Tuesday, March 28, 1995

Distinguishing "core stuttering" from learned behavior

In discussing stuttering therapies one needs to understand what the therapy addresses, and my point here is that much therapy addresses what can be considered "learned" behaviors.

I said

> In summary, instead of "show me how you stutter and I'll tell you what
> therapy will be best", I suggest "tell me how you have been coping with
> stuttering from the very beginning (i.e. what and HOW you are likely
> to have LEARNED) and I'll tell you what therapy will be best".

Woody S. pointed out that there is the possibility of misunderstandings in how stutterers define stuttering as opposed to how speech pathologists do. Stutterers think of repetitions and blocks as "stuttering" while pathologist often think also of the whole syndrome of maladaptive learned behaviors, such as eye blinking, word substitutions etc.

In answer to his point I wrote:

I was trying to draw a more subtle distinction, and I probably need
yet MORE help before I cause too much damage by clouding the picture
with my own brand new set of definitions.

I am addressing mainly core behaviors, and I am trying to assess how much
even these are the result of "coping". I'll try with some examples, then,
anyone, please feel free to suggest a set of clearer words, if what I
am saying makes sense.

I am a kid, and I suddenly start experiencing blocks. How do I cope with
this event? Some kids realize that they can substitute words, some feel
that they can blast their way through them come hell or high water, some
try to make it come out, give up, try again, give up and get into a long
set of repetitions. At a different level some will feel a great deal
of shame and try to avoid speaking, some will want to speak no matter
what. My point is simply that ALL of these kids will probably continue
to experience blocks but their blocking "style" will have been modified
by how they began coping with the problem.

So now you are the SLP and the kid (or now the adult) comes to you. You
see blocking, you assess its severity and start trying the techniques
you have had most success with. It seemed to me that the discussion
on screening and prognosis centered on the assessment of PRESENT
stuttering behavior. My question is the following:

Assume that two people have blocks of similar frequency and
intensity, but, at least initially, they "coped" differently with the
problem. Would they benefit from different therapeutic techniques?
Could their initial "coping style" be a prognosticator of the best therapy
for them? Are these considerations that enter the minds of SLPs when they
try to asses what to do?

Why am I asking this, and why do I think it might be important?

My hypthesis is that even much of what is viewed as "core behavior" is
in fact the result of a learning process, and that this process is guided
by your initial coping strategies. For instance, when I started blocking I
REFUSED to do anything that seemed "unnatural" to me. This included word
substitution and trying to use force to get the word out. Also, if a teacher
asked a question, ... and a little voice inside said "S. don't open your
mouth... you might be embarassed" ... my arm would go up in the air...
I trained it to that automatically! I was determined not to let stuttering
hold me back. It turns out that these were the right things to do, although
there was no therapist around to tell me that in post-war Italian public
schools. (Now I often ask myself, did I turn out to be a "mild" stutterer
because I did those things, or was I able to do those things because I was
a mild stutterer? But this is a slightly different issue)

In summary, I propose (but I am sure others have thought of this) that what
SLPs call "core behavior" is in fact the result of a learning process that
was framed by initial coping strategies. This initial pre-learning
behavior could be called.. sub-core?.. pre-core ...real core behavior? Help!
I guess we don't need a special word if this is not a useful concept, but if it
is...

Assuming then that a specific set of "coping" (different word needed?)
strategies led the PWS from pre-core to core... could these particular
strategies be better prognosticators for successful therapy than the
simple observation of core behaviors?

Whether or not what I said is useful, I hope it was clear.

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