Shifting Perspectives about Stuttering
What’s the first thing that you remember learning about stuttering?
If you’re like me, you probably started off by learning that stuttering is a “speech disorder” that involves certain types of interruptions in the flow speech, and that these interruptions are typically called “disfluencies.”
You probably also learned that these disfluencies are behaviors that observers classify as repetitions, prolongations, or blocks. You learned that the way to determine if a person stutters is to observe them speaking and count how many times you hear or see one of those “stuttered” disfluencies.
You even learned how to assign a severity rating to a person’s stuttering based on the number of times you saw them stutter, how intense those moments of stuttering seemed to you to be, how long you saw those moments of stuttering last, how much physical tension or struggle you saw in the person’s face or body, etc.
This is all pretty standard stuff, right? Speech-language pathologists and researchers in our field have been thinking about stuttering in this way for a long, long time.
But…what if I told you that this way of thinking about stuttering is outdated, biased and, many times, just plain wrong?
Wait…what?!
You read that right. The way that our field has long approached the evaluation of stuttering is based on old ideas that miss what’s most important about the moment of stuttering.
How can that be? Well, notice the perspective that is emphasized in the description of stuttering assessment above. At every stage of the process, stuttering was defined, identified, measured, and scaled based on what an observer can see or hear. Certainly, these types of observations are central to much of our past clinical and scientific work, but do you notice what’s missing?
Nowhere in this traditional view of stuttering is there any mention of the speaker’s perspective of the moment of stuttering. Put simply, our field has defined stuttering based on what observers hear or see rather than considering the perspectives of the person who stutters who is actually stuttering.
Sidebar: Certainly many clinicians do think about the speaker’s perspective when they assess broader aspects of stuttering, such as emotional reactions and quality of life. (If you are not already doing so, please click here to learn about the OASES!) But, when it comes to the moment of stuttering itself, and especially when it comes to measuring stuttering severity, everything has been based on the perspective of the observer.
What’s so wrong with that? Lots!First, countless studies conducted over decades have shown that, unless they have had extensive training, observers just aren’t that good at reliably determining when a disfluency has occurred in another person’s speech. That means that the frequency counts that so many people use for determining their therapy recommendations just aren’t that accurate. (That’s right…all that time spent doing stuttering counts has resulted in a lot of “bad data.”)
Second, even if one does get the training needed to count disfluencies reliably, there are still many critical aspects of stuttering that observers simply cannot see. What if a speaker has physical tension in their larynx or in their abdomen? What if they chose not to talk in a certain moment because they knew they were about to stutter? What if they felt a stutter coming on and quickly changed words so that a disfluency never made it “to the surface” of their speech? Listeners simply have no way of knowing when speakers do use these types of compensatory behaviors.
Third, and most importantly: Even if we could overcome all of these challenges, we are still faced with a fundamental, insurmountable problem: observable disfluencies are not the same thing as stuttering!
People who stutter consistently tell us that repetitions, prolongations, or blocks do not define the moment of stuttering for them. Yes, they may sometimes exhibit those behaviors when they stutter, but not always. When you ask people what the moment of stuttering feels like to them, they don’t say “it’s a moment where other people hear me repeat a sound.” (And, if you think about it, it would be kind of odd if they did say that!)
Instead, they say something more like this: “stuttering is a moment when I feel ‘stuck’ in my speech. I know exactly what I want to say, but I can’t say it…it’s like I’ve ‘lost control’ of my speech, and I am ‘unable’ to move forward.”
Note how this first-person perspective emphasizes what the speaker experiences during stuttering…not what an observer might happen to hear or see (or not).
Because our field has long prioritized the observer’s perspectives over the speaker’s perspective, we have missed what’s most important about the moment of stuttering.
This realization has several consequences, the most important of which is this: we need to change our thinking about stuttering if we are going to get a more accurate, more valid, and more meaningful understanding of what people actually experience during the moment of stuttering.
How are we going to do that?
Stay tuned, and we will tell you.
In future blog posts, Nina and I will talk more about how we shift our own perspective to think about the experiences of people who stutter. I’ll talk about what that means for our assessment of stuttered speech (for example, no more frequency counts), and we will write more about how this shift in perspective leads us to do a better job of helping people who stutter both in and out of the therapy room.
For now, get ready to shift your perspective. It’s going to change everything.
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