About the presenter: Ellen-Marie Silverman received the Ph.D. degree in speech pathology from the University of Iowa and completed a post-doctoral fellowship in developmental psycholinguistics at the University of Illinois, Urbana. A member of several university faculties, Dr. Silverman authored or co-authored more than 35 research papers, two textbook chapters, and one middle reader novel, Jason's Secret, which she presented at last year's ISAD. In 1986, she resigned a tenured faculty position to resume full-time clinical work. Six years later, she founded TSS-The Speech Source, Inc., an interpreter agency for deaf, hard of hearing,, and deaf-blind people, and hearing individuals with limited English proficiency. TSS also provides real-time (CART) captioning on-site and has pioneered captioned theater in Wisconsin. She is a Fellow of ASHA and a member of Sigma Xi and Delta Kappa Gamma Society International.

You can post Questions/comments about the following paper to Ellen-Marie Silverman before October 22, 2001.

Consumer Alert: Stuttering and Gender Research

by Ellen-Marie Silverman
from Wisconsin, USA

Scientists Confuse with Conflicting Reports

What foods to safely eat is more a question than ever to many who rely on scientists' recommendations. During the past decade alone, scientists in the United States have promulgated a bevy of confusing directives. For instance, they have warned us eggs raise cholesterol levels and endanger cardiovascular health only to later rescind that recommendation and state eggs really do belong in a healthy diet. They have told us coffee is unhealthy, only to later advise that the caffeinated beverage is not harmful if consumed in moderation. They have encouraged us to eat pasta only to caution us recently that high carbohydrate consumption can trigger adult onset diabetes. And so on. People have become so confused about what is safe to eat they are choosing foods primarily for taste, i.e., those high in fat content. Doing so has contributed to an alarming trend: Estimates suggest 50% of the population, including children, are now clinically obese.

This example says a lot about science, scientists, and consumers. While science may be an exact method, its application can be flawed. Research questions derived from scientists' incomplete knowledge of the whole, desire for recognition, and/or unwitting personal biases can lead to inadequate results, possibly harmful ones. A contemporary example is investigations into AIDS. Not long ago, researchers stated the disorder could be adequately managed by drugs. Those who had been taking the especially designed medications for several years have now demonstrated both the truth and untruth of that pronouncement: AIDS does respond to medication, but the drugs that manage the disease only do so until the virus mutates into a drug intolerant form. Then, only new drugs may be effective. Another unexpected effect was relaxation of the dread about the disease. Many young gay men believing AIDS was no longer a serious problem began disregarding safe sex practices. The incidence of new cases of AIDS in the United States is now increasing rapidly. Consumers of research findings once again have been harmed by taking recommendations at face value. We need to learn there is no adequate substitute for personal responsibility. Science alone can not answer all our questions personally and collectively at the time we most want answers. To think otherwise may be to succumb to one of the greatest temptations of all time.

Stuttering research, too, has had its share of follies. The vocal fold theory of the '70's. The stimulus - response approach to treatment in the '60's. The cerebral dominance theory of the '30's. All promised more than they ever delivered. And all, since they were championed by persuasive individuals, managed to shut-down almost all dissent of contemporaries. But, most stuttering research efforts in the United States, have been contaminated by one major, flawed assumption. Namely, that stuttering behavior could be studied satisfactorily essentially independent of individuals. Gender, race, social group, ethnic origin all were dismissed as meaningless variables. Group rather than single-subject research design was the preferred method. Groups consisting of quasi-people were studied, not individuals. In all fairness, this was true of many programs of inquiry into the nature of human behavior until quite recently. But, since that was true, what does that say about the findings of so much research into the nature of stuttering and of treatment efficacy? To whom can these findings be generalized?

In the mid - 1970's, based on my own experience, I decided to conduct a natural experiment into the effect of anxiety on stuttering. Rather than simulating anxiety as it had customarily been done by administering electric shocks to participants or by threatening to do so, I decided to compare women's fluency at two points in the menstrual cycle. By then, it was well known that, because of quite specific fluctuations in hormone levels, namely that of estrogen and progesterone, women, as a group, demonstrated increased feelings of well-being at mid-cycle and increased anxiety during the premenstrual portion of the cycle. I wasn't even considering at that time that data on women were generally lacking . I, as most investigators of the time, had tacitly accepted the rationale that males subjects were the most accessible and generally the most appropriate, so they were the subjects of choice. I realized only later, after completing the initial investigation (Silverman et. al, 1974) and two related ones (Silverman and Zimmer, 1975; Silverman and Zimmer, 1976) that that assumption was unproved. So, in the context of the times, when the scientific community began to recognize men and women may not only be hard-wired differently but may also hold different world views, I undertook research into gender differences in stuttering demographics, stereotyping, treatment preferences, treatment experiences, and attitudes toward communication (Silverman and Zimmer, 1979, Silverman, 1980; Silverman and Van Opens, 1980; Silverman and Zimmer, 1982a; Silverman and Zimmer, 1982b; Silverman, 1986).

This program of research uncovered distinct differences between male and female stutterers in demographics, stereotyping (including the distinct likelihood at the time it was conducted that teachers were less likely to refer a girl for stuttering therapy than a boy presenting the exact same symptoms, Silverman and Van Opens, 1980), treatment preferences and experiences, and approach to interpersonal communication. Yet, insofar as I am aware, these findings, summarized in "The Female Stutterer" (Silverman, 1986), have gone largely unnoticed except in a most peculiar manner. Considerable snickering and some outrage greeted the efforts and findings when mentioned in my presence. One especially vivid example follows below:

"I want to know what really is regardless of how I prefer things to be," Charles Tart, Psychologist.

