From: Kevin O'Neill
Date: 29 Sep 2012
Time: 18:40:39 -0500
Remote Name: 24.18.229.12
As a layperson who stutters, I really applaud the position you take here (despite the potential for backlash as with Perkins's 1990 paper). I think that redefining stuttering in terms of the aversion, avoidance, and effort of the person who stutters has the potential for huge impact on therapy and research. In my experience with therapy, the best SLPs knew this and made it the core of therapy. Those SLPs who focused on eliminating disfluency according to the standard definition tended to reinforce the underlying problem (even if I spoke more fluently for a few weeks or months). As I say in my own essay in this issue: "'stuttering' no longer means just pauses or repetitions or other imperfect speech, but rather speaks to habitual avoidance and struggle behaviors that make communication stressful and difficult. This isn't some arbitrary redefinition: without aversion and struggle, I bet that most listeners hear my pauses and repetitions only as naturally imperfect speech, not as a speech disorder." I'm interested in your assertion that it's probable that "surface behaviors and communicative avoidance often occur concurrently and simultaneously." I've found through careful observation of my own speech that most blocks and repetitions are triggered by avoidance or effort, i.e., even at the "micro level" it is cognitive reactions that give rise to disrupted speech, rather than non-cognitive processes. I believe in what you call a "neurobiological lack of integration" of my speech processing, but that I can compensate for this lack of integration with natural pauses and slower speech, vs. counterproductive effort/avoidance. I also believe that your redefinition pushes stuttering research towards a modern psychology of stuttering. Treating people who stutter as a block box -- for which the "input" is speech exercises and the "output" is fluent/disfluent speech -- fundamentally ignores what is stressful and difficult about stuttering, and how it manifests as a general communication disorder. While there may be underlying physical/neurological reasons why stuttering occurs in a given individual, it is avoidance behaviors and effort/struggle that primarily characterize the stuttering disorder in adults, and these factors should be prioritized in research and therapy. I look forward to more work on this topic!