO 156

TABLE

II.

III.

IV.

PAGE
Causes of Stuttering........................ 27
Summary of the Causes of Stuttering......... 70
Treatment of Stuttering..................... 72

Summary of the Treatment of Stuttering...... 132

CILIPI‘ER I

THE PRChLK.’ A???) DaillTITICl'TS 017‘ T3133 T7831)

THE PRCBLEM.AND DEFINITION OF TEENS USED

Stuttering, stammering, spasmophemia, dysphemia, speech block-
ing, or whatever one might prefer to call this disorder, has been a
problem throughout the ages, probably since man first began to speak.
History gives us records of its impartiality in striking the rich and
poor, the great and humble, alike. Stutterers have accepted their
share in the carving of the destiny of humans, for there are stutterers
among kings, ministers, physicians, orators, warriors, poets, artists,
authors, and statesmen.

Today, even though the stutterer continues to outnumber the
deaf, the blind, and the feeble-minded, we can neither tell these suf-
ferers what causes stuttering, nor can we advise a positive cure. When
one becomes aware of the contradictions among even the authorities in
the field, it is easily understood why the beginning speech correction-
ist feels at a loss when confronted with a stutterer.

Speech Correctionists can expect to work with stutterers in both
the public schools and clinics, so it seemed advisable, even though
there is an abundance of published material on the theories of stutter-
ing, to find out what established speech correctionists believe to be
the causes, and what therapeutic practices they employ. The author
felt that by collecting in one volume the unpublished theories, thera-
pies and techniques, and by making available an annotated bibliography
of published material, that a needed contribution could be made to the

field.

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da‘

I. THE PROBLEM

The purpose of this study, then, is to bring together theories,
specific therapies and techniques used by established speech correction-
ists in the field of stuttering at the present time, in addition to

making available an annotated bibliography of published material.
II. DEFINITION OF TERTS USED

Stuttering. There are many definitions of stuttering, the most

 

common being that it is a disorder in the fluency or rhythm of speech,
with repeated words, phrases or sounds, or blockages or other hesi—
tancies. Dr. Wendell Johnson, in collaboration with Dr. Spencer Brown,
Dr. James Curtis, Dr. Clarence W. Edney, and Kiss Jacqueline Keaster,
has arrived at the following definition: "Stuttering is an anticipatory,
apprehensive, hypertonic avoidance reaction."1

Dr. Charles Van Riper states:

...It is difficult to define or describe stuttering.

The flow'of speech is broken by hesitations, stoppages, or

repetitions and prolongations of the speech sounds.

Fluency is interrupted by spasms, contortions, tremors, or

abnormalities of phonetion and respiration. It consists

of moments of speech interruption of such frequency and

abnormality as to attract attention, interfere with com-
munication, and produce maladjustment....2

 

. 1 Wendell Johnson, Spencer F. Srown, James F. Curtis, Clarence
'W. Edney, and Jacqueline Keaster, Speech Handicapped School Children,
New York: Harper and Brothers, 1948, p. 182.

 

Charles Van Riper, Speech Correction Principles and Methods,
New York: Prentice-Hall, Inc., 1947, p. 17.

west, Kennedy, and Carr use the following definition:

There is some point in considering dysphemia as the
psychophysical complex of which stuttering is the outward
manifestation....Dysphemia is the condition; stuttering
is the manifestation of that condition....8tuttering is a
phenomenon; dysphemia is an inner condition.3
Theories. Theories refer to the beliefs that an individual holds

as to the cause or causes of stuttering. Different authorities, after
working with stutterers, came to certain conclusions based on observa-
tion, testing, case histories, and research. Probably all speech cor-

rectionists have their own belief, or theory, as to causation.

Specific therapies and techniques. Specific therapies and techni-

 

ques refer to all of those methods or means used by the correctionist to

effect adjustment on the part of the individual who stutters.
III. ORG NIZATION OF THE THESIS

Charts. Charts are used to ShOW’What the established speech cor-
rectionists feel to be the causes of stuttering, and to show what
therapies and techniques these participants employ to effect adjustment.
The charts listing the causes of stuttering precede the text comments
of the correctionists. Following the latter are the charts summarizing
the number of speech correctionists cooperating in this study who hold
these various theories. The charts listing the therapies and techniques
used when treating stuttering also precede the text comments of the

correctionists. Following these text comments on therapies and techniques

 

3 Robert'West, Lou Kennedy, and Anna Carr, The Rehabilitation of
Speech, New York: Harper and Brothers, 1937, p. 53.

 

are the charts summarizing the number of speech correctionists who
utilize these various therapies and techniques. The order of the mater-
ial on the charts corresponds to the order set down on the questionnaire.

Grouping of Material. The author has grouped the causes of stut-

 

tering that are similar to each other. The purpose is for clarity and
understanding. Therefore, the material on causation will be in different
order than it appears on the charts.

Comments relating to each cause listed on the questionnaire by
outstanding speech correctionists in the field, who have many publica-
tions to their credit, can be found in the review of the literature.

The author does not imply by this inclusion that these comments on causes
are in any way related to the beliefs of the people cooperating in this
study. They defined each cause for themselves, and answered according
to their own definition.

Annotated Bibliogfaphy. A carefully planned annotated bibliography,

 

which will be helpful to speech correctionists, can be found on the latter

pages of this thesis.
IV. BRIEF HISTORY AND PRESENT STATUS OF THE PROBLEM

Probably the first reference to stuttering would be in the Bible
when the great lawgiver, Moses, desiring to escape a mission offered to
him, stated, "I am slow of speech, and of a slow tongue." f

Hr. Stanley.A. Jacques, writing in the magazine, Speech,4 makes

 

4 Stanley A. Jacques, "The Story of Stammering." Speech, 2:17-19,
T-'a,y, 1938; 3:39-42, October, 1938; 5:20—23, April, 1939.

reference to stuttering and its treatment through the ages, which the
writer will summarize.

In the ancient Greek vocabulany we find a great variety of terms
relating to stammering; from this we can well assume that stuttering was
prevalent among the ancient Greeks. Herodotus (484 B.C.) says that
Therean Battos, who had been a stutterer from his youth, consulted the
oracle at Delphi. In Roman literature, stuttering was equally classed
with mental and physical deformities and peculiarities.

Throughout medieval times, very little reference was made to stut-
tering until about 1584 when Mercurialis added systematic exercises of
body and voice to the usual medical treatments. In this era are many
references to stuttering in Shakespeare's works, as in 'As You Like It:.
”I prythee take the cork out of thy mouth that I may drink thy tidings."
About this time, too, quite a few comedies were written and produced
which ridiculed and mocked stutterers, a practice which seemingly was
well taken by the public. we can still find this form of entertainment
in our present day.forms of amusement.

Mercurialis placed the seat of the trouble of the stutterer in I
the brain; this was a great advance, according to Mr. Jacques, in the i
progress of research in stuttering, and started an era of research on E
a more scientific basis. However, not much progress is recorded until i
the nineteenth century when actual cures were recorded by a combination
of physical and psychical treatments.

In 1841, Dr. Dieffenbach performed several operations on the
tongues of stutterers, which seemed to have been successful in alleviat-i

ing the stutterer's difficulty. Immediately, ambitious surgeons began

cutting at different organs that may have some effect on the speech dif-
ficulty, each in hopes of being the first one to have the honor of doing
a new type of operation. Sedical journals of that year are full of
articles with the controversy in regard to this type of surgery. After
many patients bled to death, and after stuttering returned to those who
survived the operation, surgery was permanently discarded as a means of
cure. Mr. Jacques points out: "This wave of surgery did a great deal
of good in that it brought stammering before the public eye, and from
that time on, we find in medical journals many articles on research work
in stammering."5

The tongue was the organ which got the brunt of this surgical fad.
Mr. Jacques describes some of the different types of operations which
stutterers went through:

1. The Genio-glossus, the muscle at the root of the tongue, was
cut through from the inside of the mouth.

2. The genio-glossus muscle was cut through from.the outside
under the mandible. The purpose was to make the tongue longer.

3. The frenum linguae, the musous membrane fold under the tongue,
was cut.

4. The sublingual mucous membrane, the membrane on both sides
of the frenum, was cut.

5. A subcutaneous transverse section was cut at the root of the

tongue through a puncture in the mucous membrane.

 

5 Ibid., p. 39.

6. A transverse triangular slice was cut from the top of the
tongue throughout the width and sewed up to make the tongue shorter.

7. The uvula, the piece of muscle at the upper rear of the mouth
and at the end of the palate, was cut off.

8. The palatine arches, the part of the arch at the rear of the
mouth and on either side of the uvula, were cut.

9. The anterior fauces that cover the anterior surface of the
tonsils were cut.

10. The tonsils were removed.

11. The adenoids were cut out.

12. The hypo-glosal nerve, the cranial nerve which feeds the
tongue, was severed.

13. .The tongue was pierced with hot needles and blistered with
croton oil.

The purpose of the operations was to relax the muscles used in
articulation.

The earliest reference to surgery being used to relieve stutter—
ing was in the year 600. AEtius recommended the division of the frenum.
Hildanus, in 1608, used the same method. In 1336, De Charliac used the
method of forming blisters on different parts of the head and neck, in-
'cluding the tongue. This temporarily improved speech, since the pain
was so great that it served as a distraction. This method remained popu-
lar for several centuries after that.

Alfred Appelt, in his book The Real Cause of Stammering and Its

 

_§ermanent Cure, offers us a good explanation of this temporary benefit

 

which stutterers experienced.

In surgical methods for the treatment of stammering, a
decrease in stammering undoubtedly did take place in a series
of cases, and we ourselves have noticed temporary improvement
after operations for other purposes, and after illnesses,
especially during the convalescent stage. Exhaustion and re-
laxation, particularly of the organs connected with speech,
offer an explanation of that phenomenon. A rational therapy
must decline to accept such data, since an improvement which
may possibly become apparent immediately after the operation
contains no guarantee of permanency. Any slight improvement
which may take place is not due to the operation; rather it
is due to auto-suggestion on the part of the stammerer who,
buoyed up by the hope of relief at the surgeon's skillful
hands, momentarily experiences that relief.6

"The American.Cure" based its treatment on having the stutterer
hold his tongue high in the mouth. Hrs. Leigh, in 1825, perfected this
"secret cure."

In France, meanwhile, Gregoire recommended smoking as a sedative
for the vocal cords, while Gerdts of Germany administered tincture of

peppermint oil and chloroform in the attempt to control the spasms.

Even the great Dr. Osler makes reference to stuttering: "Bloch,

in his monograph, 'Die Pathologie und therapie der mundathnug, lays

 

great stress upon the association of mouth breathing with stuttering."7

It has been during the twentieth century, however, that more
scientific methods have been applied to the treatment of stuttering.
Various theories have been expounded, many studies have been made, and
books, articles, and pamphlets are readily available.

Despite the advancements made, however, we are still trying to
solve the problem of stuttering. If this study brings us any closer to

a better understanding of the phenomenon, it will well serve its purpose.

6 Alfred Appelt, The Real Cause of Stammering and Its Permanent
Cure, New York: E. P. Dutton and Company, Inc., 1929, p. 95.

 

7'William.Osler, The Principles and Practice of Vedicine, New
York: D. Appleton and Company,“1895, p. 367.

 

C

tiAPT E.

\1

CHAPTER II
REVIEN OF THE LITERATURE

Much has been written about stuttering, its incidence, theories
as to causation, and corresponding therapies, the latter being extremely
brief. Therefore, only a brief summary as to causation of stuttering
will be included here. The author will include each theory, and the
reader must remember that for each theory, the originator has preScribed
a certain therapy.

Heredity. Several authorities in the field hold that heredity is

a cause of stuttering.

Dr. James S. Greene, Vedical Director of the National
Hospital for Speech Disorders, New York City, places the
individual who demonstrates stuttering speech in what he
terms the 'stutter-type group.‘ The individuals in this
group are characterized by a basic tendency toward excit-
ability and disorganization, an exaggerated capacity for
response to stimuli, and a relatively high potentiality
for the spread of emotional tension...The stutterer's pre-
disposition to emotional instability and disorganization
appears to be a hereditary trait, since more than seventy
per cent of Dr. Greene's patients show a family history of
stuttering.8

On the other hand, Dr. John W. Fletcher of Tulane University,

well-known exponent of the psychological theory of stutterinr

0’

has this

to say of heredity:

The claim.that stuttering per se is hereditary lacks
confirmatory evidence. Such evidence would require that
stutterers in sufficient numbers be reported who have

 

8
Eugene F. Hahn, Stuttering Significant Theories and Therapies,

Stan ford University, California: Stanford University Press, 1943,
p. 4 \

 

10

never been exposed to the stuttering of other people or to
any other experiential influences which are known to be
effective causes of stuttering. This evidence it would be
practically impossible to procure.9

Dr. Samuel D. Robbins, Emerson College, Boston, Massachusetts,
feels that:

Stuttering is one of the many symptoms of certain psycho-
neuroses. It appears most frequently in nervous individuals
who inherit a tendenqy either to stutter or to exhibit other
nervous traits.

Dr. E. J. Boome, London, England, holds:

...The instability of the nervous system is the primary
cause of stammering, while the environmental factors, by
weakening the individual's physical and psychical resistance,

serve to reveal the latent tendency.

Environment. Environment has also been cited as a cause of stut-

 

tering by leading authorities in the field. One school of thought goes
one step further when it completely rules out heredity as a cause, and
accepts environment in 3332. Dr. Stanley Ainsworth, of the Speech and
Hearing Clinic at Chio State University, summarizes this point of view

in his book, Speech Correction Vethods.

 

In this group are the theories which agree on the follow-
ing basic assumptions: the stutterer is not inherently psy-
chologically or constitutionally different from the normal
speaker; he develops stuttering speech because of situations
which occur during his development. Ideas concerning the
character of these environmental disturbances and the accom-
panying individual reactions may be quite at variance.12

9 Ibid., p. 35.
10 Ibid., p. as.
11 Ibid., p. 122.

Stanley Ainsworth, Speech Correction Uethods, New York: Pren-
tice-Hall, Inc., 1948, p. 82.

 

ll

Imitation. Stuttering may be caused by imitation, according to

Dr. John Nadison Fletcher, Professor of Psychology at Tulane University.

He states:

...As to the direct and immediate concern which the child
of normal speech has in the proper care of the stutterer, one
needs but to call attention to the fact that stuttering may
and often does have its genesis in the playful act of imitat-
ing a stuttering child.1

However, Dr. Charles Van Riper, Director of the Speech Clinic,

western Michigan College of Education, has this to say of imitation:

of the

of the

Infltation has been said to be an important cause of stut-
tering, and parents seem especially eager to adopt it as an
explanation if there is any other stutterer in the neighbor-
hood. ‘We have not found it to be nearly as frequent as might
be expected. In the more than 2,000 cases we have examined,
there were only two instances in which imitation might be
said to be of importance in precipitating the symptoms.14

Habit. Dr. Knight Dunlap, Chairman of the Psychology Department

 

University of California at Los Angeles, is one of the exponents
theory of habits, which he applies to stuttering.

...He assumes that in cases of stuttering where the
causal factors have been removed and the speech difficulty

still exists the defect is a habit which can be broken.15

Dr.'W. A. Carot, London, England, also feels that stammering "is

a deeply rooted habit...originating from a first shock."16

13 John Nadison Fletcher, The Problem of Stuttering, New York:

 

Longmans, Gree and Company. 1928:_Po 30°

14 Van Riper,‘gp.'££t., p. 276.

5 Hahn, 92, cit., p. 30.

1
6 9-2. 2323., P. 1260

12

Dr. Van Riper states:

The educational theory holds that stuttering is a bad
habit originating in the natural hesitations of children's
speech and perpetuated by penalty and fear.17

Neurosis. Neurosis, according to Stanley Ainsworth, in his Speech

Correction Vethods is:

 

...an emotional maladjustment which results in or involves,
deviate behavior....it is intended to include milder states in
addition to well-developed hysterical, anxiety, neuraesthenic,
and compulsive conditions....The feature which distinguishes
this group of theories is that stuttering is thought of as a
symptom growing out of another dissorder, and that when this
'functional' disorder i§_?3:cved, stuttering will disappear.18

1

Charles Van Riper summarizes the neurotic theony of stuttering.

The neurotic theory considers stuttering to be a symptom
of a basic personality problem, of a maladjustment to the
demands of normal life. The hesitations and anxieties are con-
sidered as symptoms of the stutterer's attitudes toward life
itself.19

Dr. Isador H. Coriat, Boston, Massachusetts believes that:

Stammering is a neurosis in which.the fixation of the
libido at the development stage of oral erotism.persists into
maturity. Stammering demonstrates that the individual in the
course of his development has not successfully overcome this
earlier phase or in other words he remains fixed and anchored
to this infantile stage of oral libido. Stammering is conse-
quently a gratification of the infantile oral tendencies.

Thus, stammering becomes a neurosis....This explains the
infantile character of the sucking and biting movements ob-
served in stammerers when they attempt to speak, that is a
compulsive rhythmical repetition of the very early nursing
activities.20

17 Van Riper, 92° cit., p. 268.

18 2220 Cite

19 Loc. cit.

20 Isador Henry Coriat, "The Nature and Analytical Treatment of
Stammering." Symposium on Stuttering, Yearbook, American Speech Correction

SOciation. Vadison, Jisconsin: College Typing Company, 1930. pp. 152-3.

 

15

Psyphological. Mrs. Mabel Farrington Gifford, Chief of the Bureau

 

of Speech Correction of the State of California, believes that psycho-
logical factors are the cause of stuttering. She states:

It must be understood that in the beginning, according to
-my theory, the causes of these nervous speech disorders are
psychologic and that the spasmodic manifestations of the
speech organs is only the external symptom of the deep-seated
mental conflict. It has now been definitely established that
severe shocks and emotional conflicts in very early childhood
remain as subconscious memories for many years, and may con-
tinue to disturb the speech function, which in itself is er-
fect, until such time as corrective measures are applied. 1

Upholding the psychological theory of stuttering is Dr. John M.
Fletcher.
...it should be diagnosed and described, as well as treat-
ed as a morbidity of social consciousness, a hypersgnsitivity

of social attitude, a pathological social response.“

Inferiority. Dr. Alfred Appelt, “unich, Germany, was a follower

 

of Adler's individual psychology, and he feels that stuttering is closely
related to the sense of inferiority and its compensation.
Psychogenetic stuttering always originates on this founda-
tion. Inferiority-diSposition, in which the child experiences
intensively his impotence and, in relation therewith, the

anxiety tension, serves as releasing moments.25

Fear. Dr. Smiley Blanton, of Cornell Medical College, upholds the

 

{mychological theory of stuttering and believes that

21 Mabel Farrington Gifford, "A Consideration of Some of The
Psychological Causes and Treatment of Stammering," Symposium on Stuttering,
.92. Cito’ p. 74.

 

Fletcher, 23. cit., p. 226.

27’ Hahn, 92. cit., p. 117.

l4

...fear states of the stutterer prevent the cortex from
exerting control over the organs used in speech. The cause
lies in the emotional conscious and unconscious mind of the
stutterer.24

0n the other hand, Dr. Isador Coriat reminds us:

Fear in stammering has been emphasized to too great an
extent as its cause. Fundamentally it represents the resis-
tance against sudden discharges of oral eroticism; as such
it becomes part of the analysis and should be handled like
other forms of morbid anxiety in which there is a sense of
internal danger.25
Drs. Richard C. Borden and Alvin C. Buses, Co-directors of the

Speech Clinic at New York University, classify stuttering as a neurotic
defect, caused by one trying to repress certain desires, and fear, as an
inhibitory idea, checks the course of normal automatic function. The
patient has buried mental desires which cause his anxiety - his fear of
himself.26

Conditioned inhibition. Conditioned inhibition, according to Dr.

 

John Fletcher, is a cause of stuttering. He explains:

...These inhibitions do not necessarily have their genesis
in any single traumatic experience, nor in any specific type
of experience, according to the Freudian formula. They mani-
fest a certain degree of permanence, but their permanence is
not due, as certain psychoanalysts would have us suppose, to
their common root. It is obvious that any experience which .
has set us a conditioned emotional response will, if constantly
repeated, tend to become strengthened. It is this accumulation
of associations, rather than any form of traumatic origin,
that keeps the stutterer's speech inhibitions going.27

 

 

24 Hahn, 92. cit., p. 11.

r
20 EB. cit., p. 28.

26 Richard C. Borden and Alvin C. Pusse, Speech Correction.
New York: F. S. Crofts and Company, 1925.

27

 

Fletcher, 92. cit., p. 233.

15

Social nnladjustment. Social maladjustmene, too, is seen as a

 

cause of stuttering. Dr. Fletcher summarizes:

ponent

The realization of the social demand, the idea that some-
thing is expected of him by way of reaction, reply or communi-
cation is consecutive speech, the compulsion arising from a
question put directly to him, or from a social or business
situation requiring speech in which he finds himself, consti-
tute the social excitants of his morbid reactions.28

Dr. Veyer Solomon, Chicago, Illinois, feels that:

...The main motives in social speaking are mastery (of
thinking and speaking) and social approval. There is a strug-
gle for adjustment and re-establishment of equilibrium and
release of tension by varied responses of thinking and speak-
ing. This is a critical or emergency situation demanding
immediate action or solution. In stuttering there is inter-
ruption of a task (that of social speaking) with disorganized
attempts at completion and resolution of tension. This may
terminate in learned maladjustment or persistent nonadjust-
ment.29

 

Stutterer washes to stutter. Dr. Isador Coriat is the chief ex-
of the theory that the stutterer wishes to stutter. He comments:

...The great difficulty in the treatment of stammerers
and the stubborness with which they resist treatment is due
to two factors, first, an unwillingness to abandon the
pleasure function of nursing activities in speech, and sec-
ondly the marked resistances arising from the anal-sadistic
level of development, which is so closely identified with
the oral level.30

In other words:

...there is an unconscious tendency to retain the orig-
inal libido binding to the mother because stammerers do not
wish to abandon the original infantile helplessness and
thus lose the early nursing object."5

28 93. cit., p. 235.

29 Hahn, pp. cit., pp. 88-9.

30 Loc. cit.

31 Hahn, 0J1: cit., pp. 27-8.

16

Personality difficulty. Dr. Alfred Appelt feels that psychogenetic

 

stuttering is the result of a compensatory system of security. He believes:
...The necessary result of such a situation is the begin-

ning of a mental compensatoriness which can be demonstrated

in every neurosis. In order to suppress his feeling of im-

potence, the child keeps himself busy with ideas of greatness

and tries to place himself in the center of attraction. In

doing so the child is concerned chiefly with his own ego and

seeks to protect by all means the value of this ego against

injuries.52

Dr. Appelt, in believing that in psychophysical events, everything
is directed toward security, indicates that personality feelings are
sensitive, especially if a child is brought up in an environment where
they are spoiled and pampered. Dr. "eyer Solomon is of the opinion that
"The first moment of stuttering depends on the momentary total internal
and external situation."53 Certain personality traits, such as excitabil-
ity, self-consciousness, oversensitiveness, timidity, or being easily

rattled, could produce an instability to predispose Stuttering.34

Yeurolcgical. Dr. Lee Edward Travis, of the University of Southern

 

California, in the past accepted the theory that stuttering was caused by
a conflict between the two hemispheres of the brain. He states:-

The stutterer, as do most other types of speech defectives,
represents a certain lack of maturation of the central nervous
system which results either in malintegration of the highest
neurophysiological levels involved in speech or the predisposi-

tion of thesevlevels to disintegration when exposed to nocicep-
tive stimuli.00

33 Hahn, Op. cit., p. 116.
33 $2. cit., p. 89.

35 Lee Edward Travis, Speech Pathology, Few York: D. Appleton
and Company, 1931, p. 254.

 

17

As Dr. Van Riper points out, as he describes the neurological
theory: "...the paired musculature used in speech does not receive prop-
erly timed nervous impulses from the various integr ting centers of the
central nervous system."

Abnormal breathing. Dr. Elmer L. Kenyon, Professor Emeritus, Rush

 

Hedical College, states:

The key to the nature of each act of stammering lies in
the complete stoppage of speech while attempting the produc-
tion of a speech sound, namely, the act of 'blocking.‘
Blocking is the typical completed individual act of stemmer-
ing. In blocking the musculature of the vocal mechanism in
each of its four divisions remains in a state of voluntary
action and yet with the movements of each division, includ-
ing chest, vocal cords, articulative and palatal organs,
completely arrested and the passage of breath stopped at the
larynx, thus rendering sound production impossible.37

Thus, it can be seen that abnormal breathing is one phase that he
includes as a cause of stuttering.

Physiological. Peoole who accept a physiological basis as a cause

 

of stuttering recognize the fact that function is dependent upon structure.

They hold that there is something structurally different within the

organism of the stutterer from that same something within the organism

of the non-stutterer or the normal speaker. It may be the muscles, nerves,

ghnms, viscera, or blood. Vetabolic differences have also been noted.
West, Kennedy, and Carr38 state:-

There are certain demonstrable differences between the
stutterer and the non-stutterer, aside from the spasms that

36 Loo. cit.

37 Hahn, 9.2. Cite, p. 650

38 Cp. cit.

18

occur during their speech. The chief of these are (l) the
slowness of diadochocinesis of the stutterer's articulatory
muscles and (2) his lack of vocal inflection....39

Lack of cerebral dominance. Dr. Eugene F. Hahn explains Dr. Lee

 

Travis' theory of a lack of cerebral dominance causing stuttering.

If neither side of the brain is dominant over the other - if,
for some reason, both halves tend to be equal - a conflict in
leadership will arise. Consequently each half sends out nerve
impulses at its own rhythm, and the muscles on the right side
of the body receive patterns of innervation impulses different
from those received on the left. The speech mechanism, as a
midline structure, suffers violently. The muscular spasm of
stuttering results from the lack of normal dominance in the
brain.40

Sideiness or laterality. Some authorities feel that sidedness or

 

laterality is a cause of stuttering.

The change of handedness is associated with stuttering be—
cause the change disrupts the natural dominance. For left-
handed persons the dominance lies in the right hemisphere. If
they are forced to change handedness, leadership is forced on
the left or weaker hemisphere. If this is continued, the
dominant hemisphere is weakened and the nondominant hemisphere
is strengthened so that the two tend to become equal in length
and disharmony occurs.4

Semantic association. The following is a summary of Wendell

 

Johnson's semantogenic theory of stuttering.

Stuttering is a semantogenic disorder with a specific diag-
nosogenic basis. That is to say, t implies that stuttering is
a disorder in which self-reflexive evaluative or semantic re-
actions play a determining role, and that the basic evaluative
reaction is that which involves the act of diagnosis..........

39 92. cit., p. 55.

4O Hahn, SE: cit., p. 100.

