Stuttering Frequently-Asked Questions (FAQ)

Last-modified: 1996/06/03
Version: 2.0
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or Casa Futura Technologies, P.O. Box 7551

The author, Thomas David Kehoe, is owner of Casa Futura Technologies; president of the Boulder, CO chapter of the National Stuttering Project; and a member of the American Speech-Language Hearing Association. I am a person who stutters, not a speech pathologist.

This is the Stuttering Frequently-Asked Questions (FAQ) file. It covers the main points about stuttering, while fitting into the 64K limit of some Internet systems (about 30 pages).

This is different from my book, Stuttering: Science, Therapy, & Social Issues. The book is 250 pages, or ten times longer, covering additional subjects and going into much more detail. When I have the time I will make the book available on the World Wide Web. Right now, the only way to read it is to send me $25 for a printed copy.




Subject: What's So Great About Stuttering?

Stuttering is a remarkable disorder. It's the easiest disease to treat, and the hardest to cure. On occasion, stutterers can talk fluently, when they're alone, by changing their manner of speaking, thinking differently, using an electronic device, or even just seeing their speech therapist walk into the room.

But stutterers can go right back to stuttering, even after weeks of the best therapy. Temporary "cures" are a dime a dozen, but a universal, permanent cure has never been found.

For many people, stuttering gets worse when we try not to do it. This paradox can be frustrating. Many stutterers are verbal, talkative people, coming from families that value speaking well. Communication is central to every aspect of civilized life.

Some stutterers have extreme physical symptoms, such as head jerks, facial grimaces, and even what listeners might think are seizures. Other stutterers hide their stuttering completely, by substituting or avoiding words. The latter can be just as disabling, because the stutterer is afraid that people will discover that he stutters. The stutterer may refuse promotions that require more talking, or avoid social interaction.

Despite the disabling effects of stuttering, the greatest orators have been stutterers. Demosthenes was the greatest orator of ancient Greece. Today, James Earl Jones is the most in-demand voice in Hollywood.

Dozens of stuttering causes have been hypothesized, but none have been proven. Suspected causes have ranged from Freudian anxieties, to parental demands, to poor vocal fold control, to neurological abnormalities.

Stutterers are both hyperaware and unaware of their stuttering. Before talking to a stranger, we have fear and anxiety that we will stutter. But when we stutter, we don't know what our lungs, vocal folds, lips, or tongues are doing. We lose awareness of our speech. Our minds seem to go "someplace else," and we lose awareness of even the passage of time.

Stuttering is one of few disabilities that gets better over time. Most children outgrow it. Even adults who stutter severely in their 20s usually learn to manage their stuttering in their 30s and 40s, and sometimes overcome stuttering completely. Your most severe stuttering is probably behind you.

Stutterers grow up humble, thinking we'll never get a job or marry. Later in life, when you realize you can do anything you want, regardless of your speech, you get what you need and appreciate what you have. Or you overcome stuttering and find pleasure in simply talking to people. Speech pathologists who treat adults who stutter say that we are the funnest, best-adjusted, most positive people they know.

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Subject: What Causes Stuttering?

The question "What causes stuttering?" is really two questions, one easy to answer, one hard to answer.

The easy question is "What causes stuttering in adults?" The answer is that we stuttered when we were children. The speech patterns we learn as children -- accent, grammar, language, etc. -- become "hard-wired" as our brains grow. An adult stutterer can learn to talk fluently about as easily as an adult nonstutterer can learn to speak Chinese.

Because stuttering develops as a child's speech and language develops, this disorder is called developmental stuttering. Developmental stuttering is distinguished from neurogenic stuttering (caused by strokes and head injuries) and psychogenic stuttering (caused by psychological trauma).

The hard question is "What causes stuttering in children?" Childhood stuttering looks simple compared to the complex behaviors of adult stuttering. But while the cause of adult stuttering is simple, the cause of childhood stuttering is an enigma. Many theories have been proposed, but none is compelling. I discuss this subject in my book, but I left it out of this FAQ due to space considerations.

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Subject: How Speech Is Produced

Speech begins with breathing. Your lungs fill with air, more air than you would inhale if you weren't talking. You expand your upper chest, as well as your diaphragm, to get all this air in. Your lung pressure and respiration muscle tension increases.

Next, you release air through your throat, past your vocal folds. Your vocal folds are a pair of small muscular folds in your larynx. If you tense these muscles slightly, and release a little air, your vocal folds vibrate. This is called phonation. If you place your fingers or palm across the front of your throat, and hum or talk, you can feel your vocal folds vibrating.

If you tense your vocal folds too much, you'll block off your throat and prevent any air from escaping your lungs.

Vowels are produced by your vocal folds, and modified by your articulation muscles (lips, jaw, and tongue). Some voiced consonants, such as /b/ and /d/, are also produced with vocal fold vibration, and modified by your jaw, lips and tongue. Other consonants are voiceless, such as /p/ and /t/, and are produced only by your articulation muscles modifying airflow, without your vocal folds vibrating.

Your ears are essential but overlooked speech-production organs. You can't speak correctly if you can't hear. Some theorists have proposed that stutterers have defective hearing in some way. Despite over 40 years of research, no such defect has ever been found.

A normal hearing reflex, while not causing stuttering, could make recovery from stuttering more difficult. The stapedius muscle reflex of the middle ear attenuates your vocal perception 5-15 dB (about an 80% reduction in sound). The attenuation is greatest at the lower frequencies of your vocal fold vibration. If you can't hear your vocal folds, you can't control them.

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Subject: Symptoms of Stuttering




Stutterers report three types of sensations:

During stuttering, stutterers usually feel a mental "blankness." Our minds go "someplace else."

Several studies have found that stutterers lose their ability to use their hands during stuttering. Other studies have found that stutterers lose sense of time during stuttering.

