A preschooler who stutters — even forcefully — may not have personalized the behavior. Our school-age children are about to start reading aloud, doing book reports, show-and-tell, plays, speak on the intercom, and other verbal activities. With these new speaking demands and more scrutinizing listeners we have new challenges in solving stuttering. A thorough evaluation must find out if the grade K-5 child has developed negative thoughts and feelings about the stuttering.
Once a child reaches elementary school there is a greater chance of negative listener reactions (i.e., teasing). The teasing and comments are often covert and not when the teacher is present. After age six, as he leaves Piaget's Preoperational Stage, a child will be much more cognizant of being "different" from his peers. Psychologists use the terms "comparing self to other" and "projecting/mind reading" when describing these cognitive processes that can lead to self-consciousness and fear.
Many famous people have overcome stuttering as adults (NBA great Bill Walton, former GE chairman Jack Welch). My intent is to educate the reader about the progression of stuttering. Please read "kudzu and stuttering" and "volcanoes and stuttering" on this site for more learnings.
The Logical Levels grew out of work by Gregory Bateson and found a home in Neuro Linguistic Programming (NLP). NLP pioneer, Robert Dilts, is often credited for popularizing it. If you think about it, the Logical Levels are a kind of thumb print for every person. The environment is where we behave and have capabilities (skills) and form beliefs and an identity. As you look at the diagram, understand that the Logical Levels are not rigid, thresholds, but rather there is fluidity between them. A child who stutters during a play (behavior and environment) and is teased afterwards and humiliated may begin to believe they are not capable of being in future plays. After the humiliation of teasing, they may have the identity of a stutterer or "the kid that can't talk."
Environment - Where, When, and with Whom
This consists of the places we talk in and people we speak with. It includes the reaction to the stuttering received in these situations and by these people. Even young children can develop consistent stuttering with certain people or in specific situations, and conversely enjoy fluent speech in others.
A "stuttering time-line" develops as the person who stutters has negative experiences with people or in places. After all, how else could a behavior (stuttering) get a meaning/stigma unless stuttering was unpleasant and perceived to be inappropriate to the one stuttering. Listener reactions, such as teasing, stern correction, and persistent questions about the speech pattern, make the person who stutters dislike the behavior and start to develop limiting beliefs about stuttering (i.e., stuttering is bad, it is not normal, it is not tolerated). As a person's stuttering develops he may have phobia-like situations based on past negative experiences with stuttering.
Example: VL, age 16, reported that he had no anticipation calling any of his friends — except one. Before calling the one friend he would run a mental movie of speech doom, insert beliefs of judgment by the boys mother (who often answered abruptly), tighten his chest, and create a silent block. He manifested consistent and severe blocking, relative to him, when calling this particular friend. He would beat himself up over it enough to insure the next call was equally difficult. Strategies from Neuro Linguistics helped alleviate the meta-state anticipatory anxiety before these calls. VL believed that the boy's mother was burdened by his stuttering and that she frowned on his friendship with her son.
Example: JR, age 38, reported that even though he stuttered mildly his entire life, he enjoyed complete comfort and fluency on the phone all through high school. He was on board a Navy ship when he had a mild stutter on the phone with a superior. The superior said: "spit it out" in a stern voice. JR reported that his telephone stuttering time line began at that moment. When I met him, 16 years later, he had developed a severe and chronic stuttering problem on the phone.
Behavior - The What
Stuttering behaviors are just that — physical (behavioral) manifestations of stuttering. Children younger than age three may already blink their eyes, have facial grimaces, clench a fist, whisper to avoid stuttering, use character voices in an attempt to prevent stuttering, and myriad of other symptoms. Older children through adults often avert their eyes purposely as they anticipate or realize stuttering. Behaviors also include all the types of disfluencies associated with stuttering: part and whole word repetitions, speech blocks, sound prolongations, use of interjections ("uh," "um") to avoid stuttering, circumlocuting (talking around a word in an attempt to avoid stuttering), and other fluent speech disruptors.
All of these behaviors are attempts at preventing stuttering. Like the Chinese finger trap, the harder one tightens the physical symptoms of stuttering grow in severity. Young children can show great creativity in devising their own strategies/behaviors in an attempt to avoid stuttering. The visible and audible struggle is the child's attempt to force the word out. This impulsivity and tendency to push, instead of release tension, gets reinforced in the speech motor system. Recall that when a young child has a sock stuck in the dresser drawer, or pull-toy wrapped around the chair leg, he will use force instead of patience to solve his problem.
Example: BB, age 2-9, was already demonstrating relatively severe stuttering. On an articulation test, in which you say one word at a time, he stuttered on every word. As he anticipated stuttering he would consistently raise his left hand to cup his mouth and look down and then create a tense speech block. His parents reported that he had been exhibiting the severe stuttering behaviors for nearly six months.