41 Leo. cit.

19

It is noted that the theoqy implies that stuttering, at
least in its more serious forms, is learned behavior, that
it is more readily learned in some semantic environments
than in others...42

Or, as Dr. Van Riper states:

...he identifies primary stuttering with the perfectly
normal hesitations and repetitions of normal children.
When these are wrongly labeled as stuttering, the child
begins to react to the evaluations as though the symptoms
were actually abnormal, and hence abnormal behavior is
produce}.43

Lack of visual imagery. Dr. C. S. Bluemel, well-known exponent

 

of the theory that a lack of visual imagery causes stuttering, defends
hiS'theony:

‘W'own feeling in the matter is that stammering is an
impediment of thought and not primarily a speech disorder.
The disability manifests itself in speech because the
speech is patterned upon the thought. The thought disturb-
ance, as I view it, is an inability to think the words
clearly in the mind...44

4‘2 Hahn, 93. cit., pp. 58-9.

43 Y{an Riper, 9—2. 2—12., p. 2690

44 C. S. Bluemel, "Stammering as an Impediment of Thought,"
iifflggsium on Stuttering, 92. cit., p, 29,

 

It is noted that the theony implies that stuttering, at
least in its more serious forms, is learned behavior, that
it is more readily learned in some semantic environments
than in others...42

Or, as Dr. Van Riper states:

...he identifies primary stuttering with the perfectly
normal hesitations and repetitions of normal children.
When these are wrongly labeled as stuttering, the child
begins to react to the evaluations as though the symptoms
were actually abnormal, and hence abnormal behavior is
produced.43

Lack of visual imageny. Dr. C. S. Bluemel, well-known exponent

 

of the theory that a lack of visual imagery causes stuttering, defends
his theory:

Ty'own feeling in the matter is that stammering is an
impediment of thought and not primarily a speech disorder.
The disability manifests itself in speech because the
speech is patterned upon the thought. The thought disturb-
ance, as I view it, is an inability to think the words
clearly in the mind...44

42 Hahn, 2p. cit., pp. 58-9.

43 Van Riper, £2. cit., p. 269.

44 C. S. Bluemel, "Stammering as an Impediment of Thought,"
§ympoSiam on Stuttering, 0p. cit., p. 29.

 

CE-IAF'I‘ ER I I I

...IALS USED AND PLLCCEDVIEE

CHAPTER III
THE .‘stRIALs USED AND PROCEDURE

The author first made a list of seventy-two established speech
correctionists, including representatives of as many states as possible,
in addition to Canada, Mexico, and Hawaii. In order to obtain a group
that would be representative, speech correctionists in the public schools,
colleges, and private clinics were included.

A letter was sent to each person, asking his cooperating in fill-
ing out the enclosed questionnaire. Tpon return, their theories, speci-
fic therapies and techniques were recorded, and form Chapters IV and V

of this thesis, in addition to the Appendix.

21

September 6, 1949

Dear Sir:

".......in partial fulfillment for the Degree of ”aster of Arts......."
Undoubtedly you still recall the ominousness of these words, as I am.now
feeling it. I am writing this letter to you requesting your cooperation
in my thesis project, the purpose of which is to assemble in one volume
the theories, specific therapies, and techniques for use with stutterers.
It is important that outstanding speech correctionists in the field be
consulted, in the hopes that their words will aid correctionists who so
oftentimes feel incompetent when faced with a stutterer.

Briefly then, would you be willing to answer the enclosed questionnaire,
in which you include the theory or theories which you hold to be most
adequate, and more specifically, your therapy, in addition.to helpful
techniques? The emphasis should be on the latter, since this will be of
the most use to the Correctionist. This will form the major part of the
thesis. I have endeavored to choose one outstanding correctionist from
each state, Canada, Yexico, and Hawaii. You are the representative of
your state.

Your cooperation in this undertaking will be greatly appreciated. Feel
free to include as much detailed material as you wish, including your
publications, references, or anything else which you believe will make
your contribution more complete. If you have any further questions, I
shall be happy to answer them.

Cordially,

(Frs.) Lou Johnson Alonso
LJA
cc - l
Encl. - 2

22
SUMMARY OF THE CAUSES OF STUTTERING

IMrections: If you feel these to be causes of stuttering, check "yes"; if not,

.Check "no." Yen may expand the thought in the Space below each cause, if you so
desire.

 

 

 

 

 

 

 

 

 

 

 

 

+ CAUSES " Yes No ; CAUSES . Yes No
Heredity a factor EEnvironment a factor

Imitation iHabit

:Neurosis Lack of visual imagery

Neurological Psychological _
:Abnormal breathing rPhysiological

Association ~ Inferiority a factor
ifear a cause Conditioned inhibition

 

 

 

 

 

 

 

 

 

l/_l -e

 

 

 

M4 I l..r, t.ut

\.

23
Causes, Continued

 

 

 

 

 

 

Page Two
1 CAUSE A _' ' Yes to CAUSE " h . ' Yes No"
Lack of cerebral dominance Sidedness or laterality
Social maladjustment Semantic association ........
%
”Stuttering a symptom Stutterer wishes to stutter
’Stuttering a compensation Personality difficulty

 

 

 

 

 

Others, or further development of ideas} Use back of page if necessary.

 

 

 

 

I/n|.n \

 

It Iii.|[

SUMMARY OF THE TREATMENT OF STUTTERING

Ihrections:- If you utilize these methods in your therapy, check "yes"; if not,

check "no". Feel free to expand the thought in the space below each therapy.

 

Yes

No

ThEATNIdM

_ Yes No‘

 

Case History Detailed

Physibal Examination

 

 

Breathing Exercises

Articulatory Exerdises

 

Physical Exercise

Group Treatment

 

Use of Suggestion

Use of Relaxation

 

Psychoanalysis

Hypnosis

 

Insure stutterer's success

Use of telephone

 

 

gMuch rest

 

 

 

 

.Pseudo stuttering

 

 

 

 

 

 

 

f.

 

,.....-.

Treatment , Continued

9

‘4

Page two

5

 

fimm

 

Create singing method of
speaking:

Yes

files

No

 

{Home cooperation

 

Depriving oral gratification

Simultaneous writing and
speaking exercises

 

Training impaired muscles

"Erecting psychological
barriers‘ ‘

 

Keep normal routine

Get rid of "crutches"

 

iflnke friends with stutterers

Give stutterer responsibility

 

Stutterer reads about stutter;
ins

Develop unilaterality

 

Mental hygiene

 

I£q|.r\\

 

 

'Progression from easy to hard

 

 

 

 

ererer

_<

 

 

26
Treatment, Continued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page Three

' TREATMENT " W 1 Yes No ' TREATMENT" W Yes No.
Phantom speech I ' Bounce technique ' ‘ "
New social contacts Work before mirror
.Thought-training exercises lRemove speech conflicts
Change environment to fit Remove speech conflicts
stutterer

t

i
:Develop an objective attitude Emphasis upon mechanical
‘ aspects of stuttering
_Others, or further development of ideas. Use back of page if necessary.

 

Namev

 

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C I‘LXPTEE I V

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HEREDITY

Twenty-six of the people cooperating in this study hold that here-
dity is a cause of stuttering, while thirteen of the participants feel
that it is not a cause. Three indicate that heredity may be a cause of
stuttering, while six have not as yet come to a yes or no decision on the
matter. One individual believes that heredity sometimes causes stutter-
ing, while another holds that heredity as a cause, is questionable.

Dr. Virgil A. Anderson, Director of the Speech and Hearing Clinic
at Stanford University, points out that "clinical experience indicates
that heredity operates to predispose the organism to stutter." Mr. C. E.
A. Hoore, Director cf the Speech and Hearing Clinic, Proviso Township
High School, Waywood, Illinois, elaborates one step further when he re-
marks that the stuttering itself is not inherited.

Hrs. Louise D. Davison, Director of the Davison School of Speech
Correction at Atlanta, Georgia, Dr. Carl Ritzman, Director of Speech Cor-
rection at the Vniversity of Oklahoma, Hr. Clark S. Carlile, Supervisor of
Speech Correction at Idaho State College, Pr. Richard R. Hutcheson, Direct-
or of the District Speech Clinic, Georgetown Hospital, washington, D. C.,
”r. Edelu Fennema, Director of the Junior League School of Speech Correction
at Columbia, South Carolina, and Dr. Harlan Bloomer, Director of the Speech
and Hearing Clinic at the University of Hichigan, agree with Dr. Anderson,
and in so doing, qualify their answering in the affirmative.

Dr. Dean G. Nichols, Director of the Wyoming Speech Clinic at the
University of'fiyoming, states that heredity is a factor "in the sense that

stuttering runs in families, probably from environmental factors. Stuttering

)l‘fl‘...

42

is not transmitted in the genes." Dr. Charles Pedrey, Director of the
Speech Clinic at Vichigan State College, advises that "studies seem.to
ShOW‘that more stutterers than non-stutterers have ancestors that stutter."

Dr. James F. Bender, Director of the National Institute for Human
Relations in New York, agrees that there is a predisposition to stutter;
and that this "takes the form of stuttering symptoms in an environment
unfavorable to smooth, fluent speech.”

Dr. Alan Huckleberry, Director of Special Education and Clinics,
Ball State Teachers College, recognizes a neurological predisposition, in
addition to the inheritance of a non-healthy body.

Dr. A. C. Lafollette, Director of the Speech and Hearing Clinic at
Ohio University, feels that heredity operates "only in that it provides a
pattern to imitate, or a disposition on the part of parents to react
critically to the first sign of stuttering in their child."

Dr. Alonzo John Korley, Director of the Speech Clinic, Brigham
Young University, accepts heredity as a limited factor of causation, while
Dr. George A. Kopp, Director of Speech Science and Correction at wayne
University, accepts it "when viewed as a determinant of potential function."

Yrs. Margaret Clark Lefevre, formerly Chief Speech Therapist of
Kabat-Kaiser Institute, Vallejo, California, and now in private practice
in Vallejo, feels that heredity is not necessarily a major factor in every
case, but that it seems to be in a significant number of cases. Niss
Lucia Forgan, Assistant Professor of Speech at Michigan State College,
holds that "a predisposition could be an inherited factor. we observe
that a large number of stutterers belong to a definite body type which is

considered to be an inherited characteristic."

43

BTW I ROE? ”EN T

Forty-four of the people cooperating in this study hold that
environment is a cause of stuttering, while four of the participants
feel that environmental factors do not cause stuttering. One other per-
son concedes that it possibly is a cause, and another does not answer the
question.

Dr. Anderson feels quite certain that environment is a cause of
stuttering, when he states, "There is no doubt. Environment is probably
the most important of precipitating causes." Ur. Hutcheson, too, believes
it to be a direct and contributing factor. Dr. LaFollette, elaborates to
say, "yes, environment is a factor, either as some pattern to imitate or,
more significantly, reacting to the attitudes and influences of parents.
Home environment seems a significant factor in stuttering histories."

Dr. Huckleberry, answering in the negative, qualifies his choice
by remarking, "if disassociated from psychological." Dr. W. Arthur Cable,
Director of the Speech Clinic, University of Arizona, is convinced that
environment is a factor in the majority of cases, while Dr. Ritzman defi-
nitely believes that parental non-acceptance behavior "is the crucial
factor in stuttering etiology." Mrs. lefevre upholds that environment
"may help or hinder, but it is not a basic causative factor." fir. Doors,
while not answering yes or no, felt that it might very well be a factor.

Miss Elsie Edwards, Supervisor of Teacher Training in Speech Cor-
rection at Michigan State College, and Dr. Jack Hatthews, Director of the
Speech and Hearing Clinic at the University of Pittsburg, also believe

that environment can operate as a cause of stuttering.

44

1TH TATION

Twenty-two of the people cooperating in this study feel that imita-
tion is a cause of stuttering, while twenty disagree and answer no to this
question on the questionnaire. Four people think that it is possible that
imitation may cause stuttering, one is doubtful that it has any effect,
and another says that only when sympathy is at work will imitation cause
stuttering. Two participants did not answer the question.

Mr. Carlile thinks that imitation is sometimes a cause, but only
then as a factor in onset. However, Dr. Anderson is convinced that imita—
tion, as a cause, is doubtful. He states, "It has been thought to be so,
but I have found very little actual evidence to support it as a cause.

It would probably operate to precipitate, if a predisposition to stutter
already existed."

Ur. Hutcheson, on the other hand, acknowledges it to be a contribut-
ing factor in a few isolated instances. Mr. Moore, hesitating to come to
a yes-no decision, states that "in some few cases this may be a minor fac-
tor." "r. Fennema, like Mr. Doors, is reluctant to make an either—or
choice, but he does remark that imitation is a possible cause. Dr. Bloomer,
too, claims that imitation operates in a few cases, "but not alone." Dr.
Bender recognizes it as a cause, "only when sympathy (affective state) is
at work."

Dr. Ritzman answers in the affirmative, qualifying his answer with,
"If this is meant identification in the strict psychoanalytic sense."

Hrs. Davison holds, "In general, no; in some cases, yes." Mr. Fred H.

Chreist, Director of the Speech and Hearing Clinic, University of Raw Mexico,

goes a little further when he says, "Seldom, if ever." Dr. Harold westlake,
Director of the Speech Clinic at Northwestern University, and Dr. C. Raymond
VanDusen, Director of the Speech Clinic at the University of Viami, concede
that "maybe" imitation is a cause of stuttering. Dr. Pedrey points out
that there is "no evidence this ever caused stuttering."

Dr. Vary Coates Longerich, Speech Pathologist at Pasadena, California,
Piss Geraldine Garrison, Supervisor of Speech and Hearing Services for the
Connecticutt State Department of Education, Dr. Norley, Dr. Nichols, Mr.
John H. Wiley, Director of the Speech and Hearing Laboratory at the Univer-
sity of Nebraska, Wiss Gladys 3. Fish, Advisor in Special Education, De-
partment of Public Instruction, Harrisburg, Pennsylvania, Mr. John R. Nont-
gomery, Director of the Speech and Hearing Clinic at Kent State University,
Dr. T. Earle Johnson, Director of the Speech Clinic, University of Alabama,
and Dr. Wallace A. Goates, Supervisor of the Speech and Hearing Center at
the University of Utah, also answer in the negative, but make no further

remarks to qualify their choice.

46

HABIT

Twenty-five of the people cooperating in this study feel that habit
is a cause of stuttering, while seventeen disagree when they hold that
habit is not a factor in causing stuttering. Two people concede that habit
could perhaps cause stuttering, while one subject points out that symptoms
become habits. Five people did not answer the question.

Hr. Robert Albright, Director of the Speech Clinic at the University
of Colorado, while he acknowledges that habit of repetition can be formed,
feels that this would not be stuttering by definition. Dr. Bryng Bnyngel-
son, Director of the Speech Clinic, University of Minnesota, does not be-
lieve that habit is a cause of stuttering. “r. John A. Tanning, Director
of the Speech Clinic, St. Olaf College, agrees with Dr. Bryngelson that
habit is not a 32313 cause, and as such, answers in the negative.

Dr. Richard A. Parry, Assistant Director of the Speech Clinic at
the University of Hawaii, while not answering yes or no, states that the
symptoms become habit. Mr. George Falconer, Director of the Hemphis Speech
and Hearing Center, University of Tennessee, enlarging upon his selection
of yes on the questionnaire, states that, "While not an initial cause of
stuttering, habit is important in keeping it going." Dr. Anderson con-
cludes that, "No doubt that a great deal, if not all of adult, confirmed
stuttering, is habit, if the concept of habit is made sufficiently broad."

Stuttering is caused "only after a stutterer has conditioned to cer-
tain stimuli and responses to form an habitual response," replies Hr.
Carlile. Hr. Hutcheson feels habit to be a "direct and contributing factor."

Hr. Doors states, "Basically, no, but some of the secondary characteristics

47

associated with stuttering may become habits." Dr. Bloomer, too, feels
that "once started, habit probably contributes to continuation of the
stuttering."

Dr. Nichols points out that "the accompanying muscular movements re-
sult from habit." Dr. Bender puts forth the idea that "the cause of the
stutter may be removed, leaving the subject with primary blocks." This
indicates that he upholds habit as a possible cause of stuttering. Mrs.
Davison remarks, "Sometimes the habit persists after the cause is removed."

0n the other hand, Dr. LaFollette contends that "habit could never
become stuttering of itself - but to label a feIIOW'a stutterer who merely
repeats or habitually 'retraces', might be enough to cause complications."

Dr. Morley, however, feels that habit is a factor in maintaining
stuttering, but is not a cause. Dr. Cable, answering yes, qualifies this
choice when he states, "When imitation is the inciting cause." Dr.'Westlake
poses the question, "The symptom may continue on a habit basis, but could
a habit initiate it?" Dr. Pedrey is of the opinion that stuttering "may

be a carry-over from the stage of childhood repetition."

48

NEUROSIS

Twenty-eight of the people cooperating in this study feel that
neurosis is a cause of stuttering, while nine disagree and answer in the
negative. One participant lists neurosis as a secondary factor, another
classifies it as a possibility, while two others point out that it is rare-
ly a cause, and one feels that sometimes it is a cause. One other partici-
pant comments that people who stutter are sometimes neurotic. Still
another believes that neurosis is a result rather than a cause. Six parti-
cipants did not answer the question.

3r. Hanning, however, believes that it is more a result, rather
than a cause. Dr. Parry concedes that it is sometimes a cause. ”r. Falconer
states, "It may be interrelated, but I have known too many stutterers who
were less neurotic than 'normal' people, and too many neurotics who didn't
stutter."

Dr. Anderson does not contend that it is a direct cause. "Stutter-
ing is not a symptom of neurosis, although the secondary stutterer may get
to be neurotic." fir. Hutcheson points out that it is a contributing factor,
while Pr. Moore emphasizes that it is a factor that cannot be ignored. He
asks the question, "would the neurotic become a stutterer, or would the
stutterer become a neurotic?" Dr. Bloomer accepts the thesis that people
who stutter are sometimes also neurotic. Dr. Longerich claims that "stutter-
ing is not a speech disorder_p::‘£3; instead, it is a psychoneurosis."

Dr. Ritzman makes the observation that "I don't believe that it can
be demonstrated that stutterers, in the beginning, are a neurotic population.

But I do believe we will be able to demonstrate that they suffer from

49

normal anxiety feelings, of inferiority, etc." Hrs. Lefevre contends
that, while neurosis is not a major factor, "stuttering might develop or

be aggravated by the anxiety neurosis."

50

PSYCHOLCGICAL

Forty-four of the people cooperating in this study feel that psycho-
logical factors are a cause of stuttering, while two disagree and answer
no, that these are not factors in stuttering. Cne lists psychological
factors as a factor to be considered, another believes it to be a result,
while still another did not answer the question.

Fr. Falconer believes that the major causes of stuttering are psy-
chological. He believes that these are "mainly the relationships between
the stutterer and society." ”r. "anning feels that psychological factors
can be both a cause and a result. Dr. Parry, while not checking either
yes or no on the questionnaire, has this to say: ""ost cases I have seen
seem to have a psychological difficulty, but it may be a result and not a
cause."

Dr. Anderson, answering in the affirmative, feels that "any source
of tension or anxiety would undoubtedly aggravate stuttering. This is
‘Very’closely related to environmental factors." Dr..Hutcheson feels that
psychological factors are partial causes of stuttering, while Vr.'”oore
contends "they are probably the most important of all the contributing fac-
t0P8. Dr. LaFollette voices agreement that this is a chief factor. Dr.
Plocnner points out that anxieties, fears of rejection, and apprehension
are inmmrtant in this regard. Dr. Pedrey, in answering yes to this question
on t1'16 questionnaire, qualifies his choice by remarking,"lf I may define

' o
Imb’Chological cause.'"

51

INFfiRIORITY A FACTCR

Thirty-eight of the people cooperating in this study feel that
inferiority is a cause of stuttering, while seven subjects are of the
opinion that this is not a factor in causing stuttering. Two participants
hold that perhaps this causes stuttering, but three others consider in-
feriority to be a result rather than a cause.

Dr. Bryngelson holds that inferiority is a factor as an after effect
of the stuttering itself. Dr. Parry, Dr. Fanning, “r.‘Iiley, and Dr.
Benjamen S. Andrews, Director of Speech Correction at the University of
Virginia, also feel that it is a result, rather than a cause. Mr. Falconer
does not believe inferiority is a factor initially, "but like habit, later
inferiorities keep it going."

Dr. Anderson states: "Probably not directly, but perhaps as a part
of a more complex unfavorable psychological set-up. More likely to result
from, rather than cause stuttering." nr. Moore asks, "Does he feel in-
fericr because he shutters, or does he stutter because he feels inferior?
It may be a factor, however." Dr. Bloomer lists inferiority as a contri—
buting factor. Dr. LaFollette indicates that inferiority is a factor, but

only one aspect of the psychological problem.

C 71
DJ)

FEAR A CIYSE

Thirty-seven of the people cooperating in this study feel that fear
is a cause of stuttering, while six other subjects hold that this is not
a factor in causing stuttering. One participant answers that in some
cases it is a cause, one reports that possibly it is a cause, another calls
fear an aggrative factor, and another refers to it as a precipitating fac-
tor; where one calls for a symptom, another prefers the term result. One
person did not answer the question.

"r. Carlile feels that fear is a cause "only as it is indicative of
an insecure feeling in the organism." “r. Hutcheson is of the opinion that
it is a "direct and contributing factor." Dr..Anderson interprets fear to
be "a maintaining factor, once the secondary aspects of stuttering have
developed. Stuttering is in proportion to the fear of stuttering." Yr.
*anning and Dr. Andrews propose that fear is a result rather than a cause

”“ o

of stuttering. 7r. 1-"anning points out its circular process. J1. Parry
lists it as a symptom and not a cause. Fr. Falconer feels that fear keeps
the stuttering continuing, but he is not at all sure that it causes it
initiall‘.

' while Ur. Voore be-

Dr. Bloomer calls fear "an aggravating factor,‘
lieves it to be "a contributing factor." Dr. Huckleberry checks yes, only
after altering the question to read, "Fear of social disapproval." Dr.
LaFollette feels that fear is a cause, ”but only as one factor of a more
complicatei picture - the total impact of which thwarts and blocks."

Dr. Ritzman points out that "there are levels of causation - all of which

must operate. What begins is a predisposition in a neurologically atypical

I...

.1. .1.-. ad

organism comes to function as a stuttering symptom at the level of atti-
tude as a result of fear of rejection of oneself as an object intrinsically
worthy of regard."

Fear, accord'ng to Dr. "orley, is a "precipitating cause." “rs.
Lefevre claims that "fear might be a precipiiory factor, might in some
cases become chronic, but not fundamental." Vr. Chreist also agrees that

fear is a precipitating factor, but maintains that it is not a basic cause.

Dr. Van Dusen concedes fear to be a cause of stuttering in some cases.

CCNDITICYE IIHIBITION

Twenty-four of the people cooperating in this study feel that con-
ditioned inhibition is a cause of stuttering, while seven others are of
the opinion that this is not a factor in causing stuttering. Two partici-
pants claim that possibly it is a cause, another states t..at sometimes it
is a cause, while still another lists it as maintaining, not causal. Cne
other subject is not sure if stuttering is an inhihitory phenomenon. Tlir—
teen people did not answer the question.

Dr. Kopp, in answering yes, that conditioned inhibition is a cause
of stuttering, qualifies his answer by suggesting that it all depends upon
the interpretation of the term. f'r. Albright, considers conditioned inhi-
bition as a secondary symptom, while Dr. Bryngelson feels that probably
some types of conditioned inhibition would be causes of stuttering.

Dr. Parry believes that sometimes conditioned inhibition is a cause
of stuttering. T'r. Falconer, while not taking a yes-no stand on this ques-
ti on, comments, "Eluenel's theory has possibilities I think attractive
because it is based on the great work of Pavlov." Of conditioned inhibi-
tion: Dr. Anderson states: "Yes, probably; another way of explaining habit
factors in secondary stuttering." Dr. Bloomer points out that he isn't
sure if stuttering is an inhibitory phenomenon. Dr. LaFollette answers,
Mr
‘33: but it is likely to be a phase of the psychological factor." Dr.

‘J‘orley tells us that "it is a maintaining factor, not causal."

0'!
Cl

SOCIAL NALADJUSTVEH

Forty-one of the people cooperating in this study feel that social
maladjustment is a cause of stuttering, while four subjects claim that it
is not a factor in causing stuttering. One participant labels social
maladjustment a contributing factor, and two others believe social malad—
justment to be a result. One other individual admits that sometimes it
might cause stuttering, and one subject did not answer the question.

Yrs. Lefevre, although answering in the affirmative, does not con-
cede social maladjustment to be a primary cause of stuttering. Dr. La-
Follette concludes that "this factor often stems from a parental environ-
ment that is unfavorable - a family fear of a disapproval of the stuttering
symptoms."

Hr. Uoore, while not answering yes or no, states that social malad—
justment "seems to be a contributing factor in some cases." Dr. Anderson
believes that social maladjustment "could operate as a precipitating factor.
It is also related to environmental factors. Not a sole cause, but

operating in combination with others." Vr. Falconer prefers to "translate
the term to mean adjustment to a maladjusted society. The stresses and
strains in our society contribute, I believe."

Mr. manning and Dr. Bryngleson believe that social maladjustment is
not a cause, but rather a result of the stuttering. Vr. Albright classifies
this as a "which comes first question," intimating that it can act as both
a cause and a result. He checked yes on the questionnaire, however. Dr.
Pedrey is of the opinion that social maladjustment is a possible cause of

stuttering "in that it may create tensions that cause stuttering."

56

STUTTERER'WISYES TO STUTTER

Twenty of the people cooperating in this study feel that a cause
of stuttering is the stutterer wishing to stutter. Eighteen participants
disagree and answer in the negative. One person states that this cause is
infrequent, while two others say that it is possibly a cause of stuttering.
Three subjects are of the opinion that sometimes it is a cause, while five
have not answered the question. Still another alters the question to read,
"Stutterer needs to stutter."

Hiss Fish, Dr. Westlake, 3r. Wiley, Dr. Bender, Mr. floore, and ”r.
Albright contend that this desire is "on a subconscious level." Dr. Cable
states: "Occasionally, originally, either consciously or unconsciously."
Dr. Bloomer claims that this cause rarely functions. Dr. Anderson indi-
cates that he has found very little evidence to support this theory.

"r. Falconer observes that "not initially, but in later stages, I
believe some stutterers make the adjustment of enjoying the attention
their speech attracts." Dr. Parry believes that the stutterer wishes to
stutter "to preserve his own concept of his personality." Dr. Pedrey
points out that "it is possible that the stutterer uses stuttering as an

attention getter."

STUTTBRIITG A SYMPTOM

Forty-one of the peOple coooerating in this study feel that stutter-
ing is a symptom, while five subjects hold that it is not a symptom. One
participant believes that in some cases stuttering is a symptom, another
concludes that stuttering is seldom a symptom, and two people did not
answer the question.

Piss Larson explains that "stuttering is a symptom of some psycho-
logical or physiological problem." Dr. Cable is of the opinion that "stut-
tering is a symptom of a severe trauma of the nervous system." Dr. LaFol-
lette tells us that stuttering is a symptom "in the sense that it is a
learned habit stemming from something psychological, though there may be
many contributing factors."