Because we don't perceive our stuttering, we can't alter our behavior. When we are not stuttering, we may be capable of any behavior anyone asks us to do, such as altering our breathing, relaxing certain muscles, making eye contact, etc. But during stuttering we lose awareness and control of our bodies.

We may be hyperaware that we are going to stutter before we talk to a stranger. We may experience great anxiety during stuttering. But when we stutter, we have little awareness of how long our blocks are, how many times we stuttered, secondary symptoms, etc.


Stutterers believe that:

In spite of all this, many stutterers, especially children, seem unconcerned about their stuttering. Franklin Silverman asked 62 children who stutter (grades 2 to 5) to make three wishes. Only four made wishes related to speech, and one of these children wished he could go to speech class forever! Younger children don't view themselves as inferior to their classmates. This belief develops as the child grows up.


The "average" stutterer is disfluent of 10% on words. Stated conversely, we are fluent on 90% of words. But is our fluent speech normal, or are there abnormalities even in our fluent speech?

Some studies found that listeners could differentiate the fluent speech of stutterers from that of normal speakers. Other studies found that listeners could not hear a difference.

Spectrographic analysis did not find abnormal pitches in stutterers' fluent speech. But electromyographic and aerodynamic studies found abnormalities in stutterers' fluent speech.

The problem may be that in what each research team considered to be fluent speech. Some studies used mild stutterers, other studies used severe stutterers. Some stutterers may have used therapy techniques resulting in abnormal muscle activity in order to sound fluent.


Stutterers will tell you that they talk too fast, and this results in stuttering. We feel like our minds can produce speech "a mile a minute," and that our speech-production muscles can't keep up, and we stumble and fall over our words.

Several studies by Joy Armson and Joseph Kalinowski found that auditory feedback (DAF and FAF) enabled stutterers not only to talk fluently, but to talk extremely fast (averaging 6.5 words per second), while reading out loud.

Martin Schwartz suggests that a fast start on a sentence increases vocal fold tension before the first word of a phrase, which then leads to stuttering. He believes, however, that speaking fast on the rest of the sentence has much less effect on stuttering than starting the first word fast.

Studies of stutterers' fluent speech have found that our fluent speech is slower than nonstutterers. Early studies measured overall speaking rate of fluent speech (not counting disfluencies), and found that stutterers talk slower. Many other studies have found various results, sometimes faster, sometimes slower. Stutterers seem to do some speech movements faster, and other speech movements slower, which result in an overall slower speaking rate.

Variance in these studies may also be due to some stutterers having learned compensation techniques (from therapy or on their own) to produce fluent speech.

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Subject: Physical Constitution and Personality of Stutterers


Stutterers' physical and psychological constitutions have been studied with practically every instrument known to medicine and inventory known to psychology. Stutterers are normal in every respect.

Studies have generally found that parents of stutterers are normal in most respects, including their attitudes and behaviors towards their child.


There is evidence that children who stutter start talking later or are slow in developing language skills. But by school age, stutterers have caught up with other children in language ability.

Many studies have shown that children who stutter also have articulation disorders, such as lisping, indistinct speech, or difficulty saying the sound /r/. Stuttering and articulation disorders appear to be related.


Studies seem to indicate that children who stutter score about five IQ points lower than children who don't stutter.

Other studies found that college students who stutter are more intelligent than their peers. However, any person with a disability has to be especially intelligent and motivated to attempt college work, so this doesn't mean that stutterers are more intelligent in general.

Stuttering among mentally deficient individuals appears to be far higher than the 1% prevalence in the general population.

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Subject: Incidence and Prevalence of Stuttering

1% of the population stutters now.

Between 5% and 15% of children stutter at some point in childhood.

The typical age for stuttering to begin is 2 or 3. One study found that three-quarters of stutterers begin by age 6, and all before the age of twelve.

Researchers used to believe that many young children recovery from stuttering without speech therapy. However, recent research suggests that once a child has moved from normal disflunencies to stuttering, he is unlikely to spontaneously recover.


80% of adult stutterers are men.

Of two- and three-year-olds, equal numbers of boys and girls stutter.5

The sex ratio becomes 3:1 by the first grade and 5:1 by the fifth grade, the same ratio as adults.

Girls begin stuttering earlier, but are more likely to outgrow it. Boys start stuttering later, and are less likely to outgrow it. The earlier development of language in girls enables them to cope with stuttering better.6


If you stutter, you are about three times more likely to have a close relative who stutters. This suggests that there may be a genetic component in stuttering.

Studies of the families of stutterers failed to find simple Mendelian types of inheritance, such as sex-linked, autosomal dominant, or recessive. This does not rule out unknown, complex types of inheritance.

It's also possible that stuttering is socially conditioned, not genetic.

A study of 95 identical twins reared apart found 5 stutterers, but none of their twins stuttered. This is in spite of finding similarities in talkativeness, pitch, and hoarseness, as well as tastes in clothing, books, etc. This suggests that stuttering is not genetic.

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Subject: Conditions That Increase or Decrease Stuttering


Stuttering is most likely to occur on:

- The initial sound or syllable of a word (90% of stuttering). Initial consonants are more difficult than initial vowels.

- The first word of a sentence.

- Accented syllables of words.

- Content words (nouns, verbs, adjectives, and adverbs) rather than function words ("and," "but," "he").

- Longer words, than shorter words.

- Less-frequently-used words.

- Transitions from voiceless to voiced sounds (i.e., when switching on your vocal fold vibration.)


- Speaking on the telephone. In telephone conversations, pauses are less acceptable. You are expected to continuously keep the conversation going. Also, you are unable to use non-verbal communication.

- Saying one's name. However, I haven't found any studies showing that stuttering is more likely on words starting with the initial sound of your name.

- Telling jokes. Timing is critical to jokes, so there is more anxiety about saying a punchline fast.

- Saying something important or meaningful. Stuttering is less likely when, for example, reading a list of numbers.

- Time pressure.