He had stopped saying "I" and instead was saying "me." He often whispered to avoid stuttering. BB had cried when asking his parents why he spoke that way. Two months of direct treatment helped him develop a stable and fluent speech pattern. Thirty months post treatment his stuttering has remained resolved.
Capabilities - The How
How This includes the different speaking situations a person who stutters feels either competent or has trouble with; and may fear. Perceived capabilities include the "I can't" statements: "I can't read aloud," "I can't cold-call prospects," "I can't say my name."
You can draw a staircase metaphor to illustrate this. The lowest step on the left represents the easy/fluent situations, and the highest step on the right represents the hardest/most stuttered situations. This stair step diagram is similar to a fear hierarchy.
Quickly write in different situations (i.e., phone, introductions, reading aloud, oral presentations, etc.) to the different steps. When you are done you have perceived capabilities, or skill levels. Quite certainly the person who stutters has past experiences on her stuttering time-line that are references for these feelings of competence, or incompetence. I once helped a 6 year-old overcome a genuine phobia of answering or using the phone. An adult listener jokingly mocked her stuttering on "he-he-hello." That one moment, as confirmed by her parents, set the phobia. Phobias are possible with "one trial learning." One trial learning explains how one emotional incident involving heights, snakes, airplanes, spiders, or even stuttering can set a phobia.
Beliefs - The Why
This is the level of what we believe is true and what is important to us. Beliefs and values direct our lives to a considerable extent, acting both a permissions and prohibitions. Limiting beliefs about stuttering are a key ingredient in the behavior of stuttering gaining cognitions and affect. For instance, consider a 5 year-old who is being sternly corrected by his parents, teased, mocked, or constantly asked why he talks that way. This child can quickly develop the belief that stuttering is not tolerated, it is abnormal, it is wrong, or frowned upon. He will then begin trying to prevent stuttering. In attempting to prevent stuttering the child manifests more physical symptoms of struggle, avoids speaking at times, changes words, eventually withdraws, and starts feeling isolated from the "fluent world." Future negative experiences become references for reinforcing the beliefs.
Beliefs usually take the form of "mindreading." Limiting beliefs place a stigma on stuttering. Beliefs such as: "If I stutter, she won't find me attractive," "If I stutter, I won't get a job advancement," "If I stutter, my classmates will think I'm stupid," "If I stutter around my children, they will start stuttering or think less of me." I have heard all of those, and countless other limiting beliefs that have no hard evidence. Psychiatrist David Burns in his book, The Feeling Good Handbook, calls these cognitive distortions. These beliefs are the foundation and explanation for why an adult who stutters may make choices such as: fearing introductions, avoiding speaking in situations, e-mail instead of call, substitute words, allow his wife to enable by making calls for him, decline invitations to social events, and so on. Yes, these are choices to avoid and conceal stuttering. The meta-level program is saying "don't stutter or else!" The "or else" is imagined listener reaction (mindreading).
Eye contact aversion is also associated with limiting beliefs — mindreading. Mindreading is the habit of presuming to know a listener is reacting negatively to the stutter, or possible stutter. So, the positive intention of purposely looking away is for a person who stutters to protect himself from the possibility of a listener reaction to the stuttering. However, when one chooses to look away he is coming from a place of fear, self-consciousness, embarrassment, and hence the stutter intensifies. One will never learn to manage or overcome his stuttering if he chooses to avert eye contact.
Example: GG, a lawyer, believed he would not make law partner if he stuttered. He cited his worst stuttering around the partners of his firm. This is where he frequently manifested eye aversion, tense blocks, word substitutions, and fear of meetings and depositions involving them. He believed stuttering in the courtroom would get back to his firm and cost him job advancement. He reported an entirely different comfort and fluency around the younger attorneys. Reframing these thoughts and making purposeful eye contact unleashed much greater fluency and comfort. I should mention he had already been with his firm for six years and received a good review and a raise each year. How much did the partners really dwell on his stuttering?
Identity - The Who
Identity is your sense of yourself, your core beliefs, and values that define who you are. As speech disruptions are brought to the attention of a child who stutters — via questions, correcting, mocking, teasing, and other listener reactions — he can start to believe that stuttering is wrong, abnormal, and has a stigma. Continued attention to the behavior of stuttering can lead to the label or identity of a stutterer. The identity of a stutterer can have several definitions. One definition to be avoided is: "stuttering is bad and not tolerated."
The author, in third grade, was taken from a classroom into the hallway by his teacher and told with great concern on her face and in her voice: "Timmy you stutter!" This thing called stuttering — which I had never heard of before — sounded really bad!! I was labeled, identified, diagnosed, and petrified in a moment.