Dr. Anderson states: "Doubtless true; real condition is little
understood." Vr. Falconer, supporting his theory that stuttering is not
a symptom.warns, "It is more than merely a symptom, I believe. It is a
complicated process, the laWS of which we have not yet discovered."

Dr. Parry is of the opinion that "sometimes stuttering is a symptom of a

psychological trauma."

58

STUIT'S? ETC- A CO7'PEIT3ATIOI‘T

Twenty-five of the people cooperating in this study feel that stut-
tering is a compensation. Twelve people do not consider stuttering to be
a compensation and therefore not a cause. Five people feel that this is
sometimes a cause, while one subject states that perhaps it is a cause.
One individual accepts the theory that it is infrequently a cause. Another
points out that stuttering is not a compensation in its beginning. Five
subjects did not answer the question.

Dr. Cable contends that originally, or when the stutterer first
starts to stutter, stuttering is a compensation, and as such, a cause.

Dr. Van Dusen, l~1'rs. Davison, Piss Garrison, firs. Lefevre, Hr. l”oore, and
Dr. Party feel that this is a cause in some cases. Dr. Ritzman believes
"this could very well be" a cause of stuttering. Dr. LaFollette, Hr. Car-
lile, and “r. Albright indicate that this would seldom operate as a cause,

and Dr. Anderson is very doubtful that it is ever a cause to consider.

59

ERSCYALITY DIFFICYLTY

Thirty-eight of the participants in this study feel that personality
difficulties cause stuttering. Six of the people do not feel that this
operates as a cause. One subject indicates that it is a circular process,
another feels that.personality difficulties sometimes cause stuttering,
while three people did not come to a yes-no decision.

Dr. Anderson has this to say about personality difficulties as a
cause of stuttering: "Certainly personality difficulty can result from
stuttering. It might also operate in a complex of general factors to bring
about the onset of stuttering."

Hr. Albright suggests that it is "perhaps a conflict of aggression
vs. high idealism. There are certainly other conflicts, too." Dr. LaFol-
lette points out that "these stuttering symptoms may in part be generated
by maladjustment such as when starting to talk, starting to school, or
adolescence."

Dr. Ritzman comments, "Host assuredly." Dr. Parry and Hr.'Wiley
concede that personality difficulties sometimes operate as a cause. Hr.
ibore poses the question, "Does he stutter because of personality diffi-
culty, or does he become a personality problem because he stutters?" Hr.
Moore concludes that personality difficulty does cause stuttering, as he
answers in the affirmative.

Yrs. Lefevre believes that it is more likely a result rather than a
cause. Vr. Falconer feels that "being a speech handicapped person would
give any of us difficulty," as he intimates that it is a result, rather than

u
'.|

causal. Ia Tanning is convinced that it is a circular process.

60

YEUROLOGICAL

Twenty-eight of the subjects participating in this study are of
the opinion that neurological factors are a cause of stuttering, while
nine disagree and answer in the negative. Three participants hold the
belief that neurological factors possibly cause stuttering, one feels
that they seldom cause stuttering, while still another points out that
neurological factors sometimes are causative factors. Eight subjects did
not answer the question.

Hr. Manning is of the opinion that a neurological cuase is the

' while Ur. Albright acknow-

"principle predisposing factor in stuttering,‘
ledges it to be "a cause with the exception of those blocks found with
certain cerebral palsied cases." Dr. Parry and Dr. Van Dusen agree that
it is "sometimes" a cause of stuttering.

Yr. Falconer believes that "it is a cause in a limited number of
cases," but that it is important to consider stuttering as ”a neurological
process in all cases of stuttering."

Dr. Anderson hesitates to say that such factors are direct causes.
"They are related? he thinks, "but probably in a more complex, indirect
way." Hr. Carlile is very doubtful that neurological factors cause stut-
tering, but Vr. Hutcheson, Hiss Garrison, and Er. Hoore contend that they
are contributing factors.

Dr. Bloomer concedes that "possibly" they are causes of stuttering.
Dr. Huckleberry, answering in the affirmative, emphasizes that "an in-
herited system may be such as to react to environment by stuttering, thus

being a part of the cause. Neurology, as such, does not cause stuttering,

 

61

however." Dr. Ritzman states: "I accept the dominant gradient concept as
the neurological basis of fluency as the best theoritical explanation we

have."

4..

..Ia .Qr.

,3

62

AEYCRYAL FREATHING

Nine of the subjects cooperating in this study feel that abnormal
breathing is a cause of stuttering, while thirty-one do not believe this
to be a causal factor. One participant points out that it is related,
another calls abnormal breathing a concomitant, while still another feels
that this factor possibly causes stuttering. Two individuals list abnormal
breathing as a symptom, while five subjects did not answer the question.

Hr. Manning and Dr. Bender feel that abnormal breathing is a result
of stuttering, rather than its cause. Dr. Severina l’elson, Director of
the Speech Clinic at the University of Illinois, and Dr. Bloomer contend
that abnormal breathing is a concomitant, rather than the cause of stutter-
ing. Dr. Parry prefers to classify it as a symptom. The latter believes
"that it may be related as an accompanying symptom of a more basic condi-
tion, or merely as part of the stuttering pattern."

fir. Hutcheson lists abnormal breathing as a contributing factor,
and Dr. Cable cites an example of a subject he worked with who stuttered
when he tried to talk during inhalation. When the habit was remedied, he
ceased stuttering permanently.

Dr. westlake has this to say of abnormal breathing as a cause of
stuttering: "Yight possibly, if breathing were very abnormal, as with
abdominal hernia. Usually it appears to be a part of the symptom." Dr.
Pedrey remarks, "Stutterers breathe normally when not speaking." He

checked no as his choice on the questionnaire.

-T

63

KYSIOLOGICAL

Twenty-eight of the people cooperating in this study accept physio-
logical factors as a cause of stuttering, while fifteen answer no to this
question on the questionnaire. Cne subject points out that there is a
normal structure but an abnormal use of it. Another participant feels
that physiological factors possibly cause stuttering, while still another
points out that sometimes it is a causal factor. Three people did not
answer the question.

Vr. Albright, indicating that he believes physiological factors to
be a cause of stuttering, qualifies his answer by saying that "a poor
physiological condition affects the individual's well-being." Dr. Bryngel-
son and Dr. Hutcheson classify this as "partially" a cause. Dr. Parny
suspects that it may be, but not in all cases. Vr. Falconer agrees, and
says, ”Stuttering is a physiological process, though causes are not usually
within the process."

Dr. Anderson states: "It is probable that some factors are involved
here, but just what is not known for sure. Heurolcgical organization and

57

motor skill seem to be related in some way." r. Fennema feels that the
"stutterer probably has a predisposing'weakness which leads him to adopt
this type of symptom." Dr. Bender, not checking either a yes or a no, con-
tends that "spastic conditions and other physical diseases oTten show
symptoms resembling stuttering.

Dr. Huckleberry checks a yes, if the physiological is associated

with rehabilitation of speech physiology. Dr. Cable does not agree that

physiological factors are a cause of stuttering. "The physiological

 

I'M

64

malfunctioning should not be regarded as a cause of stuttering, but rather

CD

as a result of the spasmophenia." "iss arriscn feels that it could be a
cause "in some cases where the resistance is lowered, or there is lowered

vitality." Dr. Goates points out that there is a "normal structure, but

an abnormal use of it."

65

LACK OF TREDRAL DC"IYAVCE

Twenty-one of the subjects participating in this study feel that
a lack of cerebral dominance is a cause of stuttering. Seventeen others
disagree and answer no to this question on the questionnaire. Three
participants concede that perhaps this is a cause, three others list it
is a cause in some cases, while one feels that a lack of cerebral domi-
nance seldom operates as a cause. Five people did not answer the question.

”r. Albright concedes that a lack of cerebral dominance is partial-
ly a cause of stuttering. Dr. Fryngelson points out that the "difference
is in kind and not in degree of normal speech." Dr. Parry thinks that it
is questionable if this lack of cerebral dominance is a cause of stutter-
ing. He answers in the negative. Dr. Anderson is of the belief that a
lack of cerebral dominance is not a direct cause. "It is an associated
symptom of some more basic condition rather than a cause, I mould say."

"r. Hutcheson is of the opinion that it "can be a direct and con-
tributing factor," while Mr. Voore disagrees when he says, "This factor
may have some weight as a cause, but does not have nearly the importance
that we used to attach to it." "r. Fennena, however, believes that a lack
of cerebral dominance is a cause in some cases of stuttering, while Dr.
Bloomer and Dr. Dender maintain that it is perhaps a cause of stuttering.
”iss Shirley E. Larson, Speech Therapist at the Crippled Childrens School,
Jamestown, Worth Dakota, points out that a lack of cerebral dominance

"seems to be especially true with cerebral palsied speech cases.”

Twenty-two of the people cc0perating in this study list sidedress
or laterality as a cause of stuttering, while thirteen conclude that it is
not a cause. Four people acknowledge that perhaps laterality is a cause,
while one classifies it as an irritant. One subject feels that it seldom

ight people did not answer the question.

L‘j

operates as a cause.

Dr. Van Dusen feels that in some instances, sicedness or laterality
could be a cause of stuttering. Dr. Fender and Dr. Parry believe that
perhaps it could be a cause, but they do not venture a yes or no answer.
Dr. Bloomer prefers to list it as an irritant factor.

Vrs. Daviscn points out that "tiere should be no interference with
the handedness of the child. In cases where laterality is not established,
tests are adrinistered to determine the hand which should take the lead."

"rs. Lefevre contends that sidednees or laterality is a cause of
stuttering, "if it is mixed." Hr. "core stresses that it "may have some
weight as a cause, but does not have nearly the importance we used to
attach to it."

Dr. Anderson concludes that it is not a direct cause, but ”an asso-

ciated symptom of some more tasic condition." 7r. Ialooner has this to

1

say: "Probaoly in some cases. laterality still holds my attention because

so many stutterers I've worked with have had sidednoss conflicts."

o-l-‘"l ivm f1 LHGAAT INT ‘T
as A.,.-IL had-ukb hilt;

Twenty-eight of the people cooperating in this study feel that
semantic association is a cause of stuttering, while ten people do not ac-
cept this as a causal factor. One of the subjects believes it to be a
factor, and another person concedes that it is sometimes a cause. One
other participant suggests that is is perhaps a cause. Fine subjects did
not answer the question.

'lfr

_r. Chreist concludes, "It

H.

s a contributing factor, if not a basic
cause." Tr. Wiley feels that sens; ic association is occasionally a cause.
Dr. Pedrey feels that, "There is considerable evidence that this is one of
the causal factors." hiss Garrison points out that it may be a cause in
some cases "in that the word arouses conflict." "rs. lefevre qualifies
her affirmative choice when she concedes that "when the pred'sposition or
actual stuttering is prosen., yes," it is a cause.

Dr. Cable includes "labeling"'when he calls semantic RSSOCIatlon a
cause of stuttering. Dr. LaFollette reflects, "The subject associates
stuttering with a meaning that is highly unacceptable, even repugnant,
Hence he disapproves bf himself and discredits himself." Dr. Anderson
holds that semantic association is not a sole cause. "It may operate to
aggravate a stuttering condition. It may hasten the onset of secondary
symptoms." While Mr. ”core acknowledges that it is a factor involved in

stutterinc 'r. .annin" calls semantic association a reci itatin cause.
b,

CB

iCK CE VISUAL IVAGERY

Fine of the people cooperating in this study believe that a lack of
visual imagery is a cause of stuttering, while twenty-seven of the subjects

are unable to accept it as a cause. Three subjects feel that perlaps it

eldcm operates as a cause, but still

no

is a cause, one states that this
another believes it to be related. T’ine participants did not answer the
question.

Dr. Parry contends that a lack of visual imagery is a questionable
cause of stuttering. Dr. Anderson also believes that it is very doubtful
that it is a cause. On the other hand, 7r. Hutchescn is of the opinion
that it is a "contributing factor." Dr. Bender holds that perhaps it is a
cause, "in the sense that stuttering symptoms are often noticed in certain
asphasics." Drs. Lefevre believes a lack of visual imagery to be related,
rather than causative, while Dr. Van Dusen indicates that it is possible
that this lack of visual imagery could be a cause of stuttering. Dr.
Andrews states, "Possibly hyperkinaesthetic, at the expense of auditory

inage."

ASSOCIATION

This subject of association on the questionnaire was not at all
clear to the people participating in this study, since eighteen subjects
did not answer the question. Thirteen of the participants believe that
association is a cause of stuttering, while ighteen do not accept it as
a causative factor. One subject indicates that association is possibly a
cause of stuttering.

"r. Falconer is of the opinion that association is a cause "when
interfering associations or conditioned responses may operate in stutter-
ing." Vr. Futchcson considers association to be a contributing factor,
while Dr. LaFollette feels association to be a cause in the sense that
the stuttering of a parent, brother, or sister, or playmate, may be imi-
tated. Dr. Pedrey and "iss Vorgan interpreted this to mean semantic asso-
ciation” and after altering the question to read this way, answered yes

on th e on esticnna i re.

7O

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93

CASE HISTORY DETAILED

Forty-four of the participants cooperating in this study consider
a detailed case history as essential to the treatment of stuttering, while
only three feel it to be unnecessary. Three subjects did not answer the
question.

Dr. Kopp does not hold that a detailed case history is a necessity
to treat stuttering. On the other hand, Mr. Albright, Mr. Carlile, Dr.
Ritzman, Dr. LaFollette, Dr. Parry, hiss Garrison, Mrs. Lefevre, 1T. Hoore,
Dr. Van Dusen, Hrs. Davison, Miss Mary M. HoAlister, of the Hard—of-Hear—
ing Kimberly School, Toronto, Canada, in addition to Viss horrison, Yr.
'Wiley, Hr. Hutcheson, Hr. Falconer, Vr. Fennema, Dr. Nelson, Dr. George
R. R. Pflaum, Director of the Speech Clinic, Kansas State Teachers College,
Miss Larson, Dr. Charlotte G. wells, Director of the Speech and Hearing
Clinic at the University of Hissouri, Dr. Bloomer, Dr. Nichols, Dr. Bender,
Dr. Worley, Dr. Pedrey, Hrs. Longerich, Dr. Cable, Vise Fish, Dr. Eleanor
E. Luse, Director of the Speech Clinic at the University of Vermont, Dr.
Goates, Yr. Chreist, Mr. Nontgomery, Dr. Andrews, and five out of the six
in the California group, headed by Yrs. Osea Brooksbank, Director of
Speech Correction in the Oakland, California Public Schools.. Mr. Tanning
indicates that he makes use of a case history, but "not detailed."

Dr. Huckleberry specifies that a case history is not written down,
but that it just "comes out." Dr. Westlake points out that he has never
thought of this as therapy, and does not indicate whether or not he
utilizes a case history. Dr. Anderson comments that he uses the usual

form, which he finds helpful.

 

94

PHYSICAL EIAYIHATICN

Thirty-eight of the people cooperating in this study report a
physical examination to be a part of their treatment. Five consider it
unnecessary, but two people believe that it is helpful in some cases.
Five participants did not answer the question.

Dr. Anderson informs us that he does not make a practice of a
routine physical examination for all stutterers, but "only if there are
certain factors I wish to check upon.” Dr. LaFollette, agreeing with
Hr.'Wiley, does not feel it important to treatment. re. Hoore utilizes
a physical examination in some cases, which inmlies that he bases its use
upon need. Dr. Johnson is not certain whether or not a physical examina-
tion is necessary.

Dr.'Westlake questions its use as a part of therapy, and does not
indicate whether or not he makes use of a physical examination. Dr. Bender
states that "it is required before a re-educational program” is embarked
upon. Dr. Bloomer uses a routine medical examination as part of his
therapy. fir. Falconer uses a physical examination ”only in cases where
it is indicated." Dr. Nelson, too, thinks it important "if the patient

seems to need it, but not necessarily for stuttering alone."

PREATHIUG EXERCIS“

Twenty-four of those participating in this study utilize breathing
exercises as a part of their therapy, while nineteen answer that they do
not consider this a part of their treatment. Three participants use
breathing exercises sometimes, and one participant states that she does
not utilize them too much. Another participant feels that breathing exer-
cises are incidental, not EEELES‘ Two participants did not answer the
question.

Y?

Dr. Kopp, Hr. Vanning, Hr. Fennema, Dr. Bloomer, Dr. Huckleberry,

v' --,r 11'

Mr. Yoore,. Yrs. Longerich, fir. nlle, Dr. Westlake, yr. Ventgomery, Dr.
Johnson, Kiss Garrison, Drs. 7crley,Ritzman, LaFollette, and 7r. Carlile
do not feel that breathing exercises should be a part of the treatment of
stuttering.

Drs. Bryngelson, Pflaum, and Yelson, Hr. Chreist, Hr. Hutcheson,
hiss Larson, and Viss Vorris, Dr. Luse, Dr. Nichols, and the California
group, in addition to Hrs. Lefevre and Yrs. Albright, feel that breathing
exercises have their place in the re—education of stutterers.

Dr. Bender reports the use of breathing exercises, "but always in
speech; not as gymnastics." Dr. Cable states, "Only when the case has
been found to need them, and when the proper sequential time comes for
them", are they used. Dr.'Wells tells us that "sometimes" she makes use
of breathing exercises in her therapy.

Dr. Coates intimates that he uses breathing exercises in his therapy,

but they are "incidental, not per se." Dr. Andrews reports that he makes

use of breathing exercises for the purpose of relaxation. Dr. Van Dusen,

 

‘V

hrs. Davison, and Dr. Parry employ this technique in some cases. Ur.
Falconer uses them "in rare cases where breathing incoordination is a
major difficulty."

Dr. Anderson, answering yes on the questionnaire, states, "Breath-

ing exercises are a part of the general speech reconditioning and re-

training on y."

ART . ICTTL ATIOII annex-ass

:Jo

Eighteen of the subjects coopera at ng in this study indicate that
they feel that articulation exercises should be a part of the therapy
for stutterers. On the other hand, twenty-five of the subjects believe
that these exercises should not be included in the treatm nt.

Cne participant feels that they should rarely be used, Dr. Bender
claims that they mar sometimes be used, iss Edna: ds believes they may be
used to satisfy teachers and parents of young children, and Dr. Luse feels

they serve a purpose when IMti iz ed as the ey come in vocal exercise. Three

partici Hp nts did not answer the question.

b

Dr. Anderson reports that articulation exercises are ”of dubious

value. There is very little carryover, and they may do more harm than
good." Dr. Parry informs us that some of his Cc" ses of stuttering are in
combination.with foreign dialect. He males use of these articulation

exercises when a need for them is inlicated. Yr. ”core, “rs. Dav

Flo

O)

O

H

h.-
B

1

an fr. Falconer feel that articulation exercises are superfluou

O)
c+
0

treatment unless the s tterer has an articulatory problem.

7iss Garrison loes not at 3 use of this there. py at any time, but

yr "“ra'

iss Fish assures us, may stutterers have articulation problems, too.
Security in articulation helps in the speech situ aticn." Dr. Cable be-
lieves that "after 9 lotional retraining, psychiatry, or mental hygiene,
objectivity, relaxation, etc., have been achieved; i.e., approach the
mechanical only when the more deep-seated aspects have yielded."

firs. Longerich elucidates:

In dealing "nth children stutterers who are not yet aware
of their problem, we concentrate on treatne nt solely in the

realm of psycho-therapy. as f
to know'why he is being brough
'enjcy himself.’

To speech exercises are given if the stuttering can be
alleviated while it is in the primary stage.

In the case of children (whose stuttering has reached the
secondary stage) adolescents, and adults, we do not employ

el it tetter for the child not
4.
D

e
t 0 our office--other than to

speech exe cises until after the major causes of the stutter-
ing have been alleviated. In other words, speech exercises
are not given until the final stages of therapy.

‘Ne first deal with the causes. After dealing with the
causes, we then give the articulation exercises to alleviate

the symptoms.

:A>.vv y» . ,

 

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PtlLIJJ. «4.11.1 BALD-\CI‘3.)

Eighteen of the suhjects contributing to this study, feel that

physical enercise is i dicated as a part of the thera.;. Twent~—tvo

bel eve it to be unirportant “hen treati::g stutte rers. ‘ne swl ject states

P.

not too much. Two participants find it useful in some cases, but seven

sutchts make no yes or no decisioa as to its use

"

Dr. Floomcr prefers to list physical exercise as a correlate and

not a speech corrective device." Ur. Yelson concludes that "recreation,
dancing, etc., are recommerded" as part of the physical exercise. :r.

Cable feels that physi al exercise should be recommended when the need
for it is indicated, WhiCh mould or ‘tail' be "occasionally.” Dr. Goates

also feels that if a stutterer demonstrates a need for physical exercise
that t shou1:l b: included as a part of the therafy. Dr.‘flestlahe points

out that ghysical exercise is "a part of the total adjustment, and in

Dr. Andrews considers pm sical exercise ingortant because it "pro

motes genera a1 hea 1th." Dr. Parry recommeids ph*si cal exercise and h; giene.

or

.r. Carlile thinks that any p} my id: exercise which is "conducive to good
'4. H

health of the case, if he needs is, should be a part of the theru“y.

ht and 7r.31 ar DelWOI est, Suffolk Univers'ty, Boston, 'assa-

0‘:

cresetts, are of the opiL1icn that normal anounts cf phys. cal exercise is
all that is IMUOLculo, so they do not utilize this form of theragy with
the stutterers. In discussing physical exercise, Dr. Anderson states,
"Tot as such. Sonatimes TGCORLIS nded as part cf a program to develop

Better motor skill and control, or to improve toia e, etc."

3!.f. .

h.)
r. D
Q

GYCUP TPTiTVEVT

LLJ‘Q‘.

Cr

Forty-two of those participating in this stuly u ilizo grout

r treatment of stuttering. Four disapprove

kt.

therapy as a technique in the

this type of therapy. Two participants indicate that sometimes group

P“)

o
therapy is of value, while one subject finds it has value only in the
case of parent group meetings. Cne person did not answer the question.

Dr. Anderson states: "Uith adults, especially, we feel that

t follows sufficient

Ho

grcu therapy has much to recommend it, proviied

L

‘

individual training to enaole th >r to perform'without too much

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difficulty." Dr. Parry, too, feels that group treatment, coupled with
individual therapy to fit the person, has merits.

1n: 0 0

Dr. Fender and Nr. “core indicate that sometimes it is of value,

while Vr. Fennema utilizes group therapy only in the case of parent group
meetings. Dr. Pedrey finds group treatment ”beneficial from the stan.—
point of mental hygiene." V3. Toore specifies that the group be limited
to four or five stutterers when the speech correctionist employs this
particular therapy. hiss "cAlister suggests choral speaking as a techni—
que that can be used in group treatment. Yr. Falconer points out that

group therapy has merit "if they are about in the same stage of severity,"

referring, of course, to the stutterers.

101

7’9.“ "1 773* ”! 71mm \T
can Cb S.UMLVLIC“

Thirty-five of the subjects responding on the questionnaire used
in this study indicate that the use of suggestion is a part of the therapy
they utilize with cases of stuttering. Where six participants do not in-
clude it in their treatment, Dr. Bloomer feels that it probably should be
used, and Dr. Van Dusen mploys the use of suggestion in some cases.
Seven others have not come to clear-cut yes or no decisions with regard
to this therapy.

Dr. Dryngelson is of the cpinion that the use of suggestion "oper—
ates in all therapy,” but he does not utilize it as a special technique.
He seems to feel, apparently, that when he is working with a stutterer

using other techniques, that the use of suggestion is always unconsciousl‘r

present. Dr. Bloomer, too, agrees with Dr. eryngleson when he says,

k"

"Probabl". Dost teach n“ utilizes suxflestion to some extent."
J b e

therapy should be limited.

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Dr. "orlef feels that the use of thi

*r.‘3iley is of the opinion that when suggestion is used, it should he
iniirect, rather than direct. Dr. Parry specifies that all suggestion

U)

itive suggestion. Dr. Anderson believes that this therapy

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"must be used a great deal, as part of general retraining of habits of

thinking and feeling. ”ore informal than formal, however."

 

USE CF RVLAKATICW

Forty of the suhjects cooperating in thi

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of relaxation as a part of their therapy. Whil
relaxation in their treatneat of stuttering, one other participant, Vrs.
Iefevre, intimates that she has not yet come to a yes or no decision as
to the value of this technique.

Dr. Anderson uses relaxation a great deal. "It is part of the

terer." Ur. Parry, in utilizi:: this technique, makes use of suggestion.

He follows Dr. Edmund Jacrssen's regressive relaxation techniques, as

rU

does Ur. Luse.

fir. Veere feels that the use cf relaxation "varies with iodivi—

.LL, A-‘.J—

but ”iss Carri puihts out that she makes it a practice not to

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duals,
use relaxation with stutterers, unless they are cerebral palsied cases,
”r. Falconer, in accepting relaxation as a part of therapy, tries
to get all stutterers to become expert in controllisg their musculature.
Dr. Bryngelson, on the other hand, does not believe relaxation is im-

portant to the treatment of stuttering, since he hol’s that "only as

emotions are conquered do muscles relax."

PSYCHOAYALYSIS

Eighteen of the participants reporting in this study feel that
pmychoanalysis should be a part of the treatment of stuttering. Viss
Fish contends that it should be used "only when a psychiatrist is on
the case," and Dr. Goates would utilize psychoanalysis "as a probe tech-
nique." Dr. Bender has recompended it upon occasions, while Mr. Voore and
Dr. Van Dusen can see its use in some cases, too. Of the remaining
twenty-seven reporting, nineteen profess to be against the use of psycho-
analysis, Viss Edwards points out that she is not capable of utilizing
this technique, and seven people did not answer the question.

Pr. Hutcheson sends some of his cases to a psychiatrist, but 7r.
Fennema prefers to use "a type of psychotherapy based on the person's

" rather than psychoanalysis in the

need to understand his insecurity,
strict sense of the word. Dr. Bloomer reports that psychoanalysis is

not used at the University of Wichigan speech clinic, but they do some-
times refer patients for psychiatric consultation.

Dr. Yorley prefers non-directive counseling to psychoanalysis,
while Dr. Longerich feels that psychotherapy is "the most important tool
in dealing with the stutterer." Dr.'Westlake believes that "these cases
should be handled by an analyst, but we work in conjunction with them."
Nhile Dr. Anderson would not recommend psychoanalysis in the majority of
cases, Dr. Parry points out that this technique should be used when it is

indicated.

104

FYPVCSIS

Thirty-five of the subjects cooperating in this study report
that they do not use hypnosis when working with stutterers. Dr. Goates
responds that he might utilize it as a probe technique, and six partici-
pants report hypnosis to be a part of their treatment of stuttering.
Eight subjects did not answer the question.

"r. Albright, one of the five persons who considers hypnosis to
be a part of therapy, reports it to be "an aid to relaxation and tension
release, but only under highly trained psychiatric personnel." fir. Carlile
believes it to be "useful for exploratory purposes, in the main."

