Claudia Regina Furquim De Andrade Head Professor and Chair, Department of Physiotherapy, Speech-Language-Hearing Pathology and Occupational Therapy. School of Medicine. University of São Paulo. Brazil. The Professor received her BA at São Paulo Catholic University and her MA and PhD in Linguistics from The University of São Paulo. Dr. Andrade authored and co-authored numerous research and clinical articles in scientific journals on the topic of stuttering. She also presented lectures on this subject in national forums and presented her work in several international events. She is the editor of the Scientific Journal Pró-Fono. She is responsible for and coordinates the Investigation Laboratory of Fluency and Fluency Disorders. Her main interest has been the prevention, onset and development of stuttering.

You can post Questions/comments about the following paper to the author before October 22, 2003.

Some answers to William Perkins from Brazilian friends...


by Claudia Regina Furquim de Andrade

When I finished my graduation in Speech-Language Pathology in 1979, at São Paulo Catholic University I was absolutely sure: stuttering was unsolvable and incurable. I would never want to be professionally involved with this human communication disorder.

For the next 10 years I was involved with studying, working and teaching as an assistant professor at São Paulo University. My field of knowledge was public health -- epidemiology and prevention strategies in human communication disorders.

In 1989, after a long period without a professor to teach stuttering for our graduate course at São Paulo University, I became uneasy with the situation -- something had to be done and I decided that I would do something to solve the problem (even if it was temporarily...).

I knew where to begin. I had to find logical theories and a methodology to start a systematic investigation about the nature of stuttering and its implications for prevention and remediation. If I could find this support, I would be able to start ...

During the first 6 months I read everything I could about stuttering (it wasn't easy because here in Brazil we had only two books about stuttering (Jakubovicz and Friedman) and no research papers. I made many contacts with all libraries at my and other universities. After awhile I managed to get more than a 100 papers from all over the world. Then I was able to deepen my knowledge with Travis, Van Riper, Johnson, Bloodstein....and I met Perkins, his "assertiveness" and the neuropsycholinguistic theory (with Kent and Curlee).

A few years later we received in São Paulo a visit from Mr. and Mrs. Gregory and I had the opportunity to meet Hugo Gregory, who became one of my great friends (in 1996 I spent some wonderful days at their home, in Evanston, and at Northwestern University. In 1997 I took part in the Stuttering Foundation Workshop with a marvelous group -- the Gregory's, the Frasers, June Campbell, Diane Hill and several students).

Today, I have many friends all over the world who are great stuttering researchers who are all equally very special and important to me--Ehud Yairi, Ed Conture, Hans-George Bosshardt, John Van Borsel, Ashley Craig and my dearest Posha's partner Ken St. Louis.

Nowadays I have an investigation laboratory at São Paulo University where many research studies about speech fluency and stuttering are developed, involving graduation and post graduation students (theoretical and practical classes, specialization, master and doctorate degree).

Now, after about 15 years, I can say that I can see some progress. I managed to unite my prior epidemiological formation with my knowledge about stuttering. For this reason, my laboratory has special characteristics and we are trying to do what could be considered good science in mainstream research into the nature of stuttering.

The work I am going to present is in respect to Perkins contributions. I invited 4 colleagues (Brazilian professors in stuttering) from different universities to answer a few of Perkin's questions, which were formulated in his book "Stuttering and Science". With this I would like to show what we Brazilians are thinking about stuttering. The professors I invited were:

Questions:

1. What is the essence of stuttering?

Silvia - A subjective state of anxiety and/or fear of producing speech which is frequently followed by the anticipation (and likely visualization) of sounds (letters of the alphabet) or words perceived as problematic, unpronounceable.

Monica - I believe the essence of stuttering is a rupture in speech production, where the motor program of a syllable or word is not available for the speaker in a specific moment, which makes impossible the production of the word.

Ana - I think the essence of stuttering is organic i.e. something goes wrong in the neurophysiologic network that controls the temporal aspects of speech.

Isis - My line of work follows the principles of phenomenology which belongs to the human sciences and aims to understand the essence of the various phenomenon. So, this is one of my focus of interests. When I decided to know stuttering, to study stuttering, I did it according to these principles. When I see someone who stutters stuttering, I will try to find out how he constructs this stuttering in his body, how the stuttering is constituted in his body, so I go beyond appearances. If I look only at the behavior, if I observe how many times he repeated a segment, if he repeated, if he blocked, if he prolonged, I am only looking at the appearance. When you look for the essence you surpass, you go beyond the appearance, so what happens to the body that constitutes the stuttering, how is this processes on that particular individual is the way in which I will know the stuttering of each stutterer, what muscular mapping he made, what level of tension he uses, if this tension tends toward hypotension or hypertension, I see the stuttering constituted on the body and look for this essence on the body.