- If you believe a listener is hard to talk to or critical. You are likely to stutter less with someone you perceive as easy-going or understanding.

- Talking to an authority figure.

- Speaking to an audience.


- When speaking alone or when talking to animals, many stutterers are fluent.

- Speaking in chorus (unison) with another person.

- Many stutterers can read out loud fluently, especially if they don't feel emotionally connected to the book. However, other people only stutter when reading out loud, because they can't substitute words.

- Many electronic devices reduce stuttering.

- Saying a phrase repeatedly reduces stuttering.

- Some people can reduce stuttering by trying to stutter, saying that they stutter, or not hiding their stuttering. Some of us, on the other hand, succeed whenever we try to stutter.

- Stutterers can sing fluently. Singing uses continuous phonation and diaphragmatic breathing, like stuttering therapy. Singing uses a different part of the brain than speaking. Singing requires listening to your voice.

- Speaking in a novel way increases fluency. This includes whispering, using an abnormally high pitch or low pitch, using an unusual accent, speaking abnormally slowly, putting objects in your mouth, etc.

- Pretending to be a different person or persona can reduce stuttering.

- Various studies have increased or decreased stuttering through punishment and reward (operant responses). Electric shocks contingent on stuttering reduce or eliminate stuttering. Stuttering returns when the electrodes are removed.

- Saying "right," "wrong," or "tree" all decrease stuttering equally. It doesn't matter if the word is said after fluent words or disfluencies.


Several studies established that distraction does not reduce stuttering. For example, stutterers can talk fluently to the rhythm of a metronome, but an arrhythmic metronome does not enable fluency, showing that metronomes do not reduce stuttering via distraction.

A 1982 study had stutterers step on and off a 10-inch platform while reading out loud. A 1985 study had stutterers manually track an irregular line on a rotating drum while speaking. Neither distraction was able to reduce stuttering.

"Distraction" is a vague term, with different people using the word differently. Paying attention to your speech is called a distraction, e.g., speaking in an unusual accent. But paying attention to something other than your speech is also called a distraction.


"Stress" is another vague, simplistic term. Stress has never been proven to increase or decrease stuttering. Specific types of stress -- e.g., time pressure -- seem to increase stuttering.

However, emotional arousal often decreases stuttering.

Any stutterer can tell you that he has "good days" and "bad days" regarding fluency. Stutterers usually say it's "stress" or "not getting enough sleep" or something. No research has been done on whether sleep deprivation increases stuttering.

One explanation of "good days/bad days" is varying levels of dopamine in the brain. The neurotransmitter is affected by several factors, including diet.

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Subject: The Development Of Stuttering In Children

Stuttering is a developmental disorder. It begins between the ages 2 and 6.

Stuttering develops at the same time that children learn grammar, accents, and other fundamentals of speech and language. Stuttering may be a learned behavior, or, rather, the failure to learn fluent speech motor skills at the proper age. There appears to be a critical period in which children learn speech breathing, vocal fold control, how to articulate sounds, etc., and if the child doesn't learn these at the right age, it's difficult or impossible to learn these later.

Most, if not all, children have normal disfluencies. Some children seem to get onto a wrong track, with speech only slightly different from normal speech. But as the child goes further on this wrong track, he learns more and more of abnormal speech behaviors, and doesn't learn normal speech behaviors. His stuttering develops in severity and becomes resistant to treatment.

Early intervention is now considered paramount. The earlier a child's stuttering is diagnosed and treated by a speech pathologist, the more likely the child is to outgrow stuttering. The longer a child stutters, the more likely the child will never overcome stuttering.



Learning speech and language are the most complex and difficult skills children learn. Most, if not all, children have problems with speech or language at some point.

Disfluencies tend to be single, such as "That my-my ball," or "I want some...uh...juice."

Disfluencies tend to be interjections, revisions, and word repetitions.

The child does not manifest struggle behaviors, or visible tension, or frustration or embarrassment. The child experiences disfluencies as if he stumbled while walking, and recovered his balance and continued walking without a problem.

Disfluencies occur when the child is planning a long or complex language structure.

Changes in the child's environment may also cause temporary normal disfluencies. This could involve parents' divorce, the birth of a sibling, moving to a new home, etc.


The symptoms of borderline stuttering are:


The symptoms of beginning stuttering are:


At these ages the child begins to fear and avoid stuttering.


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Subject: Neurology Of Stuttering


The caudate nucleus is referred to as the "central switchboard" of the brain. Recent positron emission tomography (PET) brain scans have found the left caudate to be underactive in stutterers. The area is underactive whether the person is stuttering or fluent.

Researchers Joseph Wu and Gerald Maguire suggest that the "thinking" signals from the frontal lobes don't connect properly to the speech areas of the brain, due to malfunctions in the connecting caudate nucleus "switchboard". The result is poor control of the speech- production muscles, such as the vocal folds, lips, and tongue.

Wu and Maguire believe that the problem with the left caudate may be caused by abnormally high levels of the neurotransmitter dopamine in this area of the brain.


Normal speakers use both the left and right hemispheres of the brain for speech, but the left hemisphere is dominant. Neurologists believe that the left hemisphere is specialized for speech and language, and the right hemisphere is used for processing music, environmental sounds, and emotions.

One recent study using positron emission tomography (PET) brain scans found abnormal right-hemisphere dominance during stuttering, and normal left-hemisphere dominance when the stutterers talked fluently (reading in chorus with another person).

Another PET scan study found that only stutterers with linguistic impairments had the abnormal right-hemisphere dominance. Stutterers with normal language abilities had the normal left-hemisphere dominance.

The abnormal cerebral dominance can be interpreted in several ways: The unusual right-hemisphere activity could be the product of emotions and anxieties of stuttering. Or it could be that there is something wrong with stutterers' left-hemisphere speech centers, and the inefficient right-hemisphere takes over speech activities.