Mr. Yoore and Dr. Kopp find it to be of value during the diagnostic
period. Dr. Cable believes it to be helpful in finding the causes, and
for certain therapy purposes, too. Dr. Pflaum is of the Opinion that it
should be used only for diagnosis or suggestion. Dr. Pedrey utilizes

hypnosis "only to help with secondary symptoms."

«Av ,. I P

IT‘TSi'RE n13 ssvrrsasa's srrccsss

Thirty-one of the subuects cooperating in this study believe that
insuring the stutterer's success should be a part of the treatment of
stuttering, while nine do not consider this to be necessany. One person
feels that this technique should be used in some cases, while nine others
did not answer the question.

Dr. Bryngelson tells his patients that they can not be cured, and
”r. "anning never insure's the stutterer’s success. Dr. Cable prefers
to insure the stutterer's success at first, and then in controlled situa-
tions.

Dr. Anderson, feeling that the therapist should insure the stutter-
er's success, states: "Very definitely. Unless conditions are such as
to insure a considerable degree of success in training, the stutterer is
simply being given training in stuttering, which he can do well already."
Dr. Pedrey does not insure the stutterer's success. "He’d be to apt to

go back to stuttering away from the clinic."

YSE OF TEL TELEPWO“E

. .

Forty-two cf the people cooperating in this study feel that the
use of the telephone should be a technique used in the treatment of
stuttering, five subjects report that they do not utilize this as a
part of their therapy, "iss Fish sees it as a situational assignment,
and Dr. Van Dusen finds it necessary to employ the use of the telephone
in some cases. Cne person did not answer the question.

Dr. Anderson clains that the use of the telephone is important,
"since this is usually one of the 'Jonah' situations for the stutterer."
Dr. Goates, in answering yes to this question on the questionnaire,
states that he utilizes this technique "as an eXercise only."

Dr. Cable points out that the use of the telephone should come
"when the time is ripe." "r. Falconer makes use of the telephone in
some cases where the instrument is feared and avoided. Dr. Bryngelson

asks his stutterers to use the telephone for clinical exercises in

faking.

107

Wrote Rm?

Thirty-one of the people participating in this study feel that
much rest for the individual that stutterers must be incorporated into
the treatment of stuttering. On the other hand, Dr. Bloomer maintains
that normal physical hygiene is adequate. Mr. ”core stipulates that in
some cases much rest is recommended, but not in all cases. Dr. wells
takes the position that "perhaps" much rest is indicated. Of the other
sixteen reporting, fourteen feel that much rest is not a necessary part
of therapy, and two subjects did not answer the question.

Dr. Bryngelson is of the opinion that much rest helps the stutterer.
Dr. Nelson's program embraces relaxation, recreation, and rest. Vr. Fal-
coner warns: Y'i’ivoid making an invalid of the stutterer. Enough rest,
of course, but the same as for non—stutterers." Dr. Bender states: "In
handling a case of stuttering from a re-educational procedure, I usually
ask the subject to spend twenty-four hours in bed without speaking at
ELL—1".”

Dr. Cable specifies "adequate rest for each individual case."
Dr.'Wells is of the opinion that much rest can be utilized "perhaps as
part of a general program for an individual." Dr.'Westlake approves of
much rest "if the case isn't getting adequate rest." firs. Davison stresses
that stutterers should be treated as "norwal individuals." Yr. Carlile
believes that the stutterer should have "adequate rest, sufficient for
good health." Dr. Anderson and Wise Garrison hold that much rest is

recommended only if specially indicated.

108

PS ETDO --S TU TT BRING

Twenty-three of the subjects participating in this study indicate
that they employ the use of pseudo-stuttering as a part of their treat-
ment of stuttering. while fifteen people respond that they do not include
this in their program. Dr. Bender, Dr. Johnson, and Dr. Van Dusen re-
port its use sometimes, but Dr. Luse rarely uses pseudo-stuttering.

Eight people did not answer the question.

Dr. Anderson has used pseudo—stuttering in a limited way only.

"It may have certain value in some cases." 7r. Falconer states: "I
think 'voluntary' have value in that the stutterer runs the machinery
instead of its running him." Dr. Bryngelson suggests: "Lots of it" in

the treatment of stuttering.

109

CREATE A SITCI"G "ETHOD CF SPEAYING

Thirty-six of the people cooperating in this study feel that
creating a singing method of speaking should not be included in the
treatment of stutter in Six others, however, believe that this tech-
nique should be used. "iss Edwards states that she has tried it, and
Kiss Fish occasionally uses this as a beginning therapy. Hr. ”core is
of the opinion that a singing method of speaking should not be used as
an end in itself. Five subjects did not answer the question.

Ur. Falconer, although answering in the negative, concedes that
he "might use it in difficult cases of initial, prolonged tonic block-
ing. The trouble is that most of then can sin anyway." "iss Pb yllis
". ferris, Speech Correctionist with the Kentucky Crippled Children's
Commission, uses this technique of creating a singing method of speak-
ing "during the clinic situation only." Dr. Luse qualifies her answer
by stating, "If you :nean sustained or connected speech, yes." Kiss
Garrison, answering in the negative, lists the exceptions she would make:
"except for social adjustment and group participation." Dr. Anderson
explains that he would use a singing method of speaking "only as a sort

of 'trick' device to assist severe stutterer to get started. 'We do

'work on smooth, even rhythm, however."

llO

HCKE COOPERATION

Forty-eight of the people cooperating in this study indicate
that home cooperation is necessary in the treatment of stuttering. Two
participants did not answer the question.

Dr. Anderson states, "Veny definitely. In the case of young
children, this is often about all that can be done, and frequently all
that needs to be done to insure success." "iss Garrison is of the opin-
ion that home cooperation is essential "in all cases, if at all possible."
Dr. Cable believes that home cosperaticn is important "after conferences
and training members of the family." Dr. Bryngleson claims that where
home cooperation is important "for children," it is "not necessary for

adults as they master their own home environment."

lll

DEPRI' HG ORAL GRATIFICATION

Thirty-three of the subjects participating in this study do not
deprive oral gratification as a part of their treatment of stuttering,
vhile five of the participants feel that this is a necessary technique.
Twelve people did not answer the question.

Dr. Pflaum deprives oral gratification "within limits." vr.
Hutcheson, in depriving oral gratification requests "no social conversa-
tion during a required period of training." Dr. Huckleberry, too, de-
prives oral gratification "if it is necessary to do so." Miss Morgan

deprives oral gratification "if he understands why it is being done."

112

SIVWLIANEOUS WRITING AND SPEAKING EXERCISES

Eighteen of the people cooperating in this study include simul-
taneous writing and speaking exercises in their treatment of stuttering,
while nineteen of the participants do not consider this to be a part of
their therapy. 'Where “iss Edwards has tried it, and Dr. Bender and Dr.
Van Dusen utilize this technique sometimes, Hr. floors seldomly employs
it. Nine people did not answer the question.

Dr. Anderson uses simultaneous writing and speaking exercises "in
a very limited way, usually when laterality is being established or
changed, only." Dr. Ritzman utilizes this technique "with younger child-
ren, who have been shifted in handedness." Dr.'Westlake uses simultaneous
'writing and speaking exercises occasionally, and Dr. Huckleberry utilizes
them if they are necessary. Hr. Falconer, in stating that he uses them
"rarely," adds that when he does employ them, they are "in cases of sharp

sidedness conflict."

113

TRAIVIWG IUPAIRED MUSCLES

Fifteen of the subjects cooperating in this study answer that the
training of impaired muscles is a part of their therapy in working with
cases of stuttering. However, twenty-four of the participants report that
they do not utilize this technique. Dr. Moore, in answering yes, empha-
sizes that this is true only if the muscle is damaged. Where one partici-
pant utilizes this technique sometimes, another uses it rarely. Nine
people did not respond with a yes or no answer.

Dr. Van Dusen includes training of impaired muscles in his treat-
ment, in some cases. yr. Hutcheson answers yes, "if by impaired, you
mean faulty function." Dr. Coates explains that he does not believe that
the muscles are impaired. Dr. Anderson shares this opinion. Miss Garrison

claims that "in no case" would she train impaired muscles.

114

ERECTING PSYCHOLOGICAL BARRIERS

Seventeen people cooperating in this study reply that they do not
utilize the erecting of psychological barriers as a part of their therapy
in treating stuttering. Twelve participants consider this to be a part
of their therapy. Dr. Hells uses it sometimes, while Dr. Van Dusen uses
it "in rare instances." Seventeen subjects did not answer the question.

Dr. Ritzman erects psychological barriers through analysis of the
stutterer's fears. Mr. Manning specifies that constructive barriers be
erected. Hr. Falconer refers to a "functional barrier" that he would in-

clude in a therapy for stutterers.

115

KEEP A lTOEiliAL ROUTINE

Forty-three of the subjects participating in this study feel that
keeping a normal routine should be a part of the treatment of stuttering.
One person, however, does not feel that this is necessary. Six subjects
did not answer the question.

Yr. Falconer is of the opinion that a normal routine should be in-
cluded in therapy, but he states, "This is no more important for a stut—
terer than for a non-stutterer." Yr. T"arming, too, considers it wise to
employ a normal routine, unless the case has a "compulsive personality."
Dr. Bender is in favor of the stutterer keeping a normal routine, "except
for certain factors," which he does not disclose.

Dr. Cable feels that the stutterer should "establish and keep what
should, for the case, be a normal routine: but it may differ radically
from his previous 'normal' routine." Dr. Parry sets up a routine which
he encourages the subject to follow. Dr. Anderson emphasizes that a nor-
mal routine is "often quite important, especially in the case of a child."
Fr. Carlile suggests that the routine fit the person, "depending on age,

Q #9

home, work, etc."

a hx'fiilp? «but. 1
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.

116

GKFRNJOF"CWWCWB"

Forty-three of the people cooperating in this study are of the
opinion that getting rid of "crutches" should be a part of the treatment
of stuttering. However, four participants do not agree that this should
be taken into consideration. Dr. Westlake believes that sometimes the
stutterer should get rid of these crutches. Two people did not answer
the question.

Dr. Anderson contends that "in certain cases" the stutterer should
get rid of "crutches", "again probably as a part of a general re-education
procedure." ”iss Garrison feels that "in all cases" these "crutches"
should be removed. Dr. Goates points out that this procedure should be

a gradual process.

Pin! 5...
.—

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117

STVTTDREQ ”AYES FRIEVDS WITH OTHER STUTTEREQS

Thirty-eight of the subjects cooperating in this study are of the
opinion that the stutterer should make friends with other stutterers.

Nine others answered no to this question on the questionnaire, while the
remaining three subjects did not come to a yes or no decision.

1‘~'r. Falconer, one of the participants answering no to the question,
defends his answer with, "He should make friends with people he wants for
friends - stutterers or non-stutterers." Mrs. Davison shares this opinion
with Mr. Falconer. Dr. Kopp, too, believes that the stutterer should have
some stuttering friends, but also some friends who are non-stutterers.

Dr. Cable believes that this technique is "helpful only to certain
personality types." ”iss Garrison believes that making friends with stut-
terers is good, if the subject is an adult. Dr. Anderson considers this
technique important for morale purposes. "This is one of the values of

group therapy."

 

118

GIVE THE STVTTERER RESPONSIBIL TY

Thirty-four of the subjects cooperating in this study feel that
giving the stutterer responsibility should be included when planning a
treatment for him. Three subjects indicate that they do not utilize this
technique, and three did not answer the question.

Dr. Anderson finds giving the stutterer responsibility important
"as a part of his general 'polishing off' training. The main responsibil-
ity we give him is to cure himself of his stuttering. In other words,
adequate motivation."

Dr. Parry believes this technique to be important, and in the case
of a child who stutters, he suggests to the case's teachers that they
"make him feel a part of the group." Dr. Cable utilizes this technique
of giving the stutterer responsibility through "a graduated series of
projects." Mr. Panning emphasizes that this should be a gradual procedure,

too.

119

snowmen READS mom STUTTERI‘TG

Thirty-eight of those participating in this study believe that
the therapy of a stutterer should embrace the point of having the stut-
terer read about stuttering. Four indicate that they did not approve of
this procedure. Dr. Van Dusen, however, feels that in some cases this
therapy might be helpful. Seven people did not answer the question.

Dr. Cable points out that in addition to reading about stuttering,

the stutterer "should especially read about the experimces of stutterers,

 

i.e., wendell Johnson's Because I Stutter and Conrad wedburg's, The

Stutterer Speaks."

 

Miss Fish recommends this type of treatment when the stutterer is
mature enough to be able to understand and interpret what he reads.
Dr..Anderson comments that this technique is used "as a part of our group
therapy with adults. Helps him to help himself; also to develop an ob-

jective attitude."

120

DEVELOP UN I LATE YALITY

Twenty-one of the people cooperating in this study feel that it
is necessary to develop unilaterality in their patients. Fifteen of
the subjects conclude that this is unnecessary to the program of re-
educating the stutterer. Six participants are of the opinion that this
technique can be utilized sometimes. Eight people did not answer the
question.

Dr. Anderson states, ”Generally, yes. 'We give laterality tests
and generally believe that stutterer should be rather definitely uni-
lateral." Dr. Ritznan develops unilaterality "only with younger children."
Dr. LaFollette finds that "only rarely does this aspect enter into our
treatment."

”r. Montgomery develops unilaterality "when necessary, and if
dominance has not been established." fir. Banning is of the opinion that
"it is only second in importance to psychological aspects." The follow-
ing indicate that developing laterality should be used in some cases,
'where the need for it is positively established; Mr. Falconer, Dr. Fopp,

'DP. Bender, Dr. Cable, Dr. Johnson, Dr. Andrews, ”iss Mergan, Dr. Van

Ihisen, Hrs. Davison, nr. noore, and Dr. Parry.

121

TE‘TFAL HYGI ETTE

Forty-nine of the subjects participating in this study consider
mental hygiene to be a phase of their therapy in dealing with stutter-
ers, while only one participant does not utilize this technique.

Dr. Anderson uses the mental hygiene technique "all the way through.
This is a most important part of the therapy, especially in cases of sec-
ondary stuttering." ”r. Carlile answers, "Very definitely," and T“*"iss
Garrison emphasizes that it is important "in all cases." Vr. Falconer is
of the opinion that mental hygiene should be pointed to the patient's
stuttering, and matters relating to it, but that the speech correctionist

should "avoid prying into his personal affairs."

122

PRCGRESSICN FROM EASY TO HARD

Forty-one of the participants cooperating in this study use the
technique of progressing from the easy to the more difficult when working
vdth stutterers, but six of the subjects do not include this in their
therapy. Three people did not answer the question.

Mr. Falconer, in answering in the negative, asks, "Sounds good,
but how does one do it? 'What's easy and what's hard? Unless you are
referring to audience situations, and even then, that varies." Dr. Anderson
finds it necessary to progress from the easy to the hard "to accomplish

successful experience in training."

123

PTLETTOTF SPEECH

Five of the subjects cooperating in this study indicate that they
employ the technique of using phantom speech in the therapy for stutter-
ing. On the other hand, twenty-seven participants do not use it. Eighteen
people did not answer the question.

Dr. Bender sometimes uses phantom speech, and Dr. Cable uses it
"at a certain stage of therapy." Dr. Anderson utilizes this technique very
little, and when he does, "only as a 'trick' to accomplish some special

end."

124

BOUNCE TECHNIQUE

Sixteen of the people cooperating in this study include the
bounce technique in their therapy for treating stuttering. iowever,
twenty-two report that they do not use this technique. Three other sub-
jects state that they employ the bounce technique sometimes. Dr. wells
concedes that "perhaps" it could be used "as part of a sequence in
training." T'Tiss Forgan uses the bounce technique "if it works." Seven
people did not answer the question.

Dr. Anderson checks no to this question, but lists these exceptions:
"As a 'trick' to accomplish some Special end; or in those cases that we
feel are otherwise hopeless." Dr. Goates, in answering yes, specifies
"occasionally," while Dr. Wiley uses it "very seldom." Dr. Cable employs
the bounce technique "for cases of tonic spasms." Tr. Vanning, however,

never uses it. “r. Falconer warns that the bounce technique should be

used "cautiously, and not much of it."

125

NEW SOCIAL COTTACTS

Forty-eight of the subjects cooperating in.this study conclude
that new social contacts for the stutterer is important when planning
a program for him. Dr. Fender and Dr. Cable feel that "sometimes" this
should be done, and hrs. Lefevre did not answer the question.

Hr. Falconer emphasizes the word "social" when he recommends new
social contacts for the person who stutters. "Try to get the stutterer
out of himself, particularly in social situations involving speech."
Fr. Hanning is enthusiastic about new social contacts for stutterers,
and Dr. Parry encourages this, too. Dr. Anderson finds this technique

useful where it is indicated. "Again part of the value of group therapy."

.1. .9
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126

W'O'A’K BEE-”ORE THE 1‘7 RROR

Thirty-two of the people cooperating in this study include some
work before the mirror in their therapy for'a stutterer. While four
others indicate that they use this in some instances, two participants
use it seldom, and seven others answer that they do not utilize the
technique at all. Five subjects did not answer the question.

Dr. Anderson, replies, "Very little." When he does, it is "only
to get control of certain symptoms, for example." Hrs. Davison has
"some cases where there are grimaces or tics," work before the mirror.
"iss Fish reports the use of this technique "only when the secondary
manifestations are severe." Vr. Manning suggests working before the
mirror "for eye contact, awareness, and confidence." Dr. dender uses
this technique often, he says. On the other hand, Mr. Falconer's stut-
terers work before the mirror "very little, for I think it may aggrevate

self-consciousness, which I consider a stuttering involvement."

127

THOUGHT-TRAINING EXERCISES

In this study, twenty-three subjects hold that thought-training
exercises should be a part of the therapy for stutterers. Fifteen other
participants do not use this technique, while two additional subjects
employ it in some cases. Ten.subjects did not answer the question.

Dr. Bryngelson states that "this happens, but no specific training
is given." Dr. Anderson "tries to retrain the stutterer's thinking as
well as speaking. There is some evidence that stutterer's thinking is

disorganized."

128

RE“ TOVE SPECH CONFLI CTS

Thirty-eight of the subjects reporting in this study indicate
that they consider the removal of speech conflicts a part of their therapy.
Five subjects answer no, and seven have not come to yes or no decisions.

Dr. Anderson states, "He do everything under 'mental hygiene' that
is indicated in each case." “iss Garrison, in andwering yes to the ques-
tion stipulates, "If this means psychological." Mr. Hutchesen believes
that both physical and psychological speech conflicts should be removed.
Dr. Kopp specifies "attitudes and fixations concerning speech and situa-
tions."

Hr. Fanning would rather have his stutterers adjust to speech con-
flicts, but Dr. Bender feels that speech conflicts should be removed
"often." 3r. Falconer feels that speech conflicts should be removed, and
he states, "I've always thought stuttering may be a speech conflict in

the processes of thought and speech."

129

amps mwncnmm TO FIT smmam

Twenty-four of the subjects participating in this study feel that
the environment should be changed to fit the stutterer. Fourteen, howe
ever, do not attempt this. One person states that the speech correction-
ist should change the environment if it is a factor, and another said
that in some cases this is permissable. Ten subjects did not answer the
question.

Mr. Falconer tries to "modify it as much as possible. I haven't
known one who could afford much change." fir. Carlile states, "If it is
possible to improve the environment, I think it should be done."

Dr. Bender is of the opinion that the environment should be changed
"when it is necessary and when it is possible." Dr. Parry tries to change
the environment of primary stutters, and Fr. Wiley indicates that this
technique is fine in the case of children. Dr. Anderson warns of the
limits here. "Often some changes are indicated in the case of children,

to fit the child; I am.not sure that it would be 'to fit the stutterer.'"

130

DEVELOP AN OBJECTIVE ATTITUDE

'Nith the exception of two subjects in this study, the partici-
pants indicate that they feel that the development of an objective
attitude is important in the treatment of stuttering. Forty-eight ans-
wered yes, and two did not answer the question.

Dr. Anderson considers the development of an objective attitude
essential in the case of the secondary stutterer. Hr. Hoore states,
"Very important." Dr. Bender develops an objective attitude except in
small children. Yr. Carlile considers the developing of an objective

attitude "a must."

131

E”PHASIS UPON WBCHANICAL ASPECTS OF STUTTERING

Twelve of the subjects participating in this study answer yes to
the question, "Emphasis upon mechanical aspects of stuttering." However,
twenty-three answered in the negative. Dr. wells utilizes this emphasis
upon the mechanical aspects of stuttering "only as a part of the analysis
of the blocks," Mr. Moore "only as they apply to the secondary character-
istics and habit patterns associated with stuttering," and Dr. Parry, "to
remove the symptoms." Twelve subjects did not answer the question.

Mr. Carlile, in putting an emphasis upon the mechanical aspects
of stuttering, defends his position by saying, "The stutterer should
knOW'what he is doing when he stutters." Dr. Bloomer utilizes this tech-
nique "somewhat," and Dr. Cable states, "Usually, but only when the other
malfunctioning aspects have been cleared up or are well on their way to
being cleared up."

”r. Chreist feels that an emphasis on the mechanical aspects of
stuttering can aid the stutterer in "learning the individual pattern and
acquiring an ability to fake the pattern." Miss Vorris states that she
would use it "with high school students and adults, only."

Dr. Anderson emphasizes the mechanical aspects of stuttering in
a very limited way. "Only as necessary to include in the general re-
education of the speech habits of the stutterer. Then, only as a pat-
tern." Dr.'Westlake points out that "in certain cases" it is feasible.
Dr. Albright does not emphasize the mechanical aspects of stuttering,
but he discusses it throughly with his subjects. Dr. Bryngelson emphasizes

the mechanical aspects of stuttering only on secondary habit patterns.

132

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CHAPTER VI

SUI "T 'ARY

CHAPTER ‘VI

SIT? D'ARY

Summary of the Causes of Stuttering

 

Heredity. On the basis of this study, there is an indication that
speech correctionists still believe that the factor of heredity is a cause
of stuttering. Twenty—six of the people cooperating in this study hold
that heredity is a cause of stuttering, while thirteen of the participants
feel that it is not a cause. Three indicate that heredity may be a cause
of stuttering, while six did not answer the question. One individual be-
lieves that heredity sometimes causes stuttering, while another holds that
heredity as a cause, is questionable.

Environment. Forty-four of the people cooperating in this study

 

hold that environment is a cause of stuttering, while four of the partici-
pants feel that it is not a cause. One other person concedes that environ-
ment is possibly a cause, and another does not answer the question.

Imitation. Twenty-two of the people in this study feel that imita-
tion is a cause of stuttering, while twenty answer no to this question on
the questionnaire. Four people think that it is possible that imitation
may cause stuttering. One is doubtful that it has any effect, and another
says that only when sympathy is at work will imitation cause stuttering.
Two participants did not answer the question.

32213, Twenty-five of the people cooperating in this study feel
that habit is a cause of stuttering, while seventeen disagree and answer

no, that this is not a factor. Two people concede that habit could perhaps

136

cause stuttering, while one individual points out that symptoms become
habits. Five participants did not answer the question.

Feurosis. Twenty-eight of the people cooperating in this study

 

feel that neurosis is a cause of stuttering, while nine are of the opinion
that it was not a causal factor. One participant lists it as a secondary

factor, another classifies it as a possibility, while two others point out
that it is rarely a cause, and one feels that it is sometimes a cause.

One other subject comments that people who stutter are sometimes neurotic.
Still another believes that neurosis is a result rather than a cause.

Six individuals did not answer the question.

Psychological. Forty-four of the subjects participating in this

 

study feel that psychological factors are causes of stuttering, while two
believe that they are not factors in causation. One subject lists psycho-
logical factors as a factor to be considered, another believes it to be a
result, while still another did not answer the question. .

Inferiority a factor. Thirty-eight of the people cooperatinv in

O

 

this study feel that inferiority is a cause of stuttering, while seven
others do not. Two participants are of the opinion that perhaps inferiority
causes stuttering, but three others consider inferiority to be a result
rather than a cause.

Fear a cause. Thirty-seven individuals believe that fear is a cause

 

of stuttering, while six people are of the opinion that this is not a
factor. One participant answers that in some cases fear is a cause, another
calls fear an aggrative factor, and another refers to it as a precipitating
factor. Where one calls fear a symptom, another prefers the term result.

One person did not answer the question.

137

Conditioned inhibition. Twenty-four of the people cooperatinv 1n

L.)

 

this study feel that conditioned inhibition is a cause of stuttering, while
seven do not consider this a factor of causation. Two participants claim
that possibly it is a cause, another states that sometimes it is a cause,
while still another lists conditioned inhibition as a maintaining, but not
causal, factor. One additional person is not sure if stuttering is an
inhibitory phenomenon. Thirteen did not answer the question.

Social maladjustment. Forty—one of the people cooperating in this

 

study feel that social maladjustment is a cause of stuttering, while four

do not feel that it is a causal factor. One participant labels it a contri-
buting factor, and two others believe social maladjustment to be a result,
rather than a cause of stuttering. Cne other individual concedes that some-
times social maladjustment may cause stuttering, and one subject did not

answer the question.

Stutterer wishes to stutter. Twenty people feel that a cause of

 

stuttering is the stutterer wishing to stutter. However, eighteen partici—
pants answer no to the question on the questionnaire. Cne individual states
that this cause is infrequent, while two others say that it possibly causes
stuttering. Three subjects are of the opinion that sometimes it is a cause,
while still another alters the question to read, stutterer needs to stutter.

Five persons did not answer the question.

 

Stuttering a symptom. Forty-one of the people feel that stuttering
is a symptom, while five answer in the negative. One participant believes
that in some cases stuttering is a symptom, another concludes that stutter—

ing is seldom a symptom, and two subjects did not answer the question.

138

’4.

Stuttering a compensat on. Twenty-five of the people feel that stut-

 

tering is a compensation and a cause of stuttering, twelve believe that it
is not, while five individuals feel that it is sometimes a factor. One
subject states that perhaps this is true, another accepts the theory that
it is infrequently a cause, and still another points out that stuttering
is not a compensation in its beginning. Five subjects did not answer the
question.

Personality difficulty. Thirty-eight participants feel that person-

 

ality difficulties cause stuttering, but six people do not believe that
this operates as a cause. One subject indicates that it is a circular
process, another feels that this is sometimes a cause of stuttering, while
three people did not answer the question.

Yeirological. Twenty—eight of the subjects participating in this

 

study are of the opinion that neurological factors are the cause of stutter-
ing, while nine disagree and answer in the negative. Three participants
hold the belief that neurological factors possibly cause stuttering, one
feels that they seldom cause stuttering, while still another points out

that sometimes neurological factors are a cause of stuttering. Eight sub-
jects did not answer the question.