Our research identifying and describing gender differences in stuttering rankles some people, amuses others, and basically is viewed as an oddity, certainly not serious science. Unfortunately, that view should not be surprising. Scientists and professionals frequently take that stance with non-mainstream research programs and findings because they are people first and foremost. And, as people, scientists and professionals often tend to prefer the expected to the unexpected, the known to the unknown, unlike those with Eastern world views, who typically welcome, even become excited, by novel happenings. They believe such events better reveal the essence of life.

The fact remains that people seeking help with stuttering problems are just that -- people. And the information that therapists have and still tend to receive from those conducting research and writing books, i.e., means, standard deviations, etc., simply doesn't address that fact very well. The Method of Science with all its assumptions about reality from a human perspective, including the need for objectivity of the so-called observer, linearity of experience, and the uses of inferential and descriptive statistical analyses to interpret observations simply can not, at this point in space-time, generate information completely useful to modify behaviors of multi-tasking, complexly functioning human beings. Personal, more than impersonal, knowledge is required to inaugurate, modify, stabilize, and maintain behavioral change.

Simply put: In all therapy encounters, the person who stutters must take the driver's seat when setting goals, selecting methods, and deciding the nature and length of treatment. No one else is better equipped to do that. And to abdicate that responsibility is to provide another with power they may be unable to manage well. The "Rescue Game" first described by Eric Berne, founder of Transactional Analysis, diagrams troublesome interactions that lead to disappointments in relationships, including therapy ones. In the game, there are three roles to be taken by two participants: Rescuer, Victim, and Persecutor. The Rescuer believes his or her task is to manage the other's life. The Victim believes someone else, i.e., a Rescuer, needs to tell them how to live. And the Persecutor, formerly the Rescuer or the Victim, in a role reversal, creates an uproar and provokes feelings of shame and/or failure in the other to end the game with unpleasant feelings abounding.

Here is an example: Steve, a 29 year-old, who has enrolled in therapy almost continually since he was six and began stuttering while reading aloud in class, feels the need to continue treatment. Despite the fact he is successful in a responsible position, has a partner in life, and enjoys a cordial circle of friends, he feels he could be more successful if he no longer stuttered. He places himself in the role of Victim searching for a therapist (Rescuer) by verbally and non-verbally saying, "I need your help. Only you can help me." But Steve, in so-doing, is not honest with himself. He believes no one "out there" is able to change him from a person who stutters into someone who does not. In fact, Steve believes that since no speech therapist has cured him, none ever will. And what he really wants to do is rub that in the face of any therapist who takes his Victim bait. He does that by entering a therapy relationship with a therapist eager to be the one to change him. To prove himself correct, he resists all suggestions and recommendations the therapist makes, until the therapist, out of frustration, dismisses him or he chooses to directly say he has not benefitted from treatment. Then the game ends with the therapist angry and feeling like a failure, possibly distressed enough to avoid working with others who have stuttering problems, i.e., becoming Victim. While Steve, feeling superior at this point, at first feels good letting the therapist know just how incompetent he thinks he or she is, i.e., becoming Persecutor. But shortly feels bad when he returns to the thought he is incurable.

Playing the "Rescue Game" is like running around in a circle, never going anywhere new and getting increasingly angry and tired. If a person with a stuttering problem wants to be a person without a stuttering problem, then a radical change in thinking is required. And that is to realize and believe that: "The only one who is going to change me is Me!" The consumer, as in any other transaction, needs to know themselves first, i.e., become informed, decide what they want and or need, and what they're willing to do to get that. That is how to successfully use the valuable skills of speech-language pathologists: As resources and coaches. In reality, there is nothing more speech-language pathologists can do for their clients!

In Summary: To expect science and speech-language pathologists utilizing scientific methods and applying findings from research studies to single-handedly produce favorable outcomes when consumers adopt a passive role in the process is to be sorely disappointed at this point in space-time. The person with the stuttering problem and those who care for them are the ones who know the consumer best and the ones who need to take responsibility for personal change. There is no substitute for taking personal responsibility as a consumer to generate a favorable therapy outcome.


Silverman, E.-M., Zimmer, C., and Silverman, F., (1974). Variability in stutterers' speech disfluency: The menstrual cycle. Percept. Mot. Skills, 38, 1037-1038.

Silverman, E.-M., and Zimmer, C., (1975). Speech fluency fluctuations during the menstrual cycle. J. Speech Hearing Res., 18, 202-206.

Silverman, E.-M., and Zimmer, C., (1976). Replication of Speech fluency fluctuations during the menstrual cycle. Percept. Mot. Skills, 42, 1004-1006.

Silverman, E.-M., and Zimmer, C., (1976). The fluency of women's speech. In I. Crouch and B. Dubois (Eds.), Proceedings of the Conference on The Sociology of the Languages of American Women. San Antonio: Trinity University.

Silverman, E.-M., and Zimmer, C., (1979). Women who stutter: Personality and speech characteristics. J. Speech Hearing Res., 22, 553-564.

Silverman, E.-M., and Van Opens, K., (1980). An investigation of sex-bias in classroom teachers' speech and language referrals. Language, Speech, and Hearing Services in the Schools, 11, 169-174.

Silverman, E.-M., (1986). "The Female Stutterer," 35-63. In K. St. Louis (Ed.), The Atypical Stutterer. New York: Academic Press.

You can post Questions/comments about the above paper to Ellen-Marie Silverman before October 22, 2001.

August 3, 2001