Some subtle abnormalities have been found in stutterers' brain processing of sounds. These abnormalities are usually in discriminating small timing differences between sounds. Researchers speculate that the part of the brain that processes incoming sound timing may also process outgoing speech timing.

PET research has found that the brain's auditory processing areas shut down in stuttering. This diminished central auditory processing may explain why stutterers have poor awareness of what we do when we stutter.


Abnormal brain activity could be a cause or a result of stuttering. How a child learns speech and language affects how his brain's speech structures grow. Stuttering may cause neurological abnormalities, or vice versa, or both.


More than 20 drugs have been tested on stutterers. Only two reduce stuttering -- haloperidol and botulism toxin -- and these have severe side effects. Placebos produce extreme side effects in stutterers, without effecting stuttering, suggesting that stuttering has a low psychosomatic content.

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Subject: Other Fluency Disorders


Cluttering is defined as "...a disturbance of fluency involving an abnormally rapid rate and erratic rhythm of speech that impedes intelligibility. Faulty phrasing patterns are usually present so that there are bursts of speech consisting of groups of words that are not related to the grammatical structure of the sentence. The affected person is usually unaware of any communication impairment."

Cluttering usually includes repetitions, usually 6-10 units. Unlike stuttering, these are effortless, usually single syllables, short words, and phrases (stutterers only repeat initial sounds).

Cluttering may also be characterized by poor concentration and short attention span; perceptual weakness; and poorly organized thinking, or speaking before clarifying thoughts.

Kenneth St. Louis and Florence Myers provide the following example of a cluttering child vs. a stuttering child:

Clutterer: "I want to go to the where you st-st-store and I don't have muh-muh ti-ti-time money."

Stutterer: "I want to go to the sssssssssstore and I don't have muh-muh- muh-muh-money."


Strokes and head injuries can cause stuttering-like symptoms in adults. Neurogenic stuttering has repetitions, prolongations, and blocks. However, these sound different from developmental stuttering.

Neurogenic stutterers lack the facial grimaces, eye blinking, and fears and anxieties of developmental stuttering.

In some cases a person stuttered as a child or young adult, overcame stuttering, then had a stroke or head injury, and stuttering came back.

On the other hand, there are a few cases of development stuttering disappearing after neurosurgery for brain tumors, and even after the development of multiple sclerosis. These appear to relate to changes in brain lateralism.


Adult psychogenic stuttering begins suddenly after an event causing extreme psychological stress. It's characterized by repetition of initial or stressed syllables, lack of conditions inducing fluency, an indifferent attitude toward the disorder, and maintenance of normal eye contact. Psychogenic stuttering is rare.


Spactic dysphonia is similar to stuttering, except that it is a repeated blockage of the larynx only, the onset is in middle age, and the disorder affects an equal number of men and women. For more info, contact: Dystonia Medical Research Foundation, One East Wacker Drive, Chicago, IL 60601-2098, (312) 321-5710 FAX; National Spasmodic Dysphonia Association (NSDA), PO Box 1574, Birmingham, MI 48009-1574, (313) 645- 9352 FAX; or Our Voice, 156 Fifth Ave., Suite 1033, NY, NY 10010-7002.

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Subject: Childhood Stuttering Therapy

Federal law requires your school district to provide speech therapy to your child. Your child can be as young as three years old -- he or she doesn't have to be in school.

In my book I discuss what speech pathologists can do to treat children who stutter. Due to space considerations, this FAQ only discusses suggestions for parents:

A recent literature review by Marilyn Nippold and Mishelle Rudzinski found that the above advice doesn't do much good. They found "...little convincing evidence...that parents of children who stutter differ from parents of children who do not stutter in the way they talk with their children. Similarly, there is little objective support...that parents' speech behaviors contribute to children's stuttering or that modifying parents' speech behaviors facilitates children's fluency."

Nippold and Rudzinski caution against only changing the parents' speech, and not directly working on the child's speech. They believe that " intervention should begin with the onset of stuttering..." Their article goes into depth on the scientific research on childhood stuttering therapies. ("Parents' Speech and Children's Stuttering: A Critique of the Literature", Marilyn Nippold and Mishelle Rudzinski, Journal of Speech and Hearing Research, 38:5, October 1995.)

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Subject: Adult Stuttering Therapies

The two main stuttering therapies are stuttering modication therapy and fluency shaping therapy. There are many types of each, but this FAQ includes only one example of each.

There are several new therapies. This FAQ only includes overviews of two -- intent therapy, and stuttering voice therapy.

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Subject: Stuttering Modification Therapy

Stuttering modification therapy has two key elements:

The goal of stuttering modification therapy is not to eliminate stuttering, but to reduce its severity to an acceptable level, and to reduce the fears and anxieties associated with stuttering.

The therapy has four phases:

You begin by identifying the core behaviors, secondary behaviors, and feelings and attitudes that characterize your stuttering.

Your speech pathologist points out your "easy or effortless stuttering" first. The goal is to improve your awareness of what you do when you stutter.

Next, your speech pathologist trains you to identify and become aware of your avoidance behaviors, postponement behaviors, starting behaviors, word and sound fears, situation fears, core stuttering behaviors, and escape behaviors.

Finally, you learn to identify feelings of frustration, shame, and hostility associated with your speech.


Van Riper called this "toughening the stutterer to his stuttering." You do this in three stages. The goal is for you to become comfortable with all three of these aspects of your stuttering.


This is where you learn "easy stuttering" or "fluent stuttering", in 3 stages:


The last stage of stuttering modification therapy seeks to stabilize or solidify your speech gains.

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Subject: Fluency Shaping Therapy

Fluency shaping therapies first establish fluent, but abnormal-sounding speech in the speech clinic. This fluent speech is then shaped into normal-sounding speech. Lastly, you transfer this fluent speech outside the speech clinic, to everyday conversations.

Fluency shaping therapies do not emphasize changing your attitudes, desensitizing you about your stuttering, or reducing avoidance behaviors. The belief is that if you experience fluent speech, your negative feelings and attitudes about stuttering will diminish.