T
I

Abnormal breathing. line of the subjects cooperating in this study

 

feel that abnormal breathing is a cause of stuttering, while thirty-one do
not believe this to be a causal factor. One participant points out that

it is related, another calls abnormal breathing a concomitant, while still
another feels that this factor possibly causes stuttering. Two individuals
list abnormal breathing as a symptom, while five people did not answer the

question.

tJu

Physiological. Twenty-eight people accept physiological factors as

 

a cause of stuttering, while fifteen do not consider this to be a cause,
One subject points out that there is a normal structure but an abnormal
use of it. Another participant feels that physiological factors possibly
cause stuttering, while still another points out that sometimes this is a
causal factor. Three participants did not answer the question.

Lack of cerebralgdominange. Twenty-one subjects feel that a lack of

*—_‘—

 

cerebral dominance is a cause of stuttering, while seventeen answer no to
this question on the questionnaire. Three participants concede that per-
haps it is a cause, three others list it as a cause in some cases, while

one believes that it seldom operates as a cause. Five people did not answer
the question.

Sidedness or laterality. Twenty-two people list sidedness or later-

 

ality as a cause of stuttering, while thirteen conclude that this is not

a cause. Four people acknowledge that perhaps it is a cause, but one in-
dividual classifies it as an irritant. One other subject feels that later-
ality seldom operates as a cause. Eight people did not answer the question.

Semantic association. Twenty-eight subjects believe that semantic

 

association is a cause of stuttering, while ten people do not accept this
as a causal factor. One subject feels that sematic association is a factor,
another concedes that it is sometimes a cause, while still another partici-
pant suggests that perhaps this is a cause. Nine subjects did not answer
the question.

Lack of visual imagery. Nine of the people cooperating in this study

conclude that a lack of visual imagery causes stuttering, while twenty-seven

are unable to accept it as a cause. Three subjects feel that perhaps a

140

lack of visual imagery is a cause, one states that it seldom operates as a
cause, but still another believes it to be related. Nine participants did
not answer the question.

Association. Thirteen individuals believe that association is a

 

cause of stuttering, while eighteen do not accept it as a causative factor.
Cne individual indicates that association is possibly a cause of stuttering,

but eighteen participants did not answer the question.

Summary of the Treatment of Stuttering

 

Case history detailed. Forty-four people consider a detailed case

 

history as essential to the treatment of stuttering, while only three feel
- I,
that it is unnecessary. Three subjects did not answer the question.

Physical examination. Thirty-eight of the subjects cooperating in

b

 

this study report that a physical examination is a part of their treatment
f stuttering. Five individuals consider it unnecessary, but two believe
that it is helpful in some cases. Five participants did not answer the

question.

Freathing ex roises. Twenty-four of those people participating in

 

this study utilize breathing exercises as a part of their therapy, While
nineteen answer that they do not consider this a part of their therapy.
Three participants use breathing exercises sometimes, andone subject states
hat she does not utilize them too much. Another participant feels that
breathing exercises are incidental to treatment, not 323‘53. Two people did

not answer the question.

141

Articulation exercises. Eighteen people indicate that they believe

 

articulation exercises should be a part of the therapy for ctutterers. Cn
the other hand, twenty-five of the subjects feel that these exercises should
not be included in the treatment. One participant feels that they should
rarely be used, another claims that articulation exercise0 may sometimes be
used, while still another participant concedes that they may be used to sat—
isfy teachers and parents of young children. One subject feels that articu-
/
lation exercises serve a purpose when utilized as they come in vocal exer-

cise. Three participants did not answer the question.

Physical exercise. Eighteen of the subjects contributing to this

 

study feel that physical exercise is indicated as a part of the therapy for
stutterers. Twenty-two believe it to be unimportant. One subject states
that physical exercise should not be employed too much, but two subjects

find it useful in some cases, and seven subjects did not answer the question.

Group treatment. Forty-two individuals consider group therapy a

 

necessary technique to employ in the treatment of stuttering. Four disap-

my

prove of this type of therapy. -NO participants indicate that sometimes

1

it is of value, while one subject finds that group therapy nas value only
in the case of parent group meetings. One person did not answer the

question.

Fee of sunnestion. Thirty-five of the subjects responding on the

 

questionnaire used in this study indicate that he use of suggestion is a
part of the therapy they utilize with cases of stuttering. Where six par-
ticipants do not include the use of suggestion in their treatment, one

other participant feels that it probably should be used, and still another

142

subject employs the use of sugrestion in some cases. Seven participants
did not answer the question.

Use of relaxation. Forty of the subjects cooperating in this stu'v

 

consider the use of relaxation to be a part of their therapy. While nine

do not include relaxation in their treatment of stuttering, one participant
intimates that she has not yet made a decision.as to the value of this tech-
nique.

Esychoanalysis. Eighteen of the participants reporting in this study

 

feel that psychoanalysis should be a part of the treatment of stuttering.
One participant contends that psychoanalysis should be used only when a
psychiatrist is on the case, while another subject would utilize this as a
probe technique. Three people use psychoanalysis sometimes. Nineteen
individuals do not use psychoanalysis, in addition to one other participant
who points out that she is not capable of utilizing this technique. Seven
Leople did not answer the question.

hypnosis. Thirty-five of the subjects cooperating in this study re-
port that they do not use hypnosis as a part of their therapy when working
‘with stutterers. While one participant might utilize it as a probe tech-
nique, six people report that hypnosis is an established part of their
therapy. Eight subjects did not answer the question.

Insure the stutterers success. Thirty-one of the subjects cooperat-

 

ing in this study believe that insuring the stutterer‘s success should be
a part of the treatment of stuttering, while nine do not consider this to
be necessary. One person feels that this technique should be used in some

cases, and nine people did not answer the question.

Use of the telephone. Forty-two people report that the use of the

 

telephone should be a part of the treatment of stuttering. Five subjects
indicate that they do not utilize this technique in their therapy. Cne
subject sees the use of the telephone as a situational assignment, and
another finds it necessary to employ the use of the telephone in some cases.
One person did not answer the question.

"uch rest. Thirty-one participants feel that much rest for the
individual who stutters must be incorporated into the therapy. On the other
hand, one participant maintains that normal physical hygiene is adequate.
Another subject stipulates that in some cases much rest is recommended, but
not in all cases. Still another person takes the position that perhaps
much rest is indicated. Cf the other sixteen reporting, fourteen feel that
much rest is not a necessary part of therapy, and two people did not answer
the question.

Pseudo-stuttering. Twenty-three of the subjects participating in this

 

study indicate that they employ the use 0? pseudo-stuttering as a part of
their treatment of stuttering, while fifteen people respond that they do not
include this in their program. Three people use it in some cases, another
rarely uses pseudo—stuttering, and eight people did not answer the question.

Create a Singing method of speaking. Thirty-six people feel that

 

creating a singing method of speaking should not be included in the treat-
ment of stuttering. Six others, however, believe that this technique

should be utilized. Cne participant reports that she has tried it, another
uses it occasionally as a beginning therapy, and still another contends that
a singing method of speaking should not be used as an end in itself. Five

people did not answer the question.

144

Home cooperation. Forty-eight people indicate that home cooperation

 

is necessary to the treatment of stuttering, while two participants did
not answer the question.

Depriving oral gratification. Thirty-three of the subjects partici-

 

 

pating in this study do not deprive oral gratification as a part of their

0
treatment of stuttering, while five other participants feel that this tech-
nique should be an integral part of therapy. Twelve people did not answer
the question.

Simultaneous writing and speaking exercises. Eighteen people in-
clude simultaneous writing and speaking xercises in their treatment of
stuttering, while nineteen individuals do not consider this to be a part of
their therapy. One subject indicates that she has tried it, and two others

TY

utilize this technique sometimes, while another rarely employs it. wine

articipants did not answer the question.

ifteen of the subjects cooperating in

x.)

I \
3“
‘

Training impaired muscles.

 

this study answer that the training of impaired muscles is a part of their
therapy in working with cases of stuttering. However, twenty-four of the
participants report that they do not utilize this technique. One subject
uses the technique sometimes, another rarely, and nine people did not re-
spond with a yes or no answer.

Erecting psychological barriers. Seventeen people cooperating in

 

this study reply that they do not erect psychological barriers as a part
of their therapy in treating stuttering. Twelve participants consider this
to be a part of their therapy. One subject uses it sometimes, while another

uses it rarely. Seventeen of the subjects did not answer the question.

145

Keen a normal routine. Forty-three of the suhjects participating in

 

this study feel that keeping a normal routine should be a part of the
treatment of stutterinr. Cne person, however, does not feel that this is
necessary. Six subjects did not answer the question.

Get rid of "cnrtches". Forty-three of the people cooperating in

 

this study are of the opinion that getting rid of "crutches" should be a
part of the treatment of stuttering. however, four participants do not
agree with this, and answer no to the question on the questionnaire. Cne
subject believes that sometimes the stutterer should get rid of these
"crutches". Two people did not answer the question.

Stutterer makes friends with other stutterers. Thirty-eight of the
subjects cooperating in this study are of the opinion that the stutterer
should make friends with other stutterers. Nine others answer no to this
question on the questionnaire, while the remaining three subjects did not

answer yes or no.

Give the stutterer responsibility. Thirty-four of the subjects

 

cooperating in this study feel that giving the stutterer responsibility
should be included when planning a treatment for him. Three subjects in-
dicate that they do not utilize this technicue and three did not answer
the question.

Stutterer reads apput stuttering. Thirty—eight of those cooperating
in his study believe that the therapy of a stutterer should embrace the
point of having the stutterer read about stuttering. Four indicate that
they do not approve of this procedure. Cne, however, feels that in some

cases this therapv mi ht be helpful. Seven people did not answer the
-t C _ _ :4

question.

148

Develop unilaterality. Twenty-one people feel that it is necessary

 

to develop unilateralinr in their patients who stutter. Eifteen subjects
conclude that this is unnecessary to the program of re-educating the stut-
terer, while six others are of the opinion that sometines this technique
may be utilized. Bight people did not answer the question.

q

'ental hygiene. tortr-nine of the subjects participating in this

I
‘1

 

study consider mental hygiene to be a phase of their therapy in dealing
with stutterers, while only one participant does not utilize this tech-
nique.

Progression Iron easy to hard. Forty—one of the participants cooper-

 

ating in this study use the technique of progressing from the easy to the
more difficult when working with stutterers, but six of the subjects do
not organize their therapy in this way. Three people did not answer the
question.

Phanton speech. Vive of the subjects cooperating in this study

 

indicate that they employ the technique of using phantom speech in the
therapy for stuttering. Cn the other hand, twenty-seven subjects do not
use it, and eighteen people did not answer the question.

“ounce_technique. Sixteen of the people cooperating in this study

 

include the bounce technique in their therapy for treating stuttering.
fowever, twenty—two report that they do not use this technique. Three
other subjects state that they enploy it sometimes. One subject employs

f

the bounce technique i it works, another concedes that perhaps it could
be used as part of a sequence in training, and seven people did not answer

the question. '

147

New social contacts. Forty—eight of he subjects conclude that new

 

social contacts for the stutterer is important when planning a program for
him. Two individuals feel that this should sometines be done, and one
person did not answer the question.

Kerk before the mirror. Thirty—two of the people participating 1“

 

this study include some work before the mirror in their therapy for a
stutterer. While four others indicate that they may use this in some in-
stances, two subjects use it seldomly, and seven others answer that they
do not use the technique at all. Five of the subjects did not answer the
question.

Thou;jt_praining exercises. In this study, twenty-three of the sub-
jects hold that thought-training exercises should be a part of the therapy
for stutterers, while fifteen other subjects do not use it. Two additional
participants employ it in some cases. Ten people did not answer the

question.

Remove speech conflicts. Thirty-eight people indicate that they

 

consider the removal of speech conflicts as a part of their therapy. Five
subjects answer no to this question on the questionnaire, and seven parti-
cipants did not answer the question.

Change environment to fit stutterer. Twenty-four people feel that

 

the environment should be changed to fit the stutterer. Fourteen, however,
do not attempt to do this. Cne person states that the speech correctionist
should change the environment if it is a factor, and another believes that
in some cases this is permissable. Ten subjects did not answer the question.

Develop an objective attitude. Hith the exception of two subjects

.L

 

in this study, the participants indicate that they feel that the development

a

of an objective attitude is important in the treatment of stuttering.
Forty-eight answered yes, and two did not answer the question.

Ennhasis upon mechanical aspects of stuttering. Twelve partici-

 

pants emphasize the mechanical aspects of stuttering, while wenty-three
do not place their emphasis on this. Cne individual utilizes this empha—
sis upon the mechanical aspects of stuttering only as a part of the analy-
sis of the blocks, while another only as they apply to the secondary char-
acteristics and habit patterns associated with stuttering. Another parti-
cipant emphasizes the mechanical aspects of stuttering to remove the

symptoms. Twelve people did not answer the question.

149

757' \(x 1) V "fr?!
_V/lCI 4: JLin4u.

1

The author was born in Tason, T"icnigan, a small community twelve
miles from East Lansing, on February 2, 1925. She was named Lulu "ae
Johnson by her fraternal grandmother, after her only daughter, who had
passed away at a very young age. "Little Lulu" was enrolled in kinder-
garten at age four, in the year 1929. This year was noteworthy in her
life, as two major developments took place. The first was the birth of
a sister, Fetty J an, and the second was a mastoidectomy performed on
her left ear. Two years later a brother, James Gorman, was born.

In 1953, the James Reginald Johnson family moved to East Lansing,

g...

Vichiran,‘where they continue to make their home.

\

T“

.he author attended
elementary school, junior high and high school in that locality, being

a member of the June, 1942, graduating class.

In he interim of graduatinr in June and beginning college in the

0
Fall, the author attended Lansing Secretarial School. Yer choice of
colleges was Vichigan State, which she attended through 1947, majoring
in Speech Correction and Education, with minors in Science and Social
Studies. She graduatel with a Bachelor of Arts Degree.

In the Fall of 1947, she journeyed to nearby Flint, Vichigan, where

she held the position of speech correctionist in the Flint Public Schools.

The following year she was appointed Graduate Assistant in the‘firitten and

Spoken English Department at Hichigan State College, at which time she

q

began work on her 7aster's Degree, majoring in Speech Correction, and

minorinq in Psychology.

\_.

1948 was a memorable year for another reason, too, for see was
married to Voah Alonso, an art student at Vichinan State College, on
December 17th.

In the Fall of 1949, the author accepted a position at the "ichigan
School for the Blind in Lansing, as a teacher of the first and second
grade sight-saving room. At the end of that teaching year, she returned
to Vichigan State to complete the requirements for the Degree of Vaster

of Arts which was awarded to her in Se tember 1950.
3 .9

-- ~n
“I “IJI CGRQA‘. Elf

A. SCCKS

Ainsworth, Stanley, Speech Correction T"ethods. Yew York: Prentice-hall,
Incorporated, 1949. 149 p.

 

 

American Speech Correction Association — Proceedings. "A Symposium on
Stutterinr." '701. 1. Yadiron, disconSin: Collese Typing Company,

1230. 199 p.

Appelt, Alfred, The meal Cause of Stammering and Its Permanent Cure.
'ew'York: E. P. Dutton and Company, Incorporated, 927. 227 p.

 

Sluemel, C. S., ”ental Aspects of Stamnering. Saltimore: The'fiilliams
And Wilkins Comoany, 1980. 152 p.

, Stampering and Allied Disorders. New York: The Vacmillan
Company, 235. 1C2 p.

 

 

 

 

Borden, Richard C., and Alvin C. Susse, Speech Correction. New York: F.
S. Crofts and Company, 1925. 150 p.

Fletcher, John Vadison, She Problem of Stuttering. New York: Lon'mans,
Green and Company, 1226. 362 p.

Gifford, ”abel Tarrington, Tow to Cvercome Stammering. Few York: Prentice-
Tall, Incorporated, 1240. If? p.

 

Cf'

fiahn, Eugene F., Stut heories an: Therapies. Stanford

 

 

 

erinr Sirnificant
a o ”r

Vniversity Press; St-ni rd ‘uiversi y, California, 1943. 177 p.
Johnson,'Tendell, Spencer F. Prown, James F. Curtis, Clarence'fi. Edney,

T

and Jacqueline Heaster, Speech handicapped School Children.
York: Yarner and Erothers Publishers, 1948. 464 p.

Yew

 

Csler, William, The Principles and Practice of Veiicine. Few York: U.
Appleton and Company, 1895. 1143 p.

 

Travis, Lee Edward, Speech Pathology. YeW'York: D. Appleton and Company.

 

 

'Van Riper, C., Speech Correction Principles and ”ethods. Few York:
Prentice-hall, Incorporated, 1947. 470 p.
D S“'CUICfI LI"? ‘m"“?
u. ..J~s.l. .x, 1 ! ..'.'-J .114. . -Lu
Jacque Stanle; A., "The Story of Stammering." Speech, 2:17-19, ‘ay,

S!
1:732; 2:59-42, October, 195p; 3:20-25, Aprii',"T§'39.

ATTCTATE) BIULIOGXAPKY

American Speech Correction Association, Proceelinfis, Vol. I, "A Symposium

 

on Stuttering." "adison, Jisconsin: College Typing Company, 1930.
199 p.

This yearbook consists of a series of papers on stuttering presented
at the meeting of the American Speech Correction Association in
1930. Causes and treatments are presented, in addition to some
public school programs in speech correction.

9 Proceedinés, Vol. VI, ‘adison, Wisconsin: College

 

 

'pinn Company, 1336. 2L2 p.

\4

{SF

mhis yearbook contains seven addresses on stuttering by outstanding

correctionists in the field.

, Proceedings, Vol. VII, ‘adison, Wisconsin: College

 

I"?

TVping Company, 1037. C7 p.

0

Seven addresses on the problem, causes, and treatment of stuttering,
are included in unis yearbook.

, Proceedinns, Vol. VIII, Vadison,'Jisconsin: College

 

' " ~ - “7’? r
lbrpinp; CCHSa‘llu, lLvU. {)0 p.

Several articles dealing with the problem and treatnmnt of stutter-
ing, including an explanation of the two-room technique for treat-
ment, are included in this yearbook.

Bender, James F., and Victor V. Kleinfeld, Principles and Practises of

Berry,

 

Speech Correction. Yew York: Pitman Publishing Company, 1938.
298 p.

 

Bender and Kleinfeld survey the problem of stuttering in Chapter
Eleven of this book. Therapies are included in the discussion.

T-T

Yildred Freburg, and Jon Eisenson, The Defective In Speech. ew

York: F. S. Crofts and Company, 1942. 426 p.

 

Chapter Nine discusses the problem of stuttering, while Chapter Ten
sugsests general therapeutic measures to be taken by the speech
correctionist.

153

 

Booms, E. J., and T. A. Richardson, The Vature and Treatment of Stammering.
New York: E. P. Dutton and Company, Incorporated, 1932. 135 p.

Causation of stuttering and its treatment can be found in Chapters
Nine, Ten, and Eleven in this book. Treatment is through relaxation,
as practiced in London clinics.

Froeschels, Emil, Speech Therapy. Boston: Exnression Company, 1933. 252 p.

 

Part II is devoted to a thorough discussion of the problems and
therapies of stuttering.

Gifford, Uabel Farrington, Sow To Overcome Stammering. New York: Prentice-
Hall, Incorporated, 1940. 169 p.

 

Mrs. Gifford's book is addressed, in the main, to the stutterer.
She feels that stuttering is an emotional or mental problem, and the
techniques for therapy are pointed to this theory.

Hahn, Eugene F., Stuttering, Significant Theories and Therapies. Stanford
University, California. Stanford University Press. 1943. 177 p.

 

Yahn's book gives the theories and corresponding therapies of twenty-
five authorities in the field. The appendix includes "Procedures in
a Clinic For Stutterers."

Johnson,‘£ende11, Pecause I Stutter. New York: D. Appleton-Century Com-
pany, 1930. 126 p.

 

This book may be used by both the speech correctionist and the stut-
terer. The latter will find that the author's own experiences as a
stutterer my help him to gain insight into his problem.

, People In Cuandries: The Semantics of Personal Adjustment. New
1York: Harper and Brothers, 1946. 214 p.

 

Stuttering is discussed in Chapter Seventeen, but the reader will
discover the whole book to be very valuable reading.

, Spencer F. drown, James F. Curtis, Clarence'w. Edney, Jacqueline
Keaster, Speech Handicapped School Children. Yew York: Harper and
Prothers, 1948. 464 p.

 

Chapter Five, dealing with stuttering and written by Dr. Johnson,
presents a very comprehensive discussion of the problem.and its
treatment. The group technique, the Iowa Speech Clinic Check List
for Stuttering, an open letter to the mother of a stuttering child,
and a case history are available in the Appendix.

154

Van Riper, C., Speech Correction, Principles and Vethods. eW Yorz:
Prentice-fia1l, Incorporated, 1939, 434 p.

 

The treatment of stuttering is given primary importance in this
book by Dr. Van Riper. The "shot-sun therapv, " used by the author,
is included. The reader will also find a usable cas se history form
in the Appendix.

figdberg, Conrad, The Stutterer Speaks. Boston: Expression Company, 1937.
121 p.

 

This book is another that may be recommended to the stutterer. It
is the story of 0r.'Wedberg's life, his stuttering, and how he
overcame it.

West, dobert, Lou Yennedy, and Anna Carr, The dehabili tat ion of Speech.
New York: Harper and Brothers, 1937. 475 p.

 

The authors discuss stuttering in Chapter Four and Twenty-Two of
this book. Case histories are presented in the Appendix.

9. P3 xlCDICAL LIT} M TVRE

Cypreansen, Lucite, "Group Therapy For Adult Stutterers." The Journal of
Speech and Hearing Disorders, jecember, 1948, Vol. 13, pp. 313-3 9.

 

 

‘ O
l
A

T11s article discusses tne technique of group therapy as it applies
to adult stutterers.

Glasner, P.1111p J. "Yat11re and Treatment of Stuttering." American Journal
of Si lsea MS of C nildren, August, 1947. Vol. 74, pp. 215-225.

l.

 

 

”r. Clasner discusses the disorder and lists possible causative fac-
tors. He also includes sugsestions for treatment.

_Ionir, Phoebe, The Stutt erer Acts It Out. Journal of Speech Disorders,
"arch, 1947. "vol. 12, pp. 105-109.

 

This article is a report of clinical experiments that utilized psy-
cho drama as a technique for treating stuttering.

Yastein, Shulamith, "The Chewing Yethod of Treating Stuttering." Journal
of Speech Disorders, June, 1947. Vol. 2; pp. 195-198.

 

 

Dr. Emil Froeschel's chewing technique for treating stutter1ing is
outlined.

155

Lane, Ruth 3., "Suflgestions for Handling Younr Stutterers " 1T‘l enentarv

{..w I u o 4

‘chool Journal, ‘arch, 1944. Vol. 7, pp. 416-419.

This article "ives suchestions to the classroom teacher and the
a A.
parent of a young stutterer.

Whittier, Ida 8., "Therapies Used For ,tutterinr: A Report of the Author's
Cwn Case." Quarterly Journal of Speech, V01. 24, April, 1938.
pp. 227-233.

Two t; pes of therapy are reviewed, personality readjustment work,
and work bearin: directly on the stuttering symptom.

C . TTTLLFX‘ IT'S

DeForest, Edjar L., and Elsie V. Edwards ,You Can Aid the Stemmering Child.
Tfichijan State Collef e, thension Serv1ce, E: :tension 7u et in 2;0
194C. 10 p.

 

An eXplanation of the problems of the stuttering child, with sug-

estions for his pa rents, teachers, and school nurses to aid him to
male a better aijustment.

Garrison, Geraldine, Stuttering. Connecticut State Department of Education,
Eureau of SchoSl and Community Services. April, 1947. C p.

 

An explanation of the causes and treatment of stuttering for the
parents.

D . TIC ’17 "TC‘CI’TS

:rynrelson, Cryng, vaanway E. Chapman and Crvetta K. Fansen, YnOW’Yours e1-
A Workbook Tor Those Tho Stutter. "inneapolis: Turgess Publishi ing

onpang, 1944. 55 p.

fl;

 

This workbook can be used by speech correctionists with secondary
stutterers. ”ental hyciene and an obj ective attitude toward the dis
order are stressed throughout all the assignments.

APPETWIF

CA' 3wa AI. ') '7‘77‘1‘L’i'7‘7m O STTTTT WIT-f}

.0

.r. Philip J. Clasner, in charge of speech therapy at the Children's

Jo

Psychiatric Serv1ce in the Johns Hopkins Hospital, rather th n filling out
the questionnaire sent him, preferred to set down his views in a letter.

...It is my experience that the cause or causes of stuttering
varies with each patient and only after a careful study of the
hild and his environment can we hope to draw any conclusions as
to possible causes. It has been my experience that the factors
known as causes are usually ceiplex and not usually clear-cut.
It is also my experience that the interpletation of causes will
depend upon the back~round and training of the examiner. Undoubt-
edly every item listed, with few exceptions, are taken into con-
sideration when a child ix e1:amined...............................

~egardinr the treatment of stuttering, I have similar views.
The treaiment, I believe, should be based on the results of an
examination taking into consideration such factors as age, both
chronoloiical and mental; possible cause, environment, emotional
needs and problems, length of stuttering, attitudes, symptoms,
etc. The tyne of nsychoth erapy varies with each patient as well
as the re-educational approach will vary as to kind and degree...

Dr. C. E. A. “oore, in addition to filling out the questionnaire,

elaborates:

As you might very well guess from my answers to your question
naire, I am of the opinion that the causative factors behind stut-
tering may very vrell be many and varied that in most cases are a
result of pressures. These pressures may very well be physical,
environmental, psycholovical, social, hereditary, etc., each play-
in: its own part in different weirhts, depending upon the individual.
The stronrest of these pressures in the najoritgr of cases, I feel,
is the psychological factor; therefore, the chief therapy revolves
around psychotherapy and the development of objective attitudes.

It should not, however, be assumed tha there is one and only
one t:1erapy or technique forz111 stutt erers In many cases the em-
phasis must be upon the environmental or upon.the physical, so that
the therapy is adapted to the individual personality

Althouvh the research of years has given us a great deal of in-
fornation about the stutterer, we must realize that there could
very' well be factors at WDFK of which we are totally i gnorant at
the present time. It is interesting to note that whatever therapy

is used at various places, the results in the long run are very
similar.

157

Dr. Eleanor 7. Luse, too, included some other information:

I use an eclectic approach to stuttering. Although I use a
case history, I believe that whatever the cause may have been,

he stutterer must learn to live with his handicap and learn to
control his speech.

The health of the stutterer iS'veny important. He mdould be
conscientious about keeping himself fit and getting adequate
sleep. Although therapies vary among speech correctionists, most
therapies benin with a period of relaxation. I feel that this is
basic to my training of stutterers. Pecause I felt so firmly that
the stutterer should learn to relax, I took work with Dr. Edmund
Jacobson in progressive relaxation. I have found his techniques
invaluable for the stutterer. Each stutterer is seen once a week
for individual work in relaxation.