The stuttering community — including people who stutter, parents, self help groups, and speech pathologists — have long had a lively debate over the appropriateness of calling someone a stutterer. The label/word/identity stutterer presumes present tense and future tense, doesn't it? The diagnosis and label can be delivered like a terminal condition. Therefore, a child with a mild stutter and without cognitions and affect surrounding it can develop limiting beliefs depending upon the manner in which this label and identity is handled. The age at which a child is told this and the way in which it is explained requires great consideration and compassion. Consider being told you are learning disabled or you are ADD (attention deficit disorder). You are is the language of permanence; it is the label and identity. A parent and person of authority should consider all perceptual positions before labeling any child.
Stuttering in young children is usually just a behavior — are disfluent, but do not have deep seated emotions, cognitions, nor a "time-line" of stuttering yet. I have witnessed children as young as three avoiding talking, averting eye contact during stuttering, and other signs of acute awareness and displeasure with stuttering. However, at this age group they can usually be assisted and freed of these habits quickly and permanently. In the book Past Remembrances, psychologists Loftus and Neisler have found that language ability determines memory storage. If a child cannot adequately describe an event or problem, the memory will be unstable at best. Many young children can experience relatively severe stuttering — with many secondary symptoms of struggle — but forget about it. These same convulsions and blocks in speech would cause great anxiety and fear in an older child with the ability to store these experiences on a time line.
This is precisely why preschoolers have a unique window of opportunity for resolution of stuttering.
For the confirmed adolescent, teen, or adult person who stutters, what does stutterer mean? Does it positively have to mean "...you have stuttered and will stutter the way you have been from now on." I hope not. We who stutter did not have a choice whether we began stuttering, but can affect the impact it has on our communication and self-image. It is very interesting and therapeutically relevant to ask a person who stutters what stuttering means, or what stuttering is like. The answer will be a metaphor, or gestalt if you will, of how they internally represent stuttering. One adult said: "…it is like being in a dark tunnel with no way out." That identity of a stutterer is certainly replete with significant affect and cognitions to work on.
Before the 1996 Paralympics in Atlanta, Georgia, a reported was interviewing a wheel chair athlete who had lost his legs in an auto accident. The reporter asked: "…should the viewing public refer to you as disabled… or perhaps physically challenged?" The athlete quickly replied: "No. I am a world class athlete!" What was his identity?
The late Wendell Johnson, a man who made many positive contributions to stuttering treatment while at the University of Iowa, made the news in 2001 for initiating some questionable research decades ago with foster children. These have since been called the Monster Studies. He assigned a research assistant/speech pathologist to go into a local foster home and conduct speech sessions with these children. They had not been tested and identified as having speech problems. Half were to have a positive play experience with praise given to their speech abilities. Half were to receive criticism and correction for imperfections in their speech. A majority of the group receiving criticism developed life long stuttering problems.
Speech Pathologists (SLPs) were quick to react to this media splash. SLPs wanted to let the world know that this was not condoned, nor ever repeated within our profession. Some scholars were quick to say that these people were not "stutterers." They went on to cite research indicating genetic and/or neurological underpinnings associated with stuttering that would have to be in place for a person to be a stutterer. Herein lies the emotional debate over stuttering and a stutterer. What do we classify these adults who developed a life long stutter after their childhood experience? Are they people with a life-long stutter, but not a stutterer? Is it a stuttering-like speech disfluency phenomenon, but not real stuttering? Do the Monster Studies help get closure on what a stuttering time-line is?
Going to the Core of Stuttering
As you look at the Logical Levels diagram, consider how stuttering drives into the core of person level by level. As mentioned in several examples above, multiple levels are struck at once by a particularly traumatic stuttering experience. Effective and lasting recovery from confirmed stuttering will require working from the outside in and from the inside out.
Early stuttering, in age 2-6, is often only an environment and behavior issue: empower the environment and modify the behavior. In this scenario, the child does not yet question his capabilities. He may exhibit secondary symptoms and have avoidance behaviors, but can forget ever having them due to his age and cognitive development.
Once the stuttering, cognitions, and affect have permeated to the core, recovery will depend upon reframing the identity, shifting limiting beliefs, and building capabilities. Some speech therapy programs use only behavioral fluency shaping targets with insufficient attention to the "core." They usually get short-term results. Relapse occurs when the person returns to his home environment and is face-to-face with his old associations, phobias, beliefs about listeners, figures of authority, and capability challenges. There is an internal tug-o-war with one side saying "use your fluency techniques," but the often stronger side overpowers it with "don't stutter!" NLP author, L. Michael Hall, uses the metaphor of facing a dragon and having to slay it. This is also synonymous with Joseph Sheehan's Approach Avoidance Conflict. The very meta-states that trigger anticipatory anxiety must be dealt with therapeutically for lasting change. One strategy Sheehan used was voluntary stuttering, or negative practice, to help desensitize the person who stutters. Charles Van Riper used the metaphor of peeling back the layers of an onion. Those onion layers are synonymous with the Logical Levels.