2) What is the cause of stuttering?

Silvia - Intersubjective relations in which the speech pattern of one subject is stigmatized for another, generating imaginary conditions for constituting a stigmatized image as a speaker. Once configured, such image sustains what has been described as the essence of stuttering.

Monica -- I believe in a genetic predisposition together with emotional and social questions.

Ana - Stuttering may be caused by different factors: the organic, the developmental and the environmental ones. The organic factors come about when a person has a tendency to stutter. The second kind are related to the development stages of a person's speech, language, cognitive, social and emotional. The environmental factors are caused by pressure from communication, speech and language environment and day to day events.

Isis - This is not something I worry about, this answer is not for me, I think that I will leave this answer for the researchers, mainly for those in the field of genetics, because I believe that one day we will have some truth said by those studying genetics about stuttering. So, I do not know the cause of stuttering, no one knows and let us wait for the research in the area. I worry about knowing the stuttering of each individual, how it presents itself, how it is formed and how it manifests on the body.

3) What determines the severity of stuttering?

Silvia - The frequency with which the state defined as essential is present in the subjective configuration of a person in communication situations, generating a tensioning effect on one or several muscle groups involved in producing speech, thus, materialized in blocks and hesitation and /or generating word switching and / or generating frequent silencing.

Monica -- We know that is the type of disfluency that shows the severity level of the stuttering and we also know that the disfluencies are linguistically determined. So, linguistic factors plus the anxiety and tension of the stutterer in a speech situation are the factors that determine the severity

Ana - A combination of the factors mentioned above.

Isis - Stuttering is in a person, it is part, it constitutes this person, this human being, this person as a whole. It is known that all emotions can interfere in the totality, therefore if the person is emotionally altered, has an emotional lack of control, is stressed, is anxious, is afraid, all of her body feels these emotions. The person will manifest the direct relation of this tension, emotion, that exists between tension and emotion. So, if the person is not emotionally well balanced, she will also alter her muscles, consequently stuttering, which is a muscle action, will also be altered. So I see that whenever stuttering gets worse or better, this has to do with an emotional state, with a physical condition, sometimes with tiredness, physical tiredness, a bad night's sleep, slept too little, this also interferes. Whenever the totality of the human being suffers an impact, suffers some kind of alteration, everything else is also altered. If you have a weak point, if you have any kind of difficulty, this is what will appear first. So stuttering can get worse or better depending on how the person is. The stutterer, the person, has feelings, has emotions and this, what he feels, what he thinks, influences his way of stuttering.

4) Can chronic stuttering be prevented?

Silvia - Yes, starting from the social enlightenment on the effects that may stem from stigmatizing intersubjective relations.

Monica -- Yes, if we have the possibility of an early and appropriate intervention

Ana - I think that controlling the factors that cause stuttering (eg. communicative pressure) could diminish the severity of the stuttering.

Isis - I see the essence stuttering. This, to define, is the trace, is the possibility that the person has to stutter. If this is proven by genetics no one can take it away, but I believe that each stutterer, having this trace, develops, forms on the body this stuttering, this can be prevented, what I call stuttering is constructed. The essence of stuttering cannot, it is born with a person and will die with this person, but the constructed stuttering can be prevented.

5) Are all who stutter alike?

Silvia - Evidently that, as people, it would be inconceivable to state that they are all the same, however, from the point of view of subjective functioning, a profound regularity is found among people who consider themselves stutterer.

Monica -- I don't believe so. I believe they have many times, similar patterns of speech, which can determine the kind of therapy the clinician is going to choose.

Ana - Stuttering is a complex disorder that depends on different factors, in that sense, I believe each person develops a specific type of stuttering.

Isis - Obviously not. Not all stuttering is alike, the same is true for the stutterers. No one is like the other. The stutterer is a person, is a human being, how can I imagine that one stutterer is the same as another stutterer? One person is not the same as another and the stuttering which is developed by each individual is a singular process. The person develops according to his life experiences, according to his possibilities in world, for this reason it is absolutely particular to each person, stuttering is individual and the stutterer as a person, obviously, is unique. He is not like anyone else. So, there is no one like you.

You can post Questions/comments about the above paper to the author before October 22, 2003.

September 1 2003