Fluency shaping therapy emphasizes slow speech. The therapy begins with extremely slow speech -- about 5-10 times slower than normal speech.

You don't stutter when you talk this slowly. You start with reading out loud, then use slow speech in conversations in the speech clinic. You don't use this slow speech outside the speech clinic.

After establishing extremely slow, fluent speech, you work on five "breath flow" motor skills. These are:

The last fluency shaping speech motor skill improves your prosody, or rhythm. The slow-motion speech produces a monotonous, droning speaking style. Now you work on adding inflections, intonations, and emotions to make your slow speech sound more normal.

When you master these fluency shaping speech motor skills at the extremely slow speaking rate, you then work on increasing your speaking rate, while continuing to use your fluent speech skills.

At this point, your speech in the speech clinic should sound normal, and you should talk fluently. You are now ready to transfer this fluent speech to conversations outside the clinic.


Fluency shaping has a number of problems:

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Subject: Schwartz's Intent Therapy

Martin Schwartz believes that if you can reduce vocal fold tension before you start speaking, your speech will be fluent.

This approach differs from stuttering modification and fluency shaping therapies because Schwartz ignores what you do after you start talking. He is not concerned with how you talk. Rather, he changes what you do before talking.

"Intent therapy" involves two intentions: the intent to rest, instead of speak; and the intent to start speaking slowly, as if you were starting to run a marathon instead of a 100-yard dash.

The main physical technique (formerly called the air flow method) dilates and relaxes the vocal cords.

This stuttering therapy trains you "exhale just before speaking as if one were not going to speak at all but were simply quietly breathing." In other words, Dr. Schwartz trains you to speak with relaxed breathing instead of speech breathing. He adds, "The passive airflow kept the vocal folds apart and relaxed prior to speech."

You say the first word slowly. You don't say it abnormally slow. You use normal emotional inflection and intonation.

Then you pause. During the pause, whether you continue exhalation or not doesn't matter. Then you say the rest of the phrase as fast as you want.

If the first word has two or more syllables, pretend you are speaking in time with a metronome. Say each syllable slowly, with equal time for each syllable. You can then go on to the rest of the sentence. You don't have to pause after the second syllable.

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Subject: Stuttering Voice Therapy

Stuttering voice therapy changes your mental state by changing how you use your voice.

The goal is a calm, relaxed, confident mental state. This mental state improves all areas of your life, not just your fluency. You achieve this relaxed, confident mental state by using relaxed, diaphragmatic breathing, and relaxing your vocal folds and articulation muscles (jaw, lips, and tongue). The resonance of your voice changes, to a lower pitch. You talk slowly and clearly. You communicate calmness and confidence to your listeners. These techniques also reduce stuttering.

Stuttering voice therapy presumes that everyone's speech can be improved. Even if you stutter severely, some aspects of your communication skills may be better than some nonstutterers. Rather than expecting to go from being a stutterer one day to being cured the next day, you work on continuously improving your speech all your life. The people who go to Toastmasters meetings for many years are an excellent example of this.

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Subject: Effectiveness Of Stuttering Therapies

Einer Boberg and Deborah Kully followed 42 stutterers over two years after a three-week intensive fluency shaping program.

The therapy program reduced stuttering from about 15-20% stuttered syllables to 1-2% stuttered syllables.

12-24 months after therapy, about 70% of the stutterers had satisfactory fluency. About 5% were marginally successful. About 25% had unsatisfactory fluency.

There are no reported studies of stuttering modification therapies. I haven't found any other published studies of fluency shaping therapies.

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Subject: Computers And Electronic Devices For Stuttering


The four main types of auditory feedback are:

- Delayed auditory feedback (DAF) delays your voice to your headphones a small fraction of a second (typically 50 milliseconds).

- Frequency-altered auditory feedback (FAF) shifts the pitch of your voice in your headphones, typically one-half octave.

- Laryngeal auditory feedback (LAF) provides the sound of your vocal fold vibration to your ears.

- Synthesized auditory feedback (SAF) provides a synthesized tone which sounds like your vocal fold vibration. The popular Edinburgh Masker device provided SAF.

All four types of auditory feedback reduce stuttering about 80%. The devices require no training or mental effort. Your speech sounds normal. You can talk as fast as you want. You just put the headphones on and talk fluently.

When you take off the headphones you go right back to stuttering. This is acceptable with a anti-stuttering telephone, or for public speaking. But with few exceptions, stutterers don't want to wear a prosthetic device all the time. They want to overcome stuttering.

Auditory feedback devices should be used in conjunction with stuttering therapy. The stutterer should switch off the device for short periods, and continue to use fluency techniques. The stutterer then switches off the device for longer periods, until he no longer needs the device.


The rate control effect of DAF has been used in stuttering therapy for over 30 years. A long delay (typically 200 milliseconds) forces the stutterer to prolong vowels, continuously vibrate his vocal folds, and slow down his speaking rate. This makes even severe stutterers almost 100% fluent. The downside is abnormally slow, monotonous speech.


Biofeedback is the measurement of a physical activity, and display to you in real time so that you can alter the physical process.

The Computer-Aided Fluency Establishment and Trainer (CAFET) monitors your breathing and your voice. The computer trains you to inhale gently, let out a little air, begin voicing quietly, and gently increase your vocal volume (gentle onset).

The computer provides instant, accurate information on what you are doing right or wrong. The computer is always paying attention, and never gets tired of helping you practice.

Several other companies make computer-based biofeedback systems for stuttering. All of these applications are priced in the $3,000-5,000 range. All are for use in a speech clinic under the supervision of a speech pathologist.


My company, Casa Futura Technologies, takes a different approach. Our biofeedback devices train you to reduce speech-production muscle tension.