The stutterers meet for group therapy once a week. This hour
begins with a period of relaxation. This is followed by breathing
and vocal exercises, designed for the non-stutterer as well as
the stutterer. During this hour, the stutterer has practice in
reading, in chorus and alone, in speaking, in conversation and in
imaginary situations which cause them difficulty - introductions,
meeting people, ordering, askina directions, etc. The speech at
these times is to be controlled - the words are to be blended into
thought units and speech is to be slow. The objective attitude
is stressed from the beginning and various periods are devoted to
discussion of improving social and mental attitudes. Since each
is an individual case, various methods, such as the bounce pattern,
may be used if I feel such techniques will be of help. I do not
put every stutterer through the same run-of-the-mill exercises.

158

Instructions for Keeping a Psychological Diary
Carl Ritzman, Ph. 9.

Director, Speech Clinic
Vniversity of Oklahoma

Get a loose-leaf notebook. preferably half as larpe as the rerular
1 , . - v . ~ , ..
Eg-by 11 S126. Be sure it‘s loose-leaf so you w111 as able to remove
pages and add them.

Keep the outside appearance as inconspicuous as possible and arrange
to sotre it in a place where it will not be tampered with. Your diary
should and rust be entirely confidential otherwise you will not feel free
to record everything as it occurs to you.

 

 

Date each entry. Put the complete date at the top and in the middle
of each new entry. Do not omit the year or the month. Ten years from now
this will be extremely important to you. dight now it is extremely impor—
tant to us.

Vse a new pace for each new day's entry. Do not run.them.together.

 

'Write in ink or type -— and in any case write so that we can read
it. Pencil is too easily obliterated by snmdfies over the years; we want
this to be permanent.

Spend about 30 minutes each day on your entries. Spend only one
minute if that's all you can spend -- but make some sort of notes to aid
your memory each day.

You will miss writing your entry from tim to time because of resis—
tance and lack of time. Don‘t worry about it, but get started again as
soon as possible. Don't try to catch up by writing up all of the time you
missed. Sumnarize that period very briefly or skip it entirely. You may
never get started apain if you feel you have to catch up before you start

again.

'Xrite only for yourself. That means ignore style, grammar, punctua—
tion. Fe as sloppy about sentence structure and choice of words as you
like but get it dovm. And be sure you can read it a month later.

 

 

 

 

Furthermore, be frank. write as if you were talking to yourself -~
and that means don't leave out the profanity, the bad words, the bad
thoughts, if they are a part of the experience or reaction you are reporting.
These words and ideas are all grist in our will --- they tell us what we
need to know to help you to talk it out in the clinic and to think it
through --- and that is half the job of solving the emotional problem back
of your speech.

 

 

.N o

159

wring th1s diary with you for each interview at the clinic.

A psychological diary will serve these purposes in our work with

you:

Continues your
autobiography

Checks on your
speech progress

Dreams

Helps us tell what's
making you better or
worse.

Helps you understand what
is going on and to
remenber what has gone on.

(1)

(

[\1

)

(4)

(5)

It will supplement your auto-
biography. Put in it additional
information about yourself each
day as it occurs to you.

It will provide a way to check
how you are proaressing from
day to day. we will see this
in your reports of how your
speech was that day, how you
felt, what you were able to do
which previously you wouldn't
do and so forth.

It will provide us with infor-
mation about your dreams, both
asleep and awake. Very important.

Jhen your speech gets worse or
better it will tell us what we
need to know to discover the
cause. Your speech will worsen
and improve as the result of
the things that heppen to you
that day and the way you react
to them. These-experiences

and your reactions to them will
be in your psychological diary.

It will give you a place to do
the thinking you must do as
your part of the treatment.
Record your version or summary
of each interview in the clinic
as soon as you can. Put there,
also, your notes on what you
are reading for the clinic.
Urite out your questions, argu-
ments, as they occur each day so
you will not forget them.

Instructions for Hriting the Autobiography
Carl Ritzman

Speech Clinic
Vniversity of Oklahoma

It helps to have a short story of your life at hand at the begin-
ning of your treatment in the Clinic. we want to know as quickly as
possible what kind of family you have, what they have meant to you, what
they mean to you now, and many other things. Remember that speech is
personality and personality is the product of your experiences. 30 the
sooner we get a line on the outstanding experiences you have had, the
sooner we will be able to get at the personality problems tied up with
your stuttering.

It would take you months to write the whole story of your life.
Take about two or three hours to write this one. It will be about five
pages long, maybe less; the length isn't important so long as you get down
the things you want to.

You might divide your autobiography into the parts given below,
but don't feel you must. Vse the suggestions only as a guide: 'write
about the matters which seem to have meant the most to you.

FAVILY: Describe your father and mother and tell how each has
brought you up. Describe your family's economic and social status.
Which parent do you get along with best? Have you always felt that both
your parents like you? How did they discipline you and how did you react
to it? Describe your brothers and sisters and how you get along with them.
Which is the favorite in your family and how have you felt about it?
Everyone has some outstanding memory of his childhood such as the time
she heard a neighbor say that her mother always wanted a boy before she was
born---what is your outstanding memory?

PEXSCVAL: To what extent are you conscious of feelings of inferior-
ty or of superiority with regard to your looks, brains, personality,

(.3

i
personal achievements, and family?

What are your sexual "skeletons in the closet"? ‘Xrite out all
your outstanding sex worries and memories.

Ihat kind of a person have you got yourself sized up to be—-too
aggressive, too submissive, etc.? Did you worry about your cowardice as
a kid? Could you fight? Are you a good fighter now? Do you think you
are well-liked (in the way you want to be liked) b’-r both boys and girls?

When do you cry? When did you last cry? Why can't you cry, (so
far as you know) when you are supposed to, as at your grandmother's
funeral, or a very sad movie? Can you laugh when you're supposed to?
When canIt you, as at a very funny movie, etc? Describe the people you

161

tend to like, and those you tend to dislike. 30 you have to watch your-
self in social situations lest you offend people or fail to impress them
favorably? H W'dO you react to disappointments, defeats, failures? Do
you sulk at home, carry a peeve a long tine, show your feelings to others?
Do you have a hard time controlling your temper? Jith whom?

W?LI?IC"S: Sketch very briefly your religious experiences. Do
you believe in God? Uhen and how did you lose your religion, or find it?
Do you have a strong conscience? 'Hhat is on your conscience (the memory
of some Petty thievery as a kid-—that sort of thing)?. Ihat was your family's
attitude toward religion? Do you usually feel "guilty" when something
goes wrong with which you are connected? Do you usually tend to be the
first to take the blane, to admit your errors, etc?

have you prided yourself on your intellectual independence and sop-
histication---on your freedom from the superstitions of the average relig-
ious nerson---on your objective, realistic attitude toward Death, and sin---
or your feeling that you and you alone are responsible for what happens to

,LV

you and if anything goes wrong you have only yourself to turn to?

SPTE07: Sketch briefly the story of your speech troubles. When
they started; how; what you have done about it. Your explanation of your
speech trouble. How has it handicapped you? Has it been of any use to
you at home at any time---maybe to protect you from criticism for not meas-
uring up to an oldir brother, or to prevent the old man from expecting as
much from you as he would if you didn't have something wrong with you.

EU"CATICTAL: Sketch the story briefly. Uhat was your family's at-
titude toward your successes and failures in school? Who were your worst
teachers---what did they do to you——how did they effect you? nhat were
your worst and best subjects? “ow has your educational experience effected
your choice of vocation? how did you get along with your classmates? hid
you feel you were "one of them", that you "belonged"? How did you tend
to interpret your social difficulties---did you decide that you were simply
inferior, that there was "something wrong" with you which made it impossible
for others to accept and like you, even your own family? Or did you tend
to think that your sensitiveness and intelligence made you so superior and
different from others that they couldn't understand you?

rear-rum casein, P‘n‘tzrms, CI“. :v'nrucrs

"Ir

LI

T. Arthur Cable

Individual T’niqueness:

Individual difderences in any two cases of stuttering and in
any two stuttering personalities; differential diagnosis required;
differential therapy required. (Thus one cannot properly think of
nor speak of the stutterer; but nmst, instead, think of and speak
of a stutterer, another stutterer, a third stutterer, etc.

 

 

 

 

Continual Flux:

”0 case revains stationary; chanfes in decree, direction, re-
lationship, configuration, etc., constantly occur.

Case-plus-7ilie1:

Treating the stuttering while disredarding the remainder of
the stuttering psycho-biological orranism is not enough. And
treating the total organism while disregarding his environment, is
inadequate. The therapist must take into account the total com-
plex person—in-his-environment, as he reacts to people in his
milieu and as they react to him.

‘\ r111

Dirst things Fir t:

(I)

First determine and then remove each active cause before trying
to remedy the symptom-~i.e., the stuttering.

Self-understanding:

The ancient maxim, "Tn w 3hyself," is of special importance
to those who stutter, provided that excess introspection does
not result. Cne source of enhancement is a wise interpretation
of personality tests such as the Yorschach, “hematic Appercep-
tion, 7iller-“urray Personal-social Adjustment, and Bernreuter
tests.

Adaptation, Adjustment, Contentment:

”any cases can be remedied; most cases can be improved; all
cases must be weaned of their bitterness, resentments, rebellion,
anti-social attitudes. Some must learn to live contentedly with
their stuttering (but not necessarily in its present form), and
take it as a matter of course. They must learn not to care, both
consciously and subconsciously, that they stutter.

l

n-ry- v~-1'

TYPES C“ J. 34L ,-A'.Z'ICIT
mr
"'J

AffluU‘Cable

Physical

Endocrine
feuroloyical
Biochemical

The Rorschach Technique of Personality Diafin sis
The Thematic Apperception Test

The ?erneuter Pers nality Inventory

A Test of Veuroticism, adapted from Louis E. Bisch,

7e Clad You're Teurotic, pi. 165-169, ”cGrawAIill, 19

H
t

L)

From the Case:

Case Histories
Biography: Factual, mental, social

From.Associates of the Case:

Pareits
Siblings

Cther Relatives

Isachors

Eamily Physician

Neighbors and Neighbor Children

C

6

3

164

DIACfiCSTIC CRITERIA
fir

W.AfimurCflfle

Inclusiveness:

Omit no aspect or fact of the total situation from con-
sideration in relation to the remainder of the synthesis.

Discard no aspect or fact until after it has been con-
idered adequately.

Differential Diagnosis:

Yet the either-or basis of diagnosis (i.e., was this the
cause, or vas that the cause?); but, when the various contri-
buting causes, both major and minor, have been determined,

1

then proceed, in turn, witn each of them; ”ow much of cause
1*- v- \' —-—‘ -—-—-—.—-— V '
-o. l? now much of cause [0. 2? etc., througnout tne list

 

I
a

of potential causes.
7bltiple Causation in Individual Cases:

Recognize that, in any case, two or more causes may have
acted conjointly to produce stuttering.

165

3'??? 8.11170:

An Organismic Treatment of the Disorder

Georpe A. Kopp

Introduction

 

The organismic method for treatment of stuttering w s introduced at
Teachers College in 1940. It has evolved from fifteen years of study and
research Of the disorder. Six of these years were devoted to intensive
biochemical studies of alveolar air, urine, and blood of stutterers and
non-stutterers in an attempt to find the cause or causes of stuttering.
Differences in blood patterns between stutt rers and non-stutterers were
established and on the basis of these findings stuttering was arrested in
seven subjects by experimentally changing the composition of the blood.

The substance used was an extract of the parathyroid glands sold under

the name of narathornone. The effects of the parathormone disappeared

after two or three days, and in each subject the stuttering returned. Since
parathormone stimulates absorption of calcium from the skeleton, it could
not be used therapeutically. The specific connections between the biochemi-
cal chanqes in the blood and the arresting of stuttering have not yet been
discoverdd. Experiments attempting to substitute other substances for para-
thormone failed. A series of injection and ingestion experiments designed
to experimentally cause a non-stutterer to stutter also failed. Yutritional
studies, especially those dealing with vitamins, were successful in arrest-
ing stuttering in several children. In others this therapy was not effec—
tive. These snidies point to the possibility of there being more than one
cause of stuttering, and they also support the contention that there may

be a common denominator for the defect. This common denominator is be-
lieved to be present when stuttering begins, but it may or may not be

pr sent after the stuttering has continued for some time and the so—called
psychological factors have complicated the problem. It is believed that
stuttering continues after its predisposing causes are no longer present,
and that its continuation may be due to many factors. hien‘we know what
processes are reversei'when the child naturally stops stuttering, we will

be able to prevent and control this disorder of speech. Until such know-
ledge is available, we are compelled to work with the stutterer, and it
seems reasonable that the method used should incorporate as many as is
possible of the limitei facts that can be proved to be related to the dis-
order in its inception and continuation. This is the basis of the organis-
mic method of treating the stutterer. It has developed from a $1 w synthe-
sis of the results of surveys and research projects. It is a combination
and modification of many methods. It includes the whole organism and is

not limited to one aspect of the organism.such as the biochemical, the
psycholoqical, the naurological, the physiological,‘the sociological, or
some other partial point of view. It is based on the fact that the highly
intergrated and automatic abtivit'es involved in speech are subject to

ice

analysis and synthesis, and that the elements of speech and sound have
their organismic counterparts in the bodily processes that function dur-

ing speech. For example, the pitch of the voice is determined by the rate
of vibration of the vocal cords. This is a part of the process, and it is
specifically related to rhythm and force. Resonation determines the

quality of the voice and is controlled by the action of the muscles that
regulate the size, shape, and alignment of the resonating cavities. The
groups of muscles that are known as articulators modify the voiced and
voiceless breath stream into the various sound units of the language. The
over-all controller of the speech processes is the brain. Here the vocabu-
lary and speech patterns are retained, coordinated, and directed. There

can be no speech without cerebration,‘but we must keep in mind th fact

hat the responsiveness of the muscles of respiration, phonation, resona-
tion, and articulation to the impulses sent out from the brain also determine
the nature of the speech produced. All of these processes are interdepen-
dent and related to each other. The automaticity of speech must be conceived
of as involving all of these processes working as an int grated whole. Since
they are related, the principle of relativity (that the qualities of re—
lated things are determined by their interrelationships) can be applied.

It follows that a chanre in the condition of any component of the system

of forces conceived of as the speech mechanism entails a change in the
unity of the entire system. The concept has a universal application, but

it is used here in connection with the structure and function of the come
ponent parts of the speech mechanism as they are rehated to the total act

of speaking. Another'concept which is basic to this system of therapy has
been derived from personal research and has been subsequently verified by
others. It is the additive phenomena present in the acquisition of language.
For example, it has been proved that if a person learns to pronounce a word
correctly that he has mispronounced for years, the old pronunciation is
not conditioned or modified, but a new habit is established for the correct
pronunciation. The old habit pattern remains, and may be subject to recall
under certain conditions. This applies to all language habits and is
beautifully demonstrated in the speech habits of foreigners. During per-
iods of emotional excitation they frecuently revert to a more unintelligible
dialect, and it is not uncommon for then to return to the use of their
native languase without being aware of doing so. Yative-born Americans who
have overcome a regional dialect also frequently return to it when they are
excited.

Research using hypnosis has established the fact that language habits,
both oral and written, change throughout life. The pre-existing habits re-
main in the organism and are subject to recall in deep hypnosis. Uhat is
the significance of this observation? It would seem that we should recog-
nize that in language re—education we are establishing new habits and we
do not erase the old. It explains the inconsistency of pronunciation of
certain words in an individual's speech as well as the return to old, incor—
rect habits by those who have been taught to speak correctly in our schools
and clinics. It explains why one may speak in one way in school and in
another way in the home, or in the alley. It is believed that the same
principle applies to stuttering when the predisposing causes are no longer
present. Therefore, new and complete speech habit patterns are necessary
to replace the old stuttering patterns.

167

Veurolofiically and psychologically the method requires a redistribu-
tion of energy from a pattern that produces stuttering to a pattern that
will result in normal speech. If only one part of the speech mechanism is
treated, respiration, phonation, resonation, articulation, or cerebration,
the chances are that the old patterns of action will reassert themselves.
Likewise, to focus the training on two phases of the mechanism.such as
respiration and articulation, without attention to the other three parts
may prove to be inadequate. Kowever, if the stuttering has just begun and
the difficulty can he located in respiration, in the mental state, or
elsewhere, and emoved, the stuttering may not return. This is illustrated
when a normal speaker becomes so frightened that he stutters. The internal
bodily state due to the fright may persist for an hour, or possibly for a
day or two. When the internal hodily functions return to normal, usually
the speech return s to normal. khan he is again frightened in the same
wav, his stuttering returns. Continue the state of fear and its concomitant
bodily changes long enough to establish the stuttering psych -motor patterns
and it will be more difficult to return to the normal pre-existing habits.
Regardless of the duration of the stuttering, its record remains in the
organism associated with the total experience and subject to recall ten or
twenty years later under the experimental conditions mentioned above. It
is because of this fast that it is unfortunate to speak of "curing" stutter-
ing. Adult stutterers may learn to speak without stuttering, but the stut-
tering psycho-motor patterns are never erased or removed from their organisms.
Conversely, the normal speech patterns are not erased, removed, or modified
when a person requires the stuttering habit. The same person may stutter
in one situation and not stutter in another. Why? He is using two psycho-
motor patterns. The changes in his internal environment precipitate the
shift. Remember that the foreign-born who has learned to speak English
correctly is likewise taken back through various states of incorrect usage
of the language during emotional excitation. The stutterer may manifest
various degrees of severity of the defect just as the foreign-horn may
speak with varying degrees of accent. Others may revert to another type of
speech when stimulated or excited in another way. This point is emphasized
because it is contrary to the usual way of thinking. ”ost people think
that stuttering is a disturbance of the normal speech, and that there is
just one speech pattern which is influenced by mental, emotional, and physi-
cal conditions. I believe that every form of speech that has been used
imprints its psycho—motor pattern in the organism and is subject to recall
when similar states prevail. There isn't just one speech pattern, but
there are many, all subject to use when the conditions under which they were
implanted recur. The bodily changes that take place during growth and
development make it difficult, if not impossible, for an adult to con-
sciously rebirn to the speech of his childhood, yet the person who has
never matured emotionally finds it difficult to keep from.using the child-
hood patterns.

In order to have the maturative processes helping to establish
normal speech habits, stuttering should be supplanted at as early an age

as possible. -he deeper the stuttering patterns are buried in time,
experience, and growth, the less likelihood there is of return to them.

If stuttering continues until adulthood, it is still possible to acquire
normal speech for most situations, but the possibility of the stuttering
returning is great.

Definition

 

Stuttering is a disturbance of metabolism manifested in tonic and
clonic oral myospasms.

Synonyms

Stammering, spasmophemia, speech blocking, speech hesitation, spas-
modic speech, broken rhythm, aphenia spastica, dysphemia, logospasm, dy-
sphonia spastica, spasmophem'a clonica - stuttering, spasmophemia cryptica-

silent stammering, spasmophenia tonica - stammering, and others.

Prevalence

 

fhe most commonly midted giess concerning the number of stutterers
in the United States is 1,400,000. It has also been estimated that approxi-
mately 13 of the school population stutter.

Description of Qtutterinf and Stutterers

 

stuttering is used syncnymously with stammering in this country. In
Europe a differentiation is still made. There stuttering is thought of as
being characterized by clonic oral myosphams. For example, the stutterer
nay say b-b-b-b—b-oy. The spasm is repetitious. Stammering speech is
characterized by blocking or stopping, which is balled a tonic oral myo-
spasm. For example, the stutterer may say b---oy. because both types of
spasms are so frequently found in the speech of the same individual, Ameri-
can workers have come to think of the two as one, and stuttering is now
the preferred term. There are those who fight for the term stamnering,

and there are others, including myself, who can't be induced to participate
in the silly argument. ghat is heard and seen is actually a manifestation
of the organismic disturbance, resardless of its unknown nature. Stutter-
ing is a symptom. The true disturbance, call it dysphemia or anything else,
is on the inside of the or:anism.and it can neither be seen nor heard.

We similarly look at the bowed legs of a child suffering from rickets, and
call the bowed-legged condition rickets. The disturbance that caused the
bowed lees is known to be an inorganic deficiency inside the body. We
should keep this differentiation of symptom and cause in mind.

The results of the Jhite House Conference Survey revealed that; the
number of children who stutter continues to increase up to the sixth grade
of school; the ma ority of stutterers begin to stutter before the age of
six; the majority of stutterers (but not all) have a period of from one to
several years of normal speech preceding the incidence of stuttering; stut—
tering boys outnumber the stuttering girls by a ratio of about four to one.

f—J
L J
(I)

The results of other reliable surveys and research indicate that;
stutterers as a group have avera e intelligence; stutterers are unable to
move the paired musculature as rapidly as normal speakers; the severity
of stuttering increases with fatigue; there is a tendency toward ambidex—
terity in stutterers; stutterers participate in acting and singing more
easily than in conversation; stutterint varies infiintensity or severity in
situations and with different stutterers; stuttering is transitory in some
persons and in others it isn't; stutterers as a group are delayed in school
progress; stutterers as a group are slower in learning to speak; stutterers
are likely to have stuttering ancestors, sinistrality is more common in the
stutterer's family than in families free from the disorder; general motor
skill of stutterers is inferior to that of non-stutterers; stuttering occurs
in deaf and deafened persons; incidence of fehrile diseases is higher for
stutterers than normal speakers; and finally, and most important therapeutic-
ally, stutterers universally have a disturbed coordination of the respira-
tory muscles, their vocal inflexibility (phonation and resonation) is ac-
cepted as a fact, their inability to articulate properly (articulation) is
characteristic of the disorder, their cerebration for speech is generally
recognized as being faulty.

In light of the above findings how is anyone justified in describ-

k

9
ing or defining stuttering as a dis urbance of speech rhythm?

Thscles and Nerves Involved

 

For a complete discussion of the muscles and nerves involved in
speech, you are advised to study "Voice Science," b7 Judson and Teaver;
"The ?ases of Speech," by Gray and Wise; Gray's CAnatomy," or any other
standard anatomy or physiology. Cur syllabus for Speech Correction, Educa—
tion 26 Y, lists the muscles and their function. Since the whole speech
mechanism is involved in stuttering, a review of the physiology of respira-
tion, phonation, resonation and articulation, is indicated. The muscle
groups that control these processes are of primary concern to the therapist
who undertakes to replace the malfunctions and incoordinations found in
stuttering with normal movements. If one is to establish normal habits, the
ability to recornize correct and incorrect coordinations is essential. With-
this ability a knowledge of what to do in order to establish correct coordi—
nations is worthless. It is pranted that for practical purposes the clini-
cian or teacher may not think of the terms of the integrity of the 5, 7, E,
9, 10, ll, and 12 cranial, as well as the cervical and thoracic, nerves
that supply the muscle groups beinfi trained, yet their importance cannot be
denied. This is obvious when we think of the cerebration involved. The
aim is to establish a new psycho-motor pattern in the brain that is of a
non—stutterinn nature. This is done through the nerves that supply the
muscles used in speech. In addition, there are the fears, anxieties, and
fixations that must be replaced with confidence and controlled assurance.

The mental hygiene in stuttering is all important in the opinion of many
workers, and it should not be ignored by anyone working with the {isorder.
It is an important part of this organismic system of therapy, but it is
not considered as being any more than a part of the total problem.

170

r‘ .
; “Glory

—.

 

The etiology of stuttering is unknown. The definition of stutter-
ing given in this outline states its etiology as being a disturbance of
metabolism manifested in tonic and clonic oral myospasms. This definition
was written thirteen years ago. It is purposively general, vague, and in-
definite. Yet it is inclusive enough to provide for the symptoms of the
disorder and their general causations when and if they are ever discovered.
Vnderlying the definition is the physiological fact that function is depen-
dent upon structure. The structure may be muscle, nerve, blood, glands,
brain, or something else, but something within the organism of the stutterer
is different from that ame something within the organism of the normal
speaker. Vetabolism includes all the bodily processes. The etiology of
stuttering can therefore be loqically placed in the metabolism of the organ-
ism until research yielded a more specific explanation. The definition
ne essarily does not name the specific metabolic difference, which is an
unknown at the present time. This is recognized as the biochemical theory
of causation of stuttering.

Cther theories that are more widely known, more extensively and
vehemently cussed and discussed, include the neurological, physiological,
psychological, psychoanalytical, and the genetic. The educational theory
of the causation of stuttering is a misnomer in that it fails to recognize
that there is a cause for the disorder. To say that the natural hesitations
of the child develop into the bad habit of stuttering ignores the fact that
many a child stutters badly when.he begins to speak. The proponents of
the educational theory also close their eyes to the fact that many normal
speakers stutter when escited or frightened and they are likewise blind to
the many differences between stutterers and normal speakers that prove be-
yond any reasonable doubt that there is something more than habit present.
So far as the other theories are concerned, they all have legitimate claims
and a body of research evidence to support them. Yet when they are criti-
cally scrutinized, they are all found to deal with one phase or aspect of
the function'of the organism. This function must ultimately be thought of
in terms of structure and the structure, in turn, is thought of in terms
of biochemistry and metabolism. This thought is not presented as a defence
of a definition but rather as an illustration of the totality of the organis-
mic point of view. If we work with the stutterer in any way we are, whether
we know it or not, affecting his physiology, neurology, psychology, and con—
sequently his biochemistry. me need to widen our mental horizons and look
beyond the limited, the partial, the restricted, and the biased explana-
tions of the causes of stuttering upon which so many therapies are based.

1

“ethods of Diarnosis

 

r-n

-ne diagnosis of stutterinr, like that for other pathologies, should

be directed toward determ'ning the functional efficiency of the speech me-
chanism as a whole and the specific nature and extent of the incoordina-
tions of the muscles that control respiration, phonation, resonation, and
articulation, as well as the disturbances of cerebration.

171

l. Respiration: Practically all stutterers have an i coordir ation of the
respi1L1t0r7 muscles during speech. ote the spasms on these muscles dur-
ing conversation and oral readinr. Observe the inefficient use of the
breath stream resultinf in breathiness, improper rhythm, phrasinv, and

peer support of tone. rrequenclgr there are attempts to speak on inhala-
tion, while holding the breath, or after the bra mth has been expired.

Have the stutterer count to twenty-five or above without forcing. have
him hold a vowel sound as lonf as possible, on one breath. Time the effort.
It should be twenty or more seconds if the person has good control. Repeat
the nrolongations of vowels, using different kinds of force. Tote the in-
efficient use of breath. Determine where the breath stream is interrupted
by the stuttering spasm. Is it in the zlottis, the mouth, the lips, or
does it take place in a combination of these places?

