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The Relationship between Stuttering and the Control of Speech Quality

Paul Brocklehurst | 01.09.2002

It is widely known that trying to speak without stammering usually makes things worse. Paul Brocklehurst describes recent research on a new perspective in this area and how he applied it to himself.

Paul BrocklehurstI've stuttered ever since I was a small child and over the years have tried all of the conventional forms of therapy in the hope of finding some sort of alleviation. Although some therapies did benefit me in the short term, after a few weeks or months I always found myself slipping back to my default level. As I've grown older, the stutter has become less severe and I've been relatively successful at adapting my life in ways that allow me to get around it. But I have continued to feel frustrated at the way it prevents me from fulfilling what I feel is my true potential when it comes to work and social interaction.

Things started to change for me at the beginning of this year when, after some particularly frustrating experiences, I decided that despite my age, 43, I just had to make a renewed effort and try and do something about my stutter.

During my search of the internet I found details of a paper that had originally been published as a chapter in the book 'Nature and Treatment of Stuttering'. The paper, Stuttering as a Covert Repair Phenomenon1 by Herman Kolk and Albert Postma provided an explanation for stuttering that was different to any I had ever heard before.

Basically, Postma and Kolk hypothesise that, when people notice that they're making a mistake while speaking (like a garbled or wrongly pronounced word), they tend to stop and repeat the word that they got wrong, until they are satisfied that they have got it right (this is called an error repair). They also point out that sometimes we detect mistakes in our words and try to repair them before we actually speak them, in which case the repetition is an internal one and all that a listener is likely to be aware of is a hesitation or silence (this type of error repair is what they call a covert error repair). In their paper, Postma and Kolk then suggest that the symptoms of stuttering (repetitions, prolongations and blocks) might arise when despite repeating a wrong sounding word over and over; a stutterer is still unable to formulate exactly the sounds he wants.

Postma and Kolk come to the conclusion that people who stutter might be somewhat slower than normal at formulating the sounds that make up the words they want to say. Thus, where a fluent speaker might only need to repeat a garbled word once in order to get it right, a stutterer may need several attempts. Moreover, if stutterers are slower than normal at formulating their words, they would be prone to making an inordinate amount of mistakes if they try to speak at what would be considered a normal rate. This would explain why by slowing down or refusing to be rushed, stutterers tend to stutter less.

Having spent some time digesting these new ideas, I found myself trying to analyse exactly what I tend to do when speaking. I've always been aware that the harder I try to speak clearly and accurately, the more likely I am to stutter. Perhaps the most clear-cut example of this is in what happens to my speech if I drink alcohol. The severity of the stutter can either increase or decrease, depending on whether or not I try to sound sober. In other words, if I am drunk and am happy to sound drunk and don't worry about slurring my words and getting them mixed up and making lots of mistakes, then the stutter seems more or less to disappear. Whereas, if I am drunk and I try to sound sober and make a special effort to speak with as few mistakes and as clearly as possible, the stutter becomes significantly worse.

Other people who stutter I've spoken to have told me the more they try to avoid making errors, the more they are likely to stutter. My own feeling is that some social settings encourage individuals to develop unreasonable expectations with respect to the level of accuracy they can achieve with their speech. For example, I was educated in rather posh English private schools in which a high standard of speech was considered very important. Under such conditions I naturally exercised a very high degree of control over the quality my speech. It's quite possible that if for some reason I was somewhat slower than normal at formulating the sounds of my words, I may well have been trying to achieve a level of perfection that was physically impossible for me.

So I decided to experiment and see what would happen if I made a conscious effort to just keep going and not correct any mistakes while speaking. Thus, each time I was talking to someone, I would try to say whatever I wanted to say, without stopping every time a word failed to materialise or came out wrong. I decided that if the person I was speaking to didn't understand me, I could always repeat the phrase in its entirety, but I would try to give priority to maintaining the flow and not get bogged down trying to repair mistakes as I went along. The experience reminded me very much of playing an instrument in an orchestra. In order to keep up with the rest of the instruments, you've just got to keep going and not worry about the occasional missed or wrong note.

It took a few days to get into the way of doing it, and I had to overcome a lot of reluctance to allow myself to speak in what I would normally have considered a slovenly way, but I did it nevertheless. The result was that I found myself often sounding a bit like I'd had a stroke. Although I didn't really stutter, my words often sounded unclear or garbled. Sometimes in order to keep going I had to miss words out completely and sometimes it was not easy for people to understand. But whenever the person I was speaking to was unable to understand, I simply repeated the whole phrase and it always came out better the second time. After a few days of practice, I started to feel much less anxious about speaking, and as my anxiety reduced the number of mistakes I was making also reduced.

After a week or so, I was aware that the fear of stuttering was disappearing. I was still mumbling and making more mistakes than people normally do. But as I was no longer overwhelmed by high levels of anxiety, I could more clearly see that the quality of my speech varies a lot according to how much I move around and how deeply I have been breathing2. It is as though the more oxygen I get, the less inclined I am to make mistakes and garble my words.

After a number of weeks, I started to feel increasingly confident about my speech and to this day that confidence continues to grow. I wouldn't say that the stutter is cured, but it is as though I've started to redefine the processes going on inside me. I can recognise that if I do try to repair individual speech mistakes as I go along, I make the same sort of repetitions, prolongations and blocks that I always did, but now I no longer interpret them as a stutter. I simply understand that repairing errors as one goes along is bound to result in a certain amount of dysfluency - it no longer feels 'wrong' in the way it used to and, perhaps more importantly, it no longer makes me anxious.

My personal observations lead me to believe that Postma and Kolk are probably correct when they say that stutterers have a slower than normal rate of phonological processing (sound formulation). If this is true, it would follow that even if a person's stutter does disappear, they would probably still be prone to making an above average number of errors when speaking. But that would be a minor inconvenience in comparison to the agony of stuttering. To me, the most important thing is not that I speak completely fluently, but that I am able to understand clearly my physical limitations with respect to speech, and act within them.

Postma and Kolk's hypothesis has provided me with a theoretical model that enables me to understand why I've been getting stuck and what I can do about it. It has also given me insight into how and why some of the more traditional fluency techniques (like diaphragmatic breathing3 and rhythmic speaking) are likely to help in certain situations, and it has helped me to recognise the value of maintaining a variety of such skills in my armoury. My experience is that a combination of such practical methods supported by a clear theoretical understanding of what is going on, has a far more powerful and lasting effect than simply employing a fluency technique without understanding how or why it is working.

Footnotes:

1 Kolk, H. & Postma, A. (1997). Stuttering as a covert repair phenomenon. In Nature and Treatment of Stuttering: New Directions, Curlee, R.F., & Siegel, G.M. (Eds.). Boston: Allyn and Bacon, 182-203.

2 For example, I make most mistakes when I first wake up, but after I've got up and become physically active, my speech becomes more accurate and fluent. I've long known that physical exercise improves my level of fluency, especially anything that involves moving my arms around a lot (like tennis).

3 A healthy rate of phonological processing requires a good supply of oxygen to the brain. This can be seen very clearly at high altitudes, where the partial pressure of oxygen is reduced. The symptoms of Altitude Sickness (which include reduced ability to formulate words and sentences, poor muscle co-ordination, slurred speech and an increased number of speech errors) arise as a direct result of a reduction in the blood oxygen level.

From the Autumn 2002 edition of Speaking Out