The devices monitor your vocal tension, and provide this information in a row of green and red lights. The devices switch on auditory feedback (DAF, FAF, LAF, and/or SAF) when your speech is fast and tense, immediately improving your vocal control. This is like having your speech pathologist follow you around and alert you when your speech is off-target.

The devices switch off when your speech is slow and relaxed. By training you to speak fluently without auditory feedback, the devices train you to no longer need the devices.

A stutterer can use the devices outside the speech clinic, without his speech pathologist. We have inconspicuous pocket-sized devices, and desktop devices for clinical and telephone use. The devices are priced in the $300-500 range.


"Fluency Master" hearing aid-sized device for immediate fluency, "modifies bone-transmitted voice", about $1,500. GN Danavox; 5600 Rowland Road, Suite 250; Minnetonka, MN 55343 (612) 930-0416; Fax: (612) 930-0516; Toll-free: (800) 432-7835

"Pacemaster" hearing aid-sized metronome for rate control, about $500. Associated Hearing Instruments; 6796 Market Street; Upper Darby, PA 19082; (215) 352-0600; Fax: (215) 352-2469; Toll-free: (800) 542-2923

A free DAF application for Power Macintosh computers is available at:

"Pocket Fluency System" and "Desktop Fluency System." Two devices providing auditory feedback and biofeedback. One device is pocket-sized ($350), the other is for clinical or telephone use ($495). Casa Futura Technologies; P.O. Box 7551; Boulder, CO 80306-7551; (303) 417-9752; Fax: (303) 413-0853; Toll-free: (888) FLU-ENCY; Internet:

"CORE -- Computation of Rate Exercises" computer application (Macintosh or PC) timing how long it takes you to read various paragraphs, to train you to talk slower. About $60. Pat Richard Sacco Fluency Management Program; 2173 SE Morningside Blvd.; Port St. Lucie, FL 34952

"Computer-Aided Fluency Establishment and Trainer" computer-based speech biofeedback (respiration, vocal volume) system for stuttering therapy. Trains seven fluency shaping motor skills. Visual feedback includes video games. About $4,000. CAFET, Inc.; 4208 Evergreen Lane, Suite 213; Annandale, VA 22003; (703) 941-8903; Fax: (703) 658-4529

"Dr. Fluency" Windows computer-based speech biofeedback (respiration, vocal volume) system for the Precision Fluency Shaping Program. Graphic animations show you how to move your jaw, lips, and tongue for each sound. $4,000 for clinical version; $1,000 for home version. Speech Therapy Systems, Ltd.; Otniel, 90407, Israel Phone: 972-2-996-3880; Fax: 972-2-996-1571; Internet:

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Subject: Alternative Medicine Stuttering Therapies


A study of acupuncture on two adult male stutterers found no effect on fluency.


Hypnosis improves your awareness and control of a physical process.

The problem is, hypnotherapists know nothing about stuttering, and have no clue what physical processes to train you to do. They can train you in some general relaxation techniques, and maybe this will reduce stress, but it won't improve your speech.

Speech pathologists may know effective techniques, but they don't know how to use hypnosis to help you use these techniques.

You'd need to find a certified hypnotherapist who is also a speech pathologist, who specializes in stuttering.


Learning to reduce specific muscles -- your breathing, vocal folds, jaw, etc. -- while talking is highly effective in reducing stuttering.

But learning general relaxation techniques, especially relaxation when you're not talking, is not effective in treating stuttering.

However, general relaxation and stress reduction may help some individuals, especially if fear of stuttering causes panic.

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Subject: United States Organizations For Stuttering

- The National Stuttering Project is the largest non-profit membership organization for stutterers. There is a monthly newsletter, about 100 local support groups, weekend workshops in various cities, and an annual convention. Annual dues are $35. Join by calling (800) 364-1677 or write to 5100 E. La Palma, Suite 208; Anaheim Hills, CA 92807; or

- The Stuttering Foundation of America is a non-profit publisher of books and videos about stuttering. The SFA also maintains a list of speech pathologists who treat stuttering. Contact the Stuttering Foundation of America at (800) 992-9392, P.O. Box 11749, Memphis, TN 38111-0749.

- The American Speech-Language Hearing Association is the professional organization for speech pathologists and audiologists. (301) 897-5700; 10801 Rockville Pike, Rockville, MD 20852. The next convention will be in Seattle in November 1996.

- ASHA has a Special Interest Division on Fluency Disorders. The group publishes a newsletter three times a year. Dues are $25. The newsletter covers professional issues for speech pathologists.

- The Stuttering Resource Foundation maintains a list of speech pathologists who treat stuttering. They have a small newsletter. (800) 232-4773; 123 Oxford Road, New Rochelle, NY 10804. Their list of speech pathologists is available free on the Stuttering Homepage.

- SpeakEasy is a small non-profit organization with support groups in the New Jersey area. (201) 262-0895; 233 Concord Drive, Paramus, NJ 07652. They have a newsletter and an annual retreat.

- National Council on Stuttering hosts an annual convention in Chicago. It also publishes a quarterly newsletter. (815) 756-6986, 558 Russell Road, DeKalb, IL 60115.

- Toastmasters is for improving your public speaking, not for stuttering, but many stutterers find the experience valuable. There are thousands of local chapters. Toastmasters International, P.O. Box 9052, Mission Viejo, CA 92690-9052, (714) 858-TALK.

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Subject: International Organizations For Stuttering

When traveling abroad, contact the stuttering organization in the country you plan to visit. They'll invite you to a support group meeting, and maybe someone will want to show you around their city.

- The International Fluency Association is a small membership organization composed mostly of Ph.D. speech pathologists. The IFA publishes the Journal of Fluency Disorders. Annual dues are $60 ($40 for students). (205) 348-7131; Box 870242, Tuscaloosa, AL 35487-0242. The IFA has a convention every two years. The next convention will be in San Francisco in August 1997.