 

2. Phonatien: Phonation takes place in the larynx and it is here that pitch
is determined. Cbserve the rigidity or inflexibility of the voice. There
is seldom a normal variation in pitch. Establish the pitch range by having
the stutterer phonate vowels from the lowest to the highest pitches that he
can make. Vse both glides and step intervals. The natural pitch may be
approximately located a few semi-tones above the lowest third of the entire
pitch range. “ake sounds on different pitch levels and see if they can be
reproduced. Produce different types of inflections and ascertain the stut-
terer's ability to reproduce them. T-’se commands, questions, statements,
and phrases connotinm different moods. Techanically, change the tension of
the vocal cords by pushing on the point of the thyroid cartilage while the
subject is phonat inn. The pitch should lower. If the quality of the voice
improves, it is an indication that the cords are too tense. Change the
alignment of the vocal corls br mechanical y pushing the larynx to one side
while the stutterer is phonatinn. Do the same for the other side. Crdi-
narilv, this produces breathiness and an abnormal vocal quality. If breathi—
ness decreases and the quality improves, it is an indication of asymmetrical
vocal cords. A larynjoscopic examination is indicated. Ahenever possible,
the laryngoscopic examination should be given as a matter of routine to de—
termine the possibility of structural abnormalities. When soreness or sen-
sitiveness is present in the region of the larynx, the subject should be re-
ferred to a laf"nP010VlSl Observe the action of the muscles in the larynx
geal region. )0 they seen over-developed? Do they protrude? Is the larynx
held high in the neck agairst the hyoid bone? These are indications of ten-
sions and im1roper coordinat ions. Lhen they are present one may usually hear
glottal attachs and glottal stops in the speech. The vibration of the vocal
ccrds is closely associated with the infra-glottal breath pressure. Have
the subject vary the breath pressure (producing sounds varying in loudness)
on different pitch levels. This is another way of determining if tension
and incoordination are present. Another interestinr test that I have used
for ma. ny years in demonstrating the functions a1 inefficiency of the phonatory
mechanism is to have the stutterer indtate first voiceless, then voiced,
sounds on different pitch levels. Varying the duration of the sounds em-
phasizes their inability to start and stop the vibrations of the vocal
cords.

5. Wesonation: Yesonation determines vocal quality. The muscles that con—
trol the size and sha.pe of the oral, pharyngea l, and nasal C9 vities , and
ali5n t:1e vibrating cordS'with tliese cavities are the peripheral determin-
ants of the tone produced. The central determinants are mainly clie factors
of hearing, especially tonal memory and the ability to detect consonance

and dissonance. A sinple yet practical test of the stutterer's ability to
discriminate between good and defective voice qualities is to produce them
and have him first recornize them.and then reproduce them. Vse such quali-
ties as are com only descriied as nasal, hoarse, or husky, breathy, 5uttura1,
and others. Fy varyin5 the def ree of defectiveness of the vocal qualities,
a roufih approx'n ation of the stulfl erer's ability to detect differences in
cuality may be obtained. The preciseness of the test is limited only by the
experimenter's s: ill. The Seashore Test of‘ usical Abilityn may be used to
more accurately test for tonal memory and consonance. Cbserve the stutter-
er's voice quality while he is conversing and durin5 oral reading. Is it
nasal, tense, or husry: Explore the stutterer's control of the resonators
by havin5 him imitate voices of his acquaintances both male and female, young
and old. Have him try to imitate two or three of the voice qualities on
different pitch levels, and with different degrees of force or loudness.

You may be surprised to note that many stutterers do not stutter when they
change the quality and pitch of their voices. ”any can sing and act without
stutterin5. The explanation is, in my opinion, to be found in the different
ali5nment of the muscles. Prove for yourself that many stutterers can con-
verse with you if they use different qualities on a higher or lower pitch
than their stuttering; speech, and you will appreciate one of the basic fac-
tors in the therapy that follows. Frequently the stutterer is unable to
imitate very many voice qualities, but he can be trained to do so.

 

4. Articulation: Articulation is the modification of the voiced and voice-
lessfibreath stree_m in such a way as to produce the various sounds of a
lanruage. Usually the stutte erer will inform you that certain sounds are his
stumbling blocks. On careful examination.you may discover that this is
only partially true. Note where the blocks and repetitions occur. Check
carefully his production of all the sounds of the lan5uage in conversation
and in reading.. Some can read without stuttering, others stutter more when
they r3ad, and there are those who stutter in all oral efforts. Note the
nature of the stutterir n5. Are there facial grimaces and bodily contortions
present? jhat happens when the stutt erin5 occurs? Does he try to force
the sound out? Is there an unvoicing of the sound? Does he stop and start
again? Is there a voicing of unvoiced sounds? Are starters used? Your
primary concern in testing articulation is to determine what sounds are
faulty, under what conditions they are faulty, and the nature of the phy-
siolo5y that makes them what they are. In workin5 with this phase of the
stutte erin5 proolen, you need to know what the articulators do and when they
do it in order to replace the stuttering habits with new articulative
patterns.

 

5. Cerebratil on: The intelli5ence of stutterers as a group has been proved
to be avera5e or above. If there is any doubt or anxiety on the part of the
stutterer or his parents concerning his intelligence, a standard test should
he given. Hearin5 may be tested by usin5 an audiometer, or if one is not

 

available the practical test usin5 the speech sounis may he used. The
fears, the anxieties, the stereotyped reactions of xpectancy, postpone-
ment, and avoidance, are all mental concomitants of stutterin5. Thar form
a confi5uration which is associated with and is a part of the psycho—motor
pattern of the stutterer. fedause of the emphatic nature of the human
animal, fear produces fear, tension produces tension, anxiety produces
anxiety, expectancy produces expectancy, calmness produces calmness, and
confidence produces confidence. The list may be extended indefinitely.

fhe importance of the observation is in helpin5 us to discover and eliminate
the environmental influences that create the disturbed mental states that
are manifested in the stutterer. When they are not present in the home, we
rust make sure that they are not in the school. Find out when the person
started to stutter. ‘Jas there a shock, fri5ht, or illness associated with
its incidence? Are there places, or situations in which stuttering is not
present? fihat factors increase the severity of the stuttering? What fac-
tors decrease the severity of the stutterin5? What is the prevailing atti—
tude of the stutterer concernin5 his handicap? Is he using it to get atten—
tion, or other reqards? Does it make him despondent? Is he becomin5
asociak? Do his parents and teachers make special concessions for him?
What are his interests, hobbies, desires and ambitions? The fundamental
objective is to obtain a functional picture of the mental activities of the
stutterer in order that you may guide and direct the establishment of a
psycho—motor speech pattern which is used with confidence and assurance.

Cther Tests

 

In testin5 the functional efficiency of any muscle or group of muscles,
the speed, strength, and accuracy of movement should be determined. We are
in need of tests that could be applied to the muscles of articulations, but
before the results could be interpreted for the stutterer, norms would have
to be established for the speed, strength, and accuracy of the articulators
of the non-stutterer. 30 such tests are now available. Handedness of
stutterers has been tested in many rays, and of the standardized measurements
the Durost asterisk test for speech, the Smedley dynamometer test for strength,
and the Jellman Tracing path test for accuracy are believed to be reliable.
Since laterality is not included in this organismic treatment of stutterers,
tests for handedness, eyedness, and footedness are not discussed. Tests for
ability to relax are desirable, but again we have never determined the normal
degree of relaxation of certain muscle 5roups when other muscle groups are
active. Excellent techniques for relaxation are to be found in Jacobson's
"Promressive Relaxation," and in hathbone's "lelaxation.“ Since so many
muscles are used in speech, the focus of attention should be on the degree
of tension of the various coordinating muscles rather than on the complete
relaxation of them. He should realize, however, the interrelationship of
tension and relaxation.

‘l‘ J

‘eChOdS of Treatment

 

The following therapy is desi5ned to replace stutterin5 habits with
normal speech habits. dasic to the method are, the concept of dealing with
the entire speech mechanism a.d the corresponding elements of speech and

174

sound that are produced by each part of the speech mec}1anisn, the belief
that speech is produced from many psycho-motor patterns, the possibility

of the replacement of the psycho-motor pattern that produces stuttering
with a psycho-motor pattern that will result in normal speech, and the
recocnition of the fact that language habits, once acquired, are never con-
ditioned, modified, or erased, and when new habits are established, as is
necessary in the growing body, they take the place of the older habits. In
order to replace stutterinf habits with normal speech habits, the various
muscles used in sneaking must be trained to function to the extent of their
ph"s11olo:ic limitations so that new coordinations may be established. The
#113 scle groups involved are those of respiration, pho.1aticn, resonation, and
articulation. They all rust be exercised and the exercises prescribed
should be for definite purposes. Thinkinfi, imagining, hoping, and wishing
have never been known to establish coordinations of muscles. Explain these
principles to the stutterer, and in making assignments be sure that he
ur:1e"st3nds what he is asked to do and why he is asked to do it. The ex-
plsrations should not be given to ore—school children, for whom a more
indirect approach nay be preferred. However, there are son e pro-school
children 1.fi are so 1:1are of their sn3ech difficulty that they profit more
from the direct attsc k on their problem. Ina any case, the explanations,
instructions, and ex3rcises mrst be adjusted to the development of the sub-
jéct, and the cooperation of the parents and teachers should be enlisted

to help with the traininn protram.

Ceneral *ealth

 

To a tt enpt to establish a distribution of enerry that will r3sult in
nornal speech when the orranismic condition is such ths.t normal funct1or1n3
is imno ssiole, will r3sult in disappointment for you and the stutterer.

Vie stutterer' s ren- tal and physical health should be made as normal as pos-
sible b his physician. Te should checlc very carefully for nutritional
disturbances, especially those lue to vita~nin and inorvanic deficiencies.
Allergies to certain foods and su1stances h3ve been 'oted in some stutter-
ers, and others he ate be3n found who have an endocrine embalance. Some-
times the stutterer possesses peculiar mental fixations and fears, is over-
anxious, over-sensitive, and worries unduly over unimportant things.
Trecuently, their emotional outlet throurh cryinv and bodily action is
thwarted by domineering but well-meaninf parents. ”any come from bish—
tension homes, and the worries, fears, and anx: eiies of the parents are
transmitted to the children. All of t ese conditions should be corrected
and alleviated as much as possible. If the child is suspected of stutter-
ing in order to get attention from oth3r members of the Jamilhr remove at—
tention from'the stuttering and focus it onLr on normal speech.

The shove factors and many variations of them have been definitely
associa fled with stutterin”, and the disorder has been correc cted in younr
children by intelligent attention, treatment, and consideration of then.
To exercises or therapy mav be needed if the stutterin“ has just berun and
the child has hada two- or t rec—_ear period of normal speech. A return
to t e norna al psyczc-motcr patterns may oe accomplished b_ removing the
physical or menta al con2itions that are precipitating and causing the

175

estahlishment of the stutterin: psycho-voter patte erns. If stutte ring
characterized the fi‘st speech activities, then there are no normal ps"cho-
motor patterns to wé1ich to return. Because oi the rapid growth during
these earlier years, if the stuttering anit e.s p3 rsisted for several
months or lonfier, it may he assumed the at the stut terinr: psycho—motor pat-
terns are quite well-established, and that the earlier normal psycho-motor
patterns are more definitely suhmerfied in experience and structural change.
We should all work toward the prevention of stutteIi , but once it is
establishe’ we should realize that normal speech habits can be attained by
specific training of the parts of the rapidly growing organism that are
used in speaking.

Respiration

 

"Te all know' hat or: narily we breathe to throw off a gas, carbondi-
oxide, which is a waste product, and take in a gas, oxvaen, which is an
essential fuel and constituent of our bodies. Good breathing habits are

ssential to good health. Ereathin: for speech has long been considered a
secondary matter. But if we look at t1e e: ired breat st son as a carrier
wave of meaninjful and meaningless sound which serves to discharge physical,
mental, anl emotional (or3anismic) energy from the bol,, it becomes more
significant. is are concerned with the establishment of habits of control
that will result in an adequate carrier of voice and articulated sound.

The terms used to desi rate ttze types of breathing are: natural, diaphrag-
matic, thoracic, abdominal, costal, and calvicular. With the exception of
clavicular breathing, good breath support for speaking may be established
”with all of these tvres of breathing. The control is our major concern.

I prefer the "nza.tural" breath control, which includes a combination of the
diaphra3matic, aodominal, thoracic, and costal. It is the type of coordi-
nation used by practically all normal children, and the one we all use

when we are asleep or lying down. This type of coordination can be recog-
nized by a slight outward movement of the abdominal wall just below the
sternum when the diaphragm.contracts on inspiration, and a simultaneous
slip 1t ouzvard movement of the lower ribs. During; this inspiralzory ph1ase
the abdominal muscles relax to permit the displacement of the viscera by
the downward moving and contracting diaphragm. In expiration, the dia-
phragm relaxes and moved upward forcing the air out of the lungs. The ab-
dominal muscles contract, causing an inward movement of the abdominal wall
and the 1 wer rihs move inward. The movements may be easily detected by
nlacing one hand just below the sternum and the other on the lower ribs.

fl

Suiiestive Erea thing 3x erci_ses

 

l. Inhale slowly - noting outward movements of the upner abdominal
wall and the lower ribs - hold - avhale slowly, noting inward
M0 ements of the upper abdominal wall and tiie lower riss — hold.
iepeat several times in a standing position and in a sitting
position.
2. Veneat th: above to counts of 2, 3, 4, and 5 for each p21ase of
t11e cycle.

3. Ir 1113 cw1iChl", 1.011, (rivals uiicll;f.
é. Pint - iihzla cut c‘ly, exhale quickly.
5. Pr'-ct i; e inhale tion and exhalaLion while‘walkinr, allowing 2, 3,

4, E, G and 7 stens ior eachn hase.

C. Prcctice the exercise everywhere until it becomes habitual.

7. Phonate "ah" for four seconds, six seconds, eight seconds, ten
seconds, etc.

a. Phonat e other vowels in the sane manner.

. Phcnate the vo’cei consonants i_n

lO. Proluce the voiceless consons nts i: 9the same manner.

ll. Corznt to 5 on one breath, inc1es.se the count to P, 12, etc.

4. Practice usins varyinr degrees of i orce with the anove exercise.

C:

881118 "1311!". 8T 0

 

 

3. Practices nen"‘n' phrases and senterces of varying length:
Te is Soils.
7e is coin: hone.
73 is going Lone toflay.
”e is going home toiay if te can.
Vs is coin: hom e today if he can finish his work.

14. Practice ph asinr numerals an d sentences.

Phonction
Phonetion tn 1 es place in the lar W1 , an:l because the larvnx was pri-

marily evolvei as a valve to he see foreign matter out of the lunfi 3, its use
for sneech has long been said to be an "overlaid" function. Since function,
or its abse ence, changes structure, it is reasonable to believe that over a
period of housands of years the human larynx has changed. The vibrations
of the vocal corls determ‘ne the fundamental of the tone nroiucei. Tzius,
pitch of the voice is determined bv the rate 0” vibration of the vocal cords.
In working with the s tutt>rer we neel to e: (tend his nitch rs nge, increase
the variation in pitch within that rance, sni train hin to ston and start
the viirsition cn di if erent nit ch levels usin" varying degrees of force. In
this unit we are actually considering respiration a i ohonation because
there can be no normal phonetion withou the breath support. "eke sure that
the breat‘ning habits established in the nreceiing unit are used in the fol-
lowing exercises.

(W Q 1‘I 7‘ J— . .1“? | - a Q flur4— , . P T V . I. 4 .
1m escive glercises 101 quenlln; and farg1nb the Titcn

 

l. "assage the larynx. "ove it from side to side. Push it uh, hen
down. 7his will stimulate circulation and speed in the removal
01 fati-ue nroiucts.

a. Yawn an.d swallow - th se are S"nergic actions thtt move the muscles
of the throat in an unlearned manner.

3. Phonate the "ah" sound softly, making sure that the mouth is onen
anl the'tongue is innohile ani flat in the mouth.

4. Yepeat the above exercise, gliding from a low pitch to a high
pitch an:1 back to t’ie low pitch. Explain to a child that he is
sli iig un eni down a hill wi 'h his voice.

a. se othzr'vowel sounds Jith the above exercise.

177

6. "se the voiced fries tive consonants with the above erercise.
7. Practice roinz up an 1 down the pitch rnn~e in sten intervals
usir" difVerent vowels sni consonenis Go up and down stairs

mi 1 the voice.
. Reheat the acove usinr rumerals.
. 3e" short sentences, putt irg th e woris on different stens of
tee stairs
10. Tse lonr‘er sentences with the above echise.
. 7st? the 370V6 exercises usinr dif‘erent defirees of loudness.
1;. Practice speaking words, phrnses, and sentences 1" ith difperert
inflections and stresses:

1")

 

 

I am going hone.
f in sci g home.
I §§.foinr home.
I an.f01nc hove.
Ch, n01
Ch, 110'”.

13. Resi sentences to connote as many menninss as possible.
14. Repeat the ahjve for 5, 5, 25, 50, 100 people.

 

SH" estive Eterc1ses for Stirt1n~ and Stoppinc the T1bration of the'Tocal
Ccnils

 

1. Practice going from the "ah" to the "h" sounis, then the "h" to
the "ah."

a. Practice producinr combinations of vowels and voiceless conso-
rnrts.

3. Pra M3109 the esuivalent voices sni voiceless consonants in pairs,
a-s; f-v; th-ch, etc.
4. Repeat ti above exercises on dit. ferent Ditch levels.

U
5. here est excr01ses 1 - 3 using varying digrees of force or loudness.
6. Recent rercise 4, usinq veryinr decrees of force or loudness.
7. Practice with words that begin with voiced and voiceless sounds.

Resonation

 

ln workin" rith re so nation you are exero1311: the muscles that con-
trol thes size nnl Shane of the resonating cavities eni those muscle es that
align the vibratins vocal cords with these cavities. As in the nreceding
exercises, the physiolo:y is the important consideration In this unit the
focus of the attention is on voice oualit ‘ vtich is insecarahle from phone-
tion ani respiration. The skills required in the preceiinq units are ex—

tendei to include dif?e”ent qualities of voice.

 

fingéesiive Exercises for Treirin“ the “useles of Tesonation
l. Imitat e the voices of animals.
2'. "eke the animals sneak to each o':.er, usinf; their voiceS.
3. Practice imitatins ' fferert voices that you have heard.
4. Practice exercises 3 - 15 in the nreceding unit, using first

one voice then another.

5. Practice reading nlays assum no a different voice for each
character.
6. Vse gam s, marionettes, t

elenfone and radio situati ns, to
motivate children to use di

f? 81'31’143 Ere-1091.3 .

 

Articulation is t‘ne m01111cst10n of the voiced and voiceless breath
ean in SlCh a'way as to produce the various sounds of the language.
articulators are those carts of the speech mechanism that function in
'fving the voiced and voiceless breath stream. They are the lips
,ial muscl s, jaws, teeth, tonrue, hard palate, so7t nalate, and the
pharynx. In working 1'rith the stutte erer we want to exercise the mxscles
u ed in articula ion to increas etheir speed, stratgth, and accuracy of co-
ordinated movements. This will 0make it possible to establish new oral
oositions (casts, forn s, or molds) from which the sounds can be made without

.L

f

s tuttering. ‘The aim is to varv the movements and positions in such a way
as to make them more nurnosive and sneci1ic but not conspicuouslys 0. {Then

the stuttering snasm occurs the stutterer s‘1ould stop and not try to force
the sound out. 10 contin1e the efiort onlr malres for gre ater tension.
Train him tC'vary the pos1Ht10n or tension of the articulators so that the
sound can be made easily. 3e sure to use the skills acquired in respira-
tion, phonetion, and resonation.

Sukrestive Exercises for'the Articulators

 

l. :ove the lies alternately from the posit ions of the i (meet) and
u (foot) sounds.

2. hove the lips alternately fron positions for whistling and smil-
inc.
3. Produce the p sound in combination with all the'vowe ls.
4. Produce t1e b soqu in com.1ination with all the vowels.
5. Produce alternatel the i (meet) sound a.nMi J1e a (father) sound.
6. ieneat nunber 5, using all the other vowels with thee (father)
sound.
7. Produce the t sound in co-Jiination with all the vowels.
P. Produce the d sound in com‘wia tion with all the vowels.
9. “e Aneat exorci see 7 and C, using the k, g, s, 2, f, v, , , ,
, etc., sounds.
lO. Produce a series of 2, Z, 4, consonants with the sane vowel:
na, ta
p9, ta, la
n3, ta, la, sa
ll. epeat ex‘rcise 10, using diffeient vowels.
12. Introduce the nasal sounds m, n, and , in the above series.
13. Int oduce t".e l and the r in exercise 10.
14. .eneat t1e aocve exercises val’ying the force or loudness.
15. lepm “t1e above exercises varving the speed or rate of utterance.
lG. Pronounce words phrases, and ontences‘xitn diff erent degrees of

force.

17. Repeat ev3rci_s e 13 varying the rszte of speaking.
1?. Tee v1ryin* inflections, intonat ions, stresses, and rates to
connote dif1erent me eanings of words, phrase es, and sentences.

Cerebration

 

In t‘1e preceding units w have tro dined the muscle rroups th.at control
respiration, nhonation, resonation, a.nd a.rticuletion. In this training pro-
cess the psycho-motor natte rns in the brain, with which the various muscular
activities are associated, have been established. All the movements, of
every exercise, for all the muscle groups, have heen directed, coordinated,
and controlled from the brain. As sounds, phrases, words and sentences
were pro ‘uced with dif“erent decrees of force, on varying pitch levels,
with dlfl erent qualities of voice, with various rates of utterance, and
with varyiné in- lections , intonations, and stresses, the psycho-motor pat-
terns concomitant to the muscular activities were cre ted. These new
psycho—motor patterns were established, therefore, through exercises. Cur
objective in this unit is to train the mind of the stutterer so that he can
use his ac uired skills. "e must be given definite things to do to help
him sneak in a new., easy, and exfortles.s manner in all situations. ,Ke must
have sonething positive to do when the stuttering occurs and he must be
trained to do it.

The s tu3te rer s attitude to:a.rd his defect is most important. Strive
to net him to admit to hinself ani to others that he has had trouble in

spearr1ngj. ”.iemove the ,rrjuilte1 ni the shame that may be associated with the
inpedinent b" explaining the conseruences of such attitudes. Wiscuss the

e1fect of fear and any iety on ihe speech of a nornal speaker. Show the
stutterer how fear of not bein: able to talk perpetuates the stuttering
hahit. Converselj, explain the aivantages of a pleasant, relaxed, (indif-

ferent) and confident attitude in builling up normal speech habits.

”avine s nethinr positive to do .hen a block occurs tenls to remove
t1e anticipation that so frem1ent1" produces stuH erinr in both speech and
readinr. Consecuentl3, the stutterer must train himself to varv the force,
pitch, qualitv, rate ani/br articulation in such a wa" as to eliminate the-
stutterinj. *9 sho 1d at3end to all 01 these factors until the new he bi ts
are firnl". fixe > 'rvinf es unl1shed normal speech habits in one situa-
tion11elns to esta‘olis h them in ot1er situations, but it is no guarantee
that stutteiing will not recur. Confidence accumulates with each success-
ful experience. Arranre a list of situations in which difficultv in speak-
ing is exnerienced. aank then f'ron the most difficult to the least diffi-
cult. We ;in with the least difficult situations and continue to work up
through the list. This is essential because it proves to the stutterer
that he can speak without stuttering and that he can return to the pre-
established psycho-motor patterns from diich stuttering is directed. The
longer he uses the new habits the stron 1er thev become entrenchel in ex-
perience, and changes brought about bv maturation. This explains why it
is difficult for the stutterer to remember how he stutt ered a1 ter he has
used normal speech for awhile.

180

in conclusion, it should be said that this organismic method for
treatment f stutterers has been proved to be effective in clinical work.
It has never been tried'with group instruction. He hone to do this in the
near future. You are urged to comoere it with other methods that aoproach
he problem from limited and partial points of view.

You will find our professional literature filled with discussions
of the stuttering problem. .All the standard speech correction books list
many references and an exhaustive bibliograohy on the subject has been com-
oiled by Dr. “luenel. These sources are so readily available that I have
onitted the readin: list from this unit.

181

SY"?7””IC"° I" TYE TYTCYY A“? TE 1T"“VT
CF FILLIBL’LL J‘iPi‘l‘jfl‘IIA, A"? 1733 HEMPTC’I, SiTTTT'Tlf'llTIG

3r

. L,
. ,AU

Bryn; ’ryngelson, Ph. 3.,

Director of Speech and learinc Clinic
T*niversity of innesota

Since the author wrote the article "mheoretic and Therapeutic Con-
side rations of Uysnhenia and 1ts€ynptom,Stuttering," found in Section I,
pa: e 19 , in Eugene Tahn' s book entitled 3”"m;3 ITG, Sign nificant Theories
and Therapies, in 1943, many of my colleafue 1ave lid icated their difi‘i-
culty in getting the full import and meaning8 of my ideas expressed therein,
and have asked me to elaborate in hopes that greater clarification and
elucidation will result. I hope that this elaborated revision will serve
this purpose, and in addition help me clarify my own thinking on this very
searching problem known to most of us as "3tuttering.‘

 

 

'3 present notions as to the etiologic factors in the speech dis-
order called "stutterinc" are first, the result of my examininr and study-
ing up usards of 10, 000 patients during: the last Quarter centurv and second,
the result of m; interpretation of the laboratory and clinical researches
on the problem during the lag t three decades. Thirty—six citations of
the most important of these studies -re found in the "arch issue 03 the
Journal of Speech disorders, 1942. Ihatever point of view I hold in this
discussion sheuId be dated as of Varch, 1950.

 

fl

?ilateral apraxia refers to an irregularity 0i neural integration
in that portion of the central nervous system_responsible for the flow of
nerve impulses to the speech musculature. The most commonly observed mani-
festation or phenomenon of this central state of neurologic disintegration
is the clonic and tonic interruotions of the breath stream, accomnenied by
marled incocriination of the midline bilateral speech structures. Such
disjointed peripheral beha.vior I prefer to call "stutterinr."

T‘ie initial onset (45 per cent of hich occurs at onset of talkinr)
usuall; is characterized b3 short, effortless, repetitive interruptions
of the speech act. The forced tonic blocks occur most often as secondary

evolvements a- ter tlie child has been exposel to maladaptive stimuli on

the part of his social environment. An"ietvn on part of parents is indicat-
ed by such suggestions as: "Take vour time,’ "Wta. e a de‘y11 breath," "say
the word over again." The child wishes to please the parents and thus
tries to stop the involuntary inteiruptions, but with little success. In
addition to the original neurolovic bloczs the child now has developed a
nunber of accessorv movements of the speech.umscles which become "habits,'
built around his stutterinN. He has also gotten the idea that it is wrong
to stutter---thus fears and personality aberrations develop.

 

"y present theoretic envisarement of "stutterin3" is that most of it
is a form of atavistic behavior resultin3 from a "throwback" state of the
central nervous firstcm. It is ouite possible that as the human nervous
system evolved from the lowly medusa to the hicliest order 01 asymmetry in
the two cerebral hemispheres, strict symmetnr, i.e., equal representation

f bilateral innervation, obtained. Thus man with his ps.ired muscles for

xieech already developed was unable to use them as sin 1e orge ns, due to
this ecual re risentaticn in the central neural mechanism. Could it,
therefore, be that before man had a hi3hlv developed cortex with its pres-
ent asvmnetrical neural representation in the two ce erebral hemisoneres he
went through a lon3 period of so-called‘ 'stutterin3"? In this sense I

speak of it as an Hrr sted state of neural development. The complete matura-
tion for a highlv corticaliz ed, one-sided cradient for smooth verbal expres-
sion does not obtain in the youn3 bilateral apraxic whose "stuttering" is
apparent at the time of his speech onset. The mechanism of central ambi-
laterality obtains, thus makinp it difficult for the peripheral speech mus—

cles to function in a synchronized manner.

