Stuttering: When Attempted Solutions Become the Problem

By Tim Mackesey PC, CCC-SLP

How is it that people who stutter develop body movements, look away during stutters, change words, avoid talking, and other maladaptive behaviors?  What motivates them to make these choices? These begin as attempted solutions but become habitual and develop into real problems and secondary symptoms.   How can we help them eliminate these behaviors?

Hank, a 4 ½ year-old boy, entered my lobby making a loud “huh” sound as he exhaled with great force and drama.  He was also saying “mmm” very loudly and making his pitch increase.  His eyes would look up to his right side and strain during these speech blocks.  After closer examination it was evident that Hank made the “huh” sound just before any word beginning with a vowel and the “mmm” sound just before any word starting with a consonant.  Anticipating a speech block as his larynx tightened, Hank used the “huh” or “mmm” as an attempted solution to prevent or escape the stutter. 

Many preschoolers have developed what are called escape behaviors.  In trying to escape the moment of stuttering and the physical tightening the child may blink his eyes, tap his foot, nod his head down, or similar signs of tension and struggle. 

Preschoolers are quite capable of remembering problem words and avoiding them.  One 4 year-old I evaluated had abandoned the word “I” six months before I met him.  He was using his first name or “he” when referring to self.  His parents described months of chronic and severe blocking on “I” preceding his choice to eliminate the pronoun from his vocabulary.  When “he” became hard, the boy interjected “says” several times before “he.”  When you think about it, this avoidance requires a great deal of concentration and pre-planning of words.  His attempted solution became the problem.

Numerous speech games that involved saying “I” got rid of the problem and unleashed consistent fluency. 

Adolescents, teens, and adults who stutter often have a long list of tricks designed to prevent stuttering.  One adult with the fear of asking for people and saying his own name on the phone had gathered his friend’s cell phone numbers.  That way he could connect directly with people and avoid what he feared.  This attempted solution only made the fear of asking for people and saying his own name grow in intensity.  A software engineer in a large four story office would email or walk to his co-workers offices.  He would never call them when they were at their desks.  If he had to call, he would leave voice mails during lunch or after hours.  He had learned which code to key in to re-record the messages until he was satisfied.  He rationalized his avoidance tricks by thinking his peers would perceive him as devoted or a workaholic when they noticed lunch and evening messages. 

“Freedom is to speak.  And, I fear to form what is air (speech)
 and may be made in a minute (a stutter.).  -
Michael McClure

Fight or Flight

What is it about the experience of stuttering that people who stutter are so motivated to prevent and conceal stuttering?  Preschoolers feel the physical struggle of a stutter, their vocal cords adduct and tighten, and fight against it by pushing (blocking) or avoid and give up.  Being in Piaget’s Preoperational Stage of cognitive development (age 2-7), they do not remember stutters as traumatic and do not personalize stuttering like the child age seven and older.  How then must it feel inside to stutter that a preschooler may start changing words, use character voices, insert “uh um” just before a speech block, or verbalize frustration to their parents?

According to Guitar (1998), the Borderline Stutterer has mostly loose and relaxed disfluencies and rarely reacts to them.  The Beginning Stutterer has more tension and hurry in the stuttering.  Further, the Beginning Stutterer is aware of his difficulty and frustrated but does not yet have strong feelings about self as speaker (identity).  The Intermediate Stutterer - typically between the ages of 6 and 13- is starting to fear and avoid stuttering.   His classifications of stuttering development and severity take into effect physical/behavioral symptoms (i.e., tension in the moments of stuttering) as well as the cognitive and affective issues related to stuttering.             

Once a child develops the identity of a stutterer she will often go into a defensive mode and try to conceal it.  Embarrassment and listeners reaction usually motivate this covert operation of hiding stuttering.  People who stutter demonstrate a higher level of cognitive anxiety than normally fluent speakers (DiLollo, et al 2003).

The Fight or Flight response is our body’s primitive, automatic, inborn response that prepares the body to “fight” or “flee” from perceived attack, threat, or harm to our survival.  Originally discovered by Harvard University physiologist Walter Cannon, this response is hard-wired into our brains and represents a genetic wisdom designed to protect us from bodily harm.  This response actually corresponds to an area of our brain called the hypothalamus, which- when stimulated- initiates a sequence of nerve cell firing and chemical release that prepares our body for running or fighting.  When we experience the Fight or Flight we feel a sensation of panic in our soma (body) as adrenaline, noradrenaline, and cortisol are released into our bloodstream.  The panicky sensations just before a stutter are similar to the Fight or Flight response.  When one understands and appreciates the intensity of this panic sensation in people who stutter he can then grasp how elaborate avoidance strategies are common. 

When our actual physical survival is threatened, there is no better response than to have the Fight or Flight.  Unfortunately, we can assign a meaning of threat to a behavior called stuttering and experience the Fight or Flight response when stuttering or blocking is anticipated.  The young child can strongly dislike the experience of being unable to speak.  The adolescent, teen, and adults can remember painful moments of stuttering on time-line and perceive threat (i.e., embarrassment, shame, teasing, bombing a job interview, rejection from an attractive person, and so on) and fire off the Fight or Flight.  This phenomenon of remembering stuttered events and fearing future ones has led to stuttering being called a variant of Post Traumatic Stress Disorder (Starkweather, 2003).

“Stuttering is everything we do trying to not stutter.”   Wendell Johnson

Attempted Solutions

A text book would be required to list all the attempted solutions tried by people who stutter.  Here is a list of some of the most popular forms of Fight or Flight:

Many people who stutter take a deep breath immediately before they manifest the speech block.  Some were taught to do it.  Unfortunately, when anxious the breath is high in the chest and not from the diaphragm. So, they feel a stutter coming and take a quick and deep inhalation with the positive intention of thrusting the word out without a stutter.  But again, the attempted solution becomes the problem. The extra air and force in a moment of panic about a   stutter is like pouring gasoline on a fire.

I help people “block the blocks.” This means they learn to feel the stutter, stop, relax, and begin the word as they gently exhale.  Remember, they have all the air they need for a word, phrase, or short sentence residing in their chest- it’s called residual capacity (Nicolosi, 1989).

It is understandable that the lay person observing blocking and apparent running out of air might say “take a deep breath.”  Scientists have discovered that the diaphragm and chest tighten during the Fight or Flight.

Not only is it unnecessary to take a deep breath, it is not suggested when the anatomy of the torso and larynx constricted and feeling like a panic attack. 

I once met a man who bought a company that was named after a word he had never said before in his life. He began stuttering on the name of his new company.  Then he started circumlocuting, which means talking around the word (i.e., “um it is like in the media industry.”)  After several experiences of blocking when cold calling to sell his service he started requesting his secretary to call and ask for people and then patch him through on the phone at his desk.  Asking others to speak for us is enabling the problem.  Do you see how he developed a full-blown phobia in a matter of two months?