- The International Stuttering Association (ISA) is an umbrella Association of 25 national stuttering associations. The ISA is on the Internet at

- European League of Stuttering Associations (ELSA) is a non-profit umbrella organization of Europe's national stuttering charities and self-help associations. Contact: ELSA, c/o BV Stotterer-Selbsthilfe, Gereonswall 112, D-50670 Koln, Germany; tel: +49-221-139-1106; fax: +49- 221-139-1370.

There are organizations for stutterers in the following countries:
Argentina, Australia, Austria, Belgium, Bulgaria, Canada, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Ireland, Italy, Japan, Lithuania, Luxemburg, The Netherlands, New Zealand, Norway, Poland, South Africa, Spain, Sweden, Switzerland, United Kingdom

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Subject: Internet Resources For Stuttering

- the Usenet interest group.

- There are three mailing lists. To subscribe, e-mail the word SUBSCRIBE to the subscription address. Send articles to:**********Send subscription command to:******* **************************

- The main World Wibe Web site is the Stuttering Homepage:

- Canadian Association Of Persons Who Stutter (CAPS)

- The International Stuttering Association

- European League of Stuttering Associations

- Dr. Martin F. Schwartz's National Center for Stuttering

- A free DAF application for Power Macintosh computers is available at:

- Eric Bourland's Strategies For Stutterers

- New Zealand SpeakEasy Association

- German Stuttering Association (Bundesvereinigung Stotterer-Selbsthilfe e.V.)

- Dutch Foundation For Education About Stuttering

- European League of Stuttering Associations (Esperanto)

- Icelandic Stuttering Association

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Subject: Books And Journals About Stuttering


- Stuttering: An Integrated Approach To Its Nature And Treatment , by Theodore Peters, Ph.D. and Barry Guitar ($45, 1991, Baltimore: Williams & Wilkins, 800/638-0672). This is my favorite textbook on stuttering.

- Knotted Tongues, by Benson Bobrick ($22, Simon & Schuster, 1995). This is my favorite non-professional book about stuttering. The book has a thirty-page, easy-to-read overview of stuttering science, and a twenty-page overview of stuttering therapies. Bobrick is a historian, and the bulk of the book (110 pages) is about historical and literary figures who stuttered.

- A Handbook On Stuttering, by Oliver Bloodstein, Ph.D. ($45, 1995, San Diego: Singular Publishing) covers all published research on stuttering. Bloodstein also wrote Stuttering: The Search for a Cause and Cure (Allyn & Bacon, 1995, about $40). This book covers the same material as his Handbook, but is written for non-professional readers.

- Self-Therapy For The Stutterer, by Malcolm Fraser (1993, Stuttering Foundation of America, $3). This book is short and extremely easy to read. The book is a stuttering modification therapy program that you can do without a speech therapist. P.O. Box 11749, Memphis, TN 38111- 0749, 800/992-9392

- Stutter No More, by Martin Schwartz, Ph.D. ($9, Simon & Schuster, 1991). This is about the Airflow Method. Dr.Schwartz has offered to give away this book for the cost of postage. Send $1 to National Center for Stuttering, 200 East 33rd St., New York, NY, 10016, or call (800) 221-2483.

- The Stutterer's Survival Guide, by Nicholas Tunbridge (about $15, Addison-Wesley, 1994, 416/447-5101), offers simple fluency techniques, and suggestions for stressful situations.


- All of the non-profit organizations for stutterers have newsletters. The National Stuttering Project's Letting GO is usually the best newsletter. SpeakEasy Canada also has a good newsletter.

- ADVANCE For Speech-Language Pathologists is a free weekly newspaper for speech pathologists and audiologists. It prints articles on stuttering a few times a year. They devote the second issue in May to stuttering. Merion Publications, 650 Park Ave. West, King of Prussia, PA, 19406, (800) 355-5627.

- The Journal of Fluency Disorders is the only journal exclusively about stuttering. It is written by and for Ph.D. speech pathologists. Published by the International Fluency Association. About $60/year for four issues.

- The American Speech-Language Hearing Association (ASHA) publishes three quarterly journals with stuttering research, plus a stuttering newsletter. All are written for speech pathologists.

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Subject: Famous People Who Stutter


Moses -- Hebrew prophet, whose brother Aaron spoke for him.

Demosthenes -- the greatest orator of ancient Greece, who practiced speaking with pebbles in his mouth to improve articulation, shouted above the ocean waves to improve his volume, and worked with a actor in reciting Sophocles and Euripedes to coordinate his voice and gestures.

Aesop -- Greek author of fables.

Vergil -- Roman poet.

Claudius -- Roman emperor. Robert Graves' novel I, Claudius suggests that Claudius overplayed his disabilities as a young man, to avoid being murdered by enemies seeking his place in line to the throne. But when he became emperor, Claudius was powerful and successful.

Dekanawida -- Great leader who invented democratic government and united the Iroquois nation, sixteenth century.

Isaac Newton -- Scientist, developed law of gravity, invented calculus.

Charles I -- King of England, 1625-1649, during the English Civil War. His inability to speak to Parliament "had an unfavorable influence on his affairs." Charles lost the war and was hanged.

Robert Boyle -- British chemist, known for his experiments on the properties of gases.

Erasmus Darwin -- Physician, scientist, and grandfather of Charles Darwin.

Charles Darwin -- Naturalist and author of The Origin of Species.

Joseph Priestley (1733-1804) -- Discovered oxygen, ammonia, carbon monoxide. Wrote U.S. Constitution's statements on personal freedom.

Charles Lamb -- Nineteenth-century British writer. He was not allowed to pursue a scholarly education because of his stuttering, but worked as an accountant and wrote on the side.

Leigh Hunt -- Nineteenth-century British writer, founded the liberal Examiner newspaper.

Charles Canon Kingsley -- Nineteenth-century English orator, writer, and chaplain to Queen Victoria.

Arnold Bennett -- British novelist and playwright (1867-1931).

Clara Barton -- Founded the American Red Cross in 1881.