5»m1 te often the two-sided state of the ce11tra1 nervous system is

indicated by a lack of a preferred hand usage. EarLr peripheral ambideI-
terity, w ich is common in most children up to the thirteenth month, often
persists and freouentlv is accompanied by retarded speech development or
by broten speech vrhen the child bevins to talk: the motor sidedness pat-
tern for nondeiness may be developin3 on the side of the brain opposite to
the side of the native physiologic speech 3radient. This condition which
one can only infer exists may be of such a nature as to demarcate the
"stu_tterin3" child as possessing a nervous sttem differinn in kind and not
in de"ree from that of the normal speakin3 child. If this be the case, a
clinician mi3ht be justified in not holdin3 out too high hopes of a com—
plete eradication 01 the deviation we call bilateral apiaizia.

The apraIic state, producin(3 peripheral mvospasns, may also be

established in a child whose inherent predisposition for the development
of a complete and normal speech function is fault;. It may obtain vrhen a
child's native sidedness or brainedness pattern is altered. Bilateral
apraxia may also arise as a result of accidents to a major cerebral hemis-
phere, preferred hand or eye. Prolonged febrile diseases and severe
traumas mav be incitin3 causes to the onset of the symptom "stuttering,"

1‘ 33 his ms prel1.sposed to a lacr of strong one-sided development. For
fu-ther elucidatlon see "1‘1 3.31,,31‘, of Latex-ality of Stutterers and 1701771811
3?eakers," Journal of Social F'svchol 3v, 11, 1940, and "arch, 1957’

(we

rneice luthe"ford, Collaboratorj.

 

1881’.le certain aspects of therapy, I want to sag,r that I
do not believe tn t one method, and onl" one, can be agreed upon by speech
pathologists. T7ecause of our difier ent bacl:3rounds of training and clini-
cal experience, we shall perhaps employ more or les ss di”ferent methods and
technios in the treatment. The psychologic treatment, however, savors of

a good deal of similarity.

-. f] ‘
-e-oze di 1sc
‘s.

135

l V

In d1°cuss1rc tre treatment of hilater al anra.xics,
primary and secondary phases of the prob]e.n, I sha qll Spa Iirst of the
management of children vhose "stutterin3" is still in the initial stage

and secondly discuss the treatment of adult "stutterers."

I. 7&3 IIL11WZI.I APIAKIC C"IL2

 

       

Provided the nhrs ical and mental conditiors are normal, there are
two main considerations in the parental mane3ement of the child.

First, there should be no interference with the natural motor develop-
ment of the child's sidedness nattern. Peripheral hand preference more
often than not is a symptom of native brain edness for speech, reading and
writinr. If there is any doubt as to his manual laterality by the time he
is ready for the first grade, it wm1ld be well to take him to a speech
clinic for a decision as to which side is the more likely to cive his
sneech and most adequate neul olo3ic compensation for its inherent central
ambilaterality. Cnce strict one-sidedness has been developed, the child
should be encourased in manual skills in order to maintain, if possible,
an asymmetr" of neural ip_nervaticn in the central nervous system. inhi-
dextrous acts such as piano olevin3 and typing are likely to delay the
setting up 0. such oh;sic103ic as m1etrj as is essential for more sr1ootb
speech flow. So much for the neurologic phase of the problem.

Second, clinical eIoerience teaches one that when the emotional
envircnnent for a "stuttering" child is full of tension, fear and anxiety,
the child reacts unfavorably toward his inability to communicate like
other children. It is therefore advisable, in order to prevent unwhole-
some speech mannerisms, (toncue protrusion, swallowinn, head jerkirp, etc.)
and emotional insecurities fron develop nine as collateral patterns'with
"s utter1n~ " for the aarept to avoid making any maladaptive evaluation of
the child's speech. Jhen the child is old enough to realize his vzay of
talkin3 is different from others who do not "st1tter"n’eshould have a
wholehearted sanction and approval from the parent. At 8this point it might
even be well i'or the pa.rent to speak very freely about the "stujtering,"
is should know the label commonly used in our culture for his "different"
speech. The humor, which the playmates may later indicate, can also be
developed between the child and the parent. Above all, a parent should
respect the child's personsli ty. he is performing according to the dic—
tates of his oraanism and althoumh the pattern may not suit the parental
supereqo, it is well not to interfere with the child's emotional matura-
tion. After the age of fifteen or sixteen when he will be personally moti-
vated to work toward improvement of his comnmnication, he will most surely
respond to clinical treatment by a trained clinician. He can learn to
minimize the speech output if he has developed any secondary patterns which
in any way prolong his speecli attempt. Talking—writinfi exercises are recom—
mended. "any of the readers will note that this susfestion is the reverse
of what has been proposed in the literature before. The chan3e in my own
thinkin: has taken place during the last fifteen years. Phyloyenetically
the speec‘i act is much older than the writin3 act. Sp we icing being the act

"L

with which'we are most cor cerned in Stuttering" therapy, it would seem

to be inporta at to excite first tzat specific nart of neural behavior,

and second the lateH‘—ecq1ired art of writinfi. If the child has difficulty
in initiating the speech act in order to follow it with the noncil in
copying material from a book, it is surfested that the child be taught to
use one of the manv voluntary technics, well known to clinicians, in order
to get started on t:1e word. Talking and writing are two symbolic activi—

ties, connlex in nature, which in most of us are closely associated in the

nervous system.

II. 7“? 71LL233.L APRALIC AdeT

 

Wecause of the frustration in conmunicat ion andt he inadeo_u1ace home
and school management of most apraxics, a warped personality is eresent
as a second handicap of a person who through the years has "stuttered."
It is somewhat rare to find a "stutterer" at the adult level who is able
to live Wholesomely Jith his sneech diiterence. ”0st adult apraxics who
come for clinical help are hvpersen sitive, socially moroid an nd clinp to
the thought that they are stigmatized on account of their speech difference.
It behooves the speech clinician to deal with personality as well as with
the disordered spee ech. In the subsequent pararraphs I shall indicate in
somefixiat sumnarr fas 1ion he main t1eraneut ic considerations for the adult
"stutterer."

A. FiYSICnL

“he clinician should be sure that the natient is in good nhjsical
condition. It would be unwise to treat the bilateral apraxia while the
physical organism'was being affected by disease. A thorough physical ex-
amination should nrecede speech treatment.

'3 fTTY“ JJCNIC

(1) In order to build up as strong a neural compensatory sidedness
pa tte urn in the place of the central ambilaterality extant as possible,
the clinician must determine within the limits of his knowledge the most
probably brainedness of the natient. Uhen this has been decided upon, all
motor sidedness acts should be develoned on the side representing the
central brainedness. The larrer muscles of peripheral handedness should
be exercised first and later the correct orientation in writing should be
introduced. "any hours of a clinical day should be devoted by the patient
to talkinc—ani—writing exercises.

(2) A voluntarv reproduction of the first sound of words while
readin ng aloud and talking should be tau ght. This clonic activity simulates
the SD eeech. act which most people refer to as "stuttering" and tends to give
the patient greater ease and fluency. -his cortical exercise tends to re-
lieve the patient of accessorv muscle movements and also to redirect the
speech enerjr into more favorable channels for exnress ion. It also re—
lieves the lower neural levels of tb e task of usurping the activity of the

corte:c. To ial speech is voluntary and cortical and the voluntary

185

simulation of "stuttering" tends to eifihten the activity of the higher
levels of neural action. There are other patterns of speech control he
can he taught later, but because of the psvchologic effects in relieving
fear before his fellows, voluntary or "bou nciny" is first recommended.
C. P‘YSICLCGIC

Sefore a full-sized mirror the patient should sit simulating all
his so-called "habit" patterns. These he has learned, in order to avoid
stutterin~ speech. Ye.v he tries to rain voluntary cortical control over
them. In adulthood these habits of motor 0v erfIOW'should be mastered and
eventually eliminated. 'Lhey are not essential to "stutterin3" communica-
tion. The slight neural interruptions which remain in his speech are of
little consequence provided a wholesome attitude surrounds then

inis part of the therapy has to do with the basic and developmental
hases 01 the patient‘s nrsonality. Fe learns of the insecurities and
heir defer 305 which have developed around the fact that he is a "stutterer.
nsirh t into men a1 mechanisms, attitudes, and unwholesome and infantile
fears is essential for the maladjusted bilateral apraxic. He must learn
new ways of evaluatin3 his aptitudes and talents and seek to establish a
new sanction for himself as a person. Lelief of inward tensions tends to
li hten the (orti cal load of individual and social inhibition.

P

.t H
TU
.L

w
3
'1
”T's
:
L.)
‘J

E} 'CTI CT AL IIYG EYE

The patient learns to accept himself as a "stutterer." After he
has admitted this fact to himself and has learned to like to "stutter"
in a new way, he experiences a sort of emotional catharsis which helps him
accept himself as he is and not as he wanted to be (a normal speaker.)
F. SCCI(LCCIC

The "stutterer" with a difference in the form and manner of communi-
cation does not live unto himself alone. He, too, is dependent upon other
people for psycholonic as well as economic security. Therefore he must have
a good deal of experience in social profiects by means of which he advertises
the fact that he "stutters." These social assignments in the form of inter-
views with clerks, passers-by, etc., should be carefully supervised at first.
Later on, in clinical therapy, the patient makes his own assignments, being
very careful to analyze his and others' reactions to every situation. At
this point in the therapy, the patient has so minimized the importance of
his speech that he is experiencing for the first time emotional freedom.
Good "stuttering" is in direct relation to emotional freedom.

Jith wholehearted cooperation and rapport between the clinician and
the patient (using the above outlined therapy for at least three months
Six hours a da" undzr clinical supervision), the patient should have ironed
out his physiologic and psychologic "crutches," should have "stamped in" a

186

‘

compensatory sidedness pattern, should have gained a good deal of insight
into himself as a person -- a "stutterer," should have fewer overt, ob—
noxious myospasms. Le should by now be a more livable person to himself
and others. The eradication of all the ori3inal neurologic spasms mi3ht

be too much to hope for. The few that may remain need not stand in his way
to a successful way of livin3, if he has learned to accept and talk about
them. .

7. VCCATIC"AL

This phase oftthe treatment refers to the aid the patient may need
in workin3 out his e3 0- -ideal. Perchance because of his "handicap" he has
become interested in a field of endeavor not suited to his aptitudes, he
rdll need the help of a testinq bureau counselor in order to learn where
he best fits in a chosen vocation. The attitude he maintains and the
amount of fluencv he has in his speech will help the counselor in his
evaluation for voca ional placem ent.

In closing may I say that I have not tried in this writing to explain
all stu tterin3, and even thou3h it mav be discovered at some future date
tha.t my thinL1n3 at present as to this one phase of the etiology of the bi-
lateral apraxic is wh ollv inaccurate, I satisfv mv super-e30 by the fact
that I attempt to represent a therapy which takes an over-9 all view of the
"stutterer" and I recommend to the speech patholo3ists that knowing as
little as we do about this most intriguing and age-long problem, we can
do little harm in touchin3 upon the problem from_as many angles and points
of View as is permissible within the scope of air trainin3. 'Te should all
feel t‘1e pre ssinl3 need of workin3 in close cooperation with other scien—
tists interested in the human being. as ing important questions, followed
by serious research on the entire or3anism, is certa ninlv a modern ur3ent
need for curious, serious-minded speech natholo3ists.

I.

197

CLLC‘LED TX?” CC"? 3

0
:3-
v 1
L‘J
y 4

3y

iichard R. Tutcheson

Initial Contact:

A. Student wrote to clinic requestin3 information.

. Personal letter sent telling hours of class, char3es, and the date
of the beginning of the next group.

C. Letter from prospective student requesting to he registered.

Nirst Dav:

1. Arrival of Student

0"

4. Interview:

a. Examination:

(1) Found that tongue was all right.

(2) Tonsils and adenoids had been taken out at five
years<x'a3e.

) There was no physical or exceptional psychological

problem at this time that would have warranted re-

ferral to a physician or psychiatrist.

(

(N

b . Gas 6 History :

(l) The student was the first to notice his speech dif-
ficulty at 11 or 12 years of age. Speech at that
time and throughout the history was characterized
by hesitation and later increasingly severe blocks.
There was no history of repetition of sound.

(2) In the ~hgsical history were noted a strep throat
at P or 9 years of a3e and an automobile accident
at 6 years of age.

A
C»)
\J

The student made avera3e marks in school and was a
very active individual throughout his childhood.

fie believed, for quite some time, that he would cut-
grow stemmerinfi. Te would fi3ht his way thru blocks.
The most difficult speech situations were found to
be periods of excitement, saying numbers, and situa—
tions that required definite phraseology.

0. Recording of Voice:

(1) Vindin3s of initial recording:

f

138

Speech verv fast.
Voice hi3h and weak.
Severe blockin3 (no repetition).

AA.“
0 0‘ 3D
‘J\Jv

d. Crientation of student.

(1) dxparsicn upon orientation outline prisented pre-
v i cus ljj .

Z. Tefiinninr 0L silence.
4. Presentation of manua and tonjne and vowel chart.
5. Teachin3 of ton3ue exercises.

a. These are done for a quick re esponse to a broken count
100 times a day in the 3rouc periods, and also by the
student outside the class.

6. Introduction to vowels
*ive Eeeks - sord Analrs ais:
(Bollowin3 outline already presentel)

Sinrle Consonant position tr u“ht in order riven oq Cha_rt _ q
t‘fl n1 If. 0

Double consonant positions PL, VL, etc., thru Q“.

The balance of this report will be the relation of the weekly

reports “ ent hr the t3901ers on each student.

0‘)

.n 'I'l' "' ‘.. ' ‘
73“}. 01 41rst ..eeza - ”337:1," Report:

1. Responses to ton3ie exercises a d vowels fair. Tonrue un-
coordinated, but not tied. Voice hi3h and ak. Thru P
wit} the vowels and words on word analysis.”

c. The student is‘a worrier. T79 is leenlv interested in cor-
rectin3 his speech - is quite analvtical and anticipates
problems that mi3ht come up in th future. Explanation
that 300d speech is easy, fluent speech, su3’ested that he
work on 3ettin3 the feelin3 of easy speech rather than
3nalvzin3 too critically.

End of Second Week: eekl*r nepofi
l. ,Lmz 8 words on word analvsis. Improvement in ease of voice

this week. Is he3innin3 to re ealize the power of vowel flu-
ency in speel :in3 well. Stress thiS'wed: in building voice.

End of 3111 rd "reel: - Weekly Rem?“

"
.4
:4.

7. Seventh, Eiqht and ”inth leeks:

I!
[1 O

189

1. Cf? silence to teacher rs. Led his zirst exercise before the
Crone. Speech in tLis instance and to the teachers well con-
trolled. "tie his seconi permanent recori. This record
shows a noticeable chanre in voice when compared to the first
one. It is lower, has better qualitv ani more power. Thri

I"!

u woris on analysis.
End of Fourth (feel? - '.':’eel:l;r "Zenort:

1. Double consonants on analysis (3 crouns - L, A and 8 Groups
tauiht). Improvement in control of voice noted this week.
Cf? silence outside the Clinic. Stressing speal :in3 on analy-
sis extensivelv to stran3e;s - in stores, on the street etc.,
to huili eoilitv to pick out the vowel in each s 11a ale and
proluce the consonant position properly. Emphasis on con-

scious proiuction of each svllahle. g Mela ation that at this
time, when he cones of? silence on the outside the real work
in the correction really starts. .he 1 nd_a mentals tauo‘nt in

class could he coppared to a set of tools, they are eliective
only insofar as the" are usei properly.

End of Lift h Seth - Ceetly ieport:

1. Lord analysis on paratraphs in manual. Horkin3 on reading
para3raphs on careful analysis with as much in71ection and
meanins as possible within the hounis of anslrsis. “ells

paragraphs in his own woris as wells as readinc thena as written.
T~se of tape recorder as a check. leports that his speech on

1

the outside is pxxxiiwien he sticks to analysis. finnnasis on
necessarv chanre of personality from egotist (bein3 extrenel"
conscious as to the ef ect of his speech on the listener) to
eéoist (havin: the confidence t speak before anfcne on analy-

sis realiz'n3 tha.t such speech at the ponent is a necessary
step in correctio nl
of Sixth heek - weekly Leport:

Cne wori at a tine. Joining syllables in polysvllahic woris making
sire that each vowel is clear v and eas ily proluced. Spend in3
nornin 8 getting speech practice outside the Clinic. working on
easy inflection 0. voice.

T

End of Seventh Heek - Ieekly depola:

l. Phrasin; in manual on paragrspis formerly used for analvsis.
Thn1 * piramranh. Stress on planning each phrase carefully
before spea.kin3, and proiucinr each vowel clearly and easily
durin: the production of speech. Yeports speech outside the
school is progressing well. Freouent reninders concerni 3

’T‘
41.

’1
U

[to

3nd

glance

190

necessity o? careful uhraslng ani pueriing awninst speaking

.)

7elling each paragraph in his own woris as well as reading
it as it is written. Answering questions concerning para-
graphs.

of 3ighth .Ieek - weekly Report:

Phra si.ng pcrwgrrois iL rerwu a1 t'ru SQ. Fl: nin; of phrases
coming more ee.si1y, incr as ed ease of production. Still us-
irj ape recorder. CMie ki ing tendency to speeiz too fast in

CC'lVBI'SEL‘JlO'l.

Of 1vll".'l7"l feel: - ‘.'.r0o3lf1:}r Report:
Is now nhresing

Complete.1 paragrnpts in manual in phrasi ng.
rc is0 es well.

uts ide tte Clinic. - hes if" group exe

1.

M1 optone pru ct ice in Clinic - calling airport, bus terninel
epc., f

-or spaech pre c:ice.

of Course:

of Tenth flees - Leeklv Report:

Furasinc cn ccnversution outline: in manuelt 0 develop h s
t 3

eoilit" in class to organize his own ideas in
tHnn just reniing paragraphs as written.

Eiterel nuclic snesl inf} Class thi ' weelf. Tiis first Wench
Hus well organizei, the proilction howeve orwas a little Iasc.

cf Eleventh Tier-21.3: 'fI-eelzly leport.

Phrisinq prose selections in manual. Pieces selected for con-
trol 0 voice; selections for irhtness, power, softness,
pulses etc., teniency to achieve ei 'ect thnt speei. Explana-
tion that good sneecn is th- result of the proper control and
use of voice, enl not

01":4— ... 1' q. I- 'v ‘
cf 3nel- h .een - Jeealv leport:

Finished nrose selections in manual and started select ions of
poetry. Emphe is 0 reading conversationally for meaning.

Work in public speaking class improvei.

’fi‘fi: ‘ v v ' '." lr ' .1_1‘, ~\ _ ._l
-nlrteentn Hee_ - Monti, Leoozt:

\

‘Etarte 1 advanced voice ani cit ion Cl'C ss this week. 731d well
in t'1at claFS‘witn his spat men or, fore a group most cf Kwom

p—TO

1L3 no speech defect.

Is explainin: quotations in the manual during class period.
3tressing full explanation, nresentinc all ideas thet cone to
his mini concerninr the cnotaticns. Since many of the cuota-

tions s an sel*—e::‘la”+*1“‘.‘or“r he neeiel a little help at lirst
in anslyzim them the outhL, but did nicely after he got the
1.133..

01' with "r. Tutcheson when he five a spe ec:1 before a local

groub. Care Back with the report that he dii well in answer-

ing the questions of the group.

'1

01 {ou1,eanth weer: — Teekly Lenort:
Started uniio selections in rarual on "OfidQY-

Tedan on Tuesdav wit1 newsn".rer articles, reed in; then ani
then relating in nforretion in his own wor is.

:1 ‘:.'1 . ‘1' r 1... ..
01 .11tamrun1 ”gel -.,eeul, ,enort:

L
('1- ‘v ‘. (1 . I‘ r3 - ' . .41 -
niozt sfluaries 111 leader‘s in ,est.

Leaiinc stories ani then telling them

in nis own words and
rnswering direct cuestions 001ce'ninL in- r

nation in the

1 > r

of Sixteenth Ieea - weekly Eeport:

T1ree-y sp o2ech in manual. This checked the excess speed of
his spa “ech, ani imrroved the czire of his phrasing. "Ede his

final recording. Improvement over nreceeiing record in con-

trol of voice, ani smoothness of speech.

. Sneech in ani out of 5011001 viell con:1rollel.
i 1 nos of doil: voice exercises and continued con-
speecha Ht leav nd the school.

[3.1

102

~ C7.- 3 Y?(~‘T"11rv 7:;I 1‘1'
1 ~ VL l I I A. J21

R. V :
'I

I n‘t ez'vi ew:

Sneech Examination:

 

{eferrei to neurolOfiist, psychiatrist, or nhysician if infli-
w:.:ei. (tor example - taut lingual frenum)

Case historv - inclulini questions concerning nsycholorical
anl nhlrs oloric fa-tors that might have been contributing
factors to stanmering.

Hecoriinr of voice on a nermanent record.

-_ -.- ‘ua -— _-

 

 

 

J— ‘7 ‘ O V\1 V V
Au111110r311,1;.

 

 

Orientation of the student to the general set~un of the Clinic
and a brief on 'line 3 the work ahjud. it this time, it is
excl: line to the student that sta ering an not be our e1, but

instead mus t be controlled.

The perioi of silence is also explained to the student. This
ilent neriod e"cludes all convers sationa.l speeC'zl during the
. '1' o
-L 2:14 .. UV ux fi‘ .LJD S L. 3.L.t1: .', -le CL J ‘, 1r...
1T6 the gir"t sri es of the new peec1m te ns r‘re main
6.

 

T“e Clinic Day is six hours (alternoon and eveninj classes).
The stuient is exoectei to practice in tt e morni nrs.

 

Each student he. a not eoook in which he keeps surmj estions
rivenvhy the instructors concerning his individual prorress,

and also a diary of the progress of his speech.

Tevinninc of Silence:

 

 

 

 

Presentation of "anual and Card of Tongue intercises:

Te

6-—

 

.chinf of census exercises - suressed throughout the course.
These are done ”to a broken count with the use of a mirror.

mi, tion to Towel Sounds:

 

 

 

1rtroduoed fix st one at a time, then two at a tine (iT-Ai etc.

for

ease and smoothness of Voice.

E.

 

105

"7 1‘1"? 7533.3 - .."Cr'l Analfs i8:

ml; sis of each wori into its conconent s3rl-
11 - _ nit ven For the rroduction of each consonant.
The consonc nt position is first joined with each of the vowels.
mhe consonant vowel relutionshin is tzien built into words - one
sylle isle beinr nroiuced at a time. After the words are completed
(cs nresentei in the manual) the st11dent noes on to the paragraphs
expression as much meeninr as possible within the hounds of analy-
$1.80

There are t o neriods of groun work daily, composed of tongue exer-
c1ses ( we T10 niin" to the broken count of the leader) and voice
evercises. 7he voice exercises are desi: nei for power, inflection,
cuick re snonse, and fluenc_v o? vowe.. [hese group exercises oro-
".1ie a c‘nnre from iniiviiue l erectice — consecuentlt are a relax
in" We 01 for the student. flhen the student cones of? silence he

is Fife 1 daily obnortunitv t
cises. (““”se crouo ere.rci 8
course, not onL during the

leei the class in one of the exer-
s e done throujhout the entire
irst five weeks).

“ll other work is 1nder individual guidance. -ue student completes
an assignei uni_t of work sni cones to one of the teachers to be
checkel. At these checrinr oeriods, not onlv is technical instruc-
tion miven, but also o""cho10"1c l orient1tion. A nsycholorical
approach to the individual prohlen is stressed throuchout the
course.

s, the student cones off silence to teach-

1 three .'.re<3_
ers, at whi h time he wsnenks to then on word analysis.

 

 

     

At the eni cf the fourth week, the student comes off silence out-
side of the clinic a which tirne speech on word enal,sis in nuner-
ous s tuations is stressed. The student is encoure ed to soend

i
nis morninés gettinc speech practice.

el

ILJo

Stress thrcu*hout the course is on echiev'1“ the test ponent
voice of the student.

hooks concerning the various theories 0? stumnerinf end its cor-
rection are available to the student.

Psvcholocicel lectures concerninc on objective approach to the cor-
rec tion c: stenmerinf are frequently oresented to the students as
a group.

The clinic freqiently plays host to visiting groups, main v embryo
eochers from nearby universities. -hese visits give the students

1

an oonortun1sv in the school to sneak oejore strongers.

Ill.

T].

104

J. it the end of the third week, the second recoriinn is
this time, the student has usually developed a keen inte
an objective demonstration of the change in his speec

K. TTse of tame recorder as a self—check on speech.

 

a. Cne word at a time is the step nresented during this week. This
step is a bridfie from Kori Analysis to Phrasing. The student
practices joinin: syllahles in rcllysyllahic words, producing

‘

one word rather tnen one syllable at a time.

Seventh, Eighth and Tinth Teets - Phrasine:

 

 

A. Teaching of normal conversational phrasing.

~"D

?. Stress on in lection.

~j~alance of Course:

 

 

A. Ernansion unon presented outlines to improve conversational nhra"-

ing.

». Selections of prose and ooetry designed to build control of voice,
vocabulary and the ability to read meaningfully.

0. Advanced voice and diction classes At this tine, the student

0
joins a weekly class of students most of whom have no speech de-

feCto

E. Keekly public speaking class.

5. Continued use of wire and tape recorders.

G. third pernanent recording.

4. Stress on di ficult sneech situations outside the Clinic.

I. Private lessons in Puhlic sneaking and voice when need is indi-
cated.

J. Discussion of timely magazine and newspaper articles.
Y. Exnansion of quotations presented in manual.

L. Students at this stage of correction accomnany "r. Hutcheson when

‘v

he speaks to local oréanizations.

PCi

Stress throughout the course is on consciousness of speech.

‘Iork on radio material nresented in manual.

The last week of the students work is spent in a review called
3 Gay Sneecn. it this time, the student uses the paragraphs in
the manual and other material, reading each sentence on word

analysis, one word at a tine, and then phrasinc

(_1

O
I
-

The Clinic attempts to keep in tone} with the nrocress of the
students after they leave the Cl'

5‘

n

USE ONLY

imr 27; ‘ . , , ”,l‘ ,
;fi; 291n.. s;‘ 'bil £33 2 hJL
4‘“;wa

18 52 agent—Jssa;=

it, (a '5?W

Se

 

 

 

HICHIGRN STATE UNIV. LIBRRRIE ES