Cotton Mather -- Puritan leader, medical scientist, prosecuted Salem witch trials. Fasting and prayers failed to affect his speech, but speaking in a "drawling...little short of Singing" enabled him to become a preacher.

Lewis Carroll -- Author of Alice in Wonderland. Carroll wasn't allowed to become a priest because of his stuttering.

Henry James -- American novelist.

Marilyn Monroe -- Actress, who used a breathy way of speaking to avoid stuttering.

Kim Philby -- British spy. Stuttering once saved his life, by confounding a fast-paced interrogator.

Winston Churchill -- Prime minister of Great Britain in World War Two. Churchill hummed discreetly to himself to get his vocal folds vibrating, and prepared his remarks in advance. Churchill wrote: "I wrote out my arguments with the greatest care, and than learned them backwards and forwards...Not many people guessed how little spontaneity of conception, fullness of knowledge, or flow of language there was behind this fairly imposing facade." Churchill tried to anticipate issues weeks in advance to prepare his remarks.

Aneurin Bevan -- British Labor Party leader in the 1930s. Bevan was Churchill's opponent in Parliament. To overcome stuttering, Bevan forced himself to do public speaking as often as possible, and did so with his passions aroused. Bevan developed an extraordinary vocabulary by substituting words to avoid stuttering. He was regarded as the best orator in the Parliament except for Churchill.

Nevil Shute -- English novelist and aeronautical engineer.

Elizabeth Bowen -- Anglo-Irish novelist.

W. Somerset Maugham -- British writer.

Edward Hoagland -- American writer.

Henry Luce -- Founder of Time magazine and Sports Illustrated.

Field Marshall Lord Carver -- British military leader.

Patrick Campbell -- British humorist.

George VI -- King of England, 1937-52, father of Queen Elizabeth II, and much-loved by his subjects.

Kenneth Tynan -- British drama critic.

Raymond Massey -- Actor.

Lord David Cecil -- Professor of English literature at Oxford.

John Slaughter -- Elected Cochise County, Arizona sheriff in 1886 with a mandate to clean up Tombstone, after Wyatt Earp's 1881 shoot-out.


James Earl Jones -- Actor, voice of Darth Vader and CNN, most in-demand voice in Hollywood. Jones discusses his stuttering at length in his autobiography.

Ben Johnson -- Runner.

Bob Love -- Basketball star with Chicago Bulls in 1960s and 1970s.

Ron Harper -- Current star with the Chicago Bulls.

Paul Johnson -- Detective novelist, author of Killing The Blues.

Margaret Drabble -- British novelist.

Tommy John -- Former Yankee pitcher.

Dave Taylor -- Former hockey star with L.A. Kings.

Lester Hayes -- Former All-Pro defensive back with the Oakland/ Los Angeles Raiders.

Ken Venturi -- Golfer, won U.S. Open in 1961.

Butch Baird -- Golfer.

John Updike -- Novelist. Until recent years he avoided interviews.

Annie Glenn -- Wife of astronaut and Senator John Glenn.

Carly Simon -- Singer.

Mel Tillis -- Country-western singer.

Richard Condon -- Novelist.

Jake Eberts -- Movie producer ("Gandhi").

Frank Wolf -- Congressman from Virginia.

Joseph Biden -- Senator from Delaware.

Jack Welch -- President of General Electric.

Thad Spencer -- Boxer.

Henry Rogers -- Public relations pioneer.

Bo Jackson -- Football and baseball star.

John Stossel -- Television reporter, ABC's "20/20".

Chris Zorich -- Football player, Chicago Bears.

Robert Heinlein -- Science fiction novelist.

Pat Leahy -- Football player, New York Jets.

Sam Neill -- Actor.

Peggy Lipton -- Actress.

Robert Merrill -- Opera singer.

John Melendez -- Rock singer, and Howard Stern radio show personality.

Howard Bingham -- Muhammed Ali's best friend and photographer, was in the O.J. Simpson trial.

John Larkin -- "Scatman John", American jazz musician.

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Subject: Employment Rights

The Americans with Disabilities Act of 1990 (ADA) prohibits employment discrimination against qualified individuals with disabilities.

Many employers say they want to hire someone with "good communication skills." Some interviewers mistakingly presume that all stutterers have poor communication skills.

For example, a job may require making presentations to clients. A stutterer may have completed a public speaking course, and be informative, interesting, and persuasive. If an interviewer assumes that stutteresr can't make presentations, he is illegally discriminating.


An individual with a disability may request a reasonable accomodation from an employer or potential employer. This could be a change in the job description, for example, having someone else make telephone calls. Or the stutterer could request an anti-stuttering telephone, or ask that the employer pay for a speech therapy program.

ADA requires the employer to make a reasonable accommodation if the employee requests one.

Employers are not "...obligated to provide personal use items, such as glasses or hearing aids..." The employer only has to pay for an anti- stuttering device or speech therapy if the employee can prove that he doesn't need it outside of work.

A reasonable accommodation need not be the best accommodation available, as long as it is effective for the purpose. If the $500 electronic fluency aid enables Mark to talk fluently, his employer does not have to pay for the $2500 speech therapy.


The Tax Credit for Small Business (Section 44 of the Internal Revenue Code) credits smaller employers for half the cost of "eligible access expenditures."

The Targeted Jobs Tax Credit Program gives tax credits to employers who hire individuals with disabilities. The IRS will give your employer up to $2400 for hiring you.

Details are available in the Americans With Disabilities Act Resource Directory and in the Pocket Guide to Federal Help for Individuals with Disabilities (available from the U.S. Government Printing Office, Pueblo, CO 81009).


If you feel you have been discriminated against, call your local office of the Equal Employment Opportunity Commission and file a complaint. You can also call the EEOC at (800) 669-4000.

After you file a charge of discrimination, the EEOC notifies the charged entity. The EEOC then investigates, and attempts to resolve the charge through conciliation. If conciliation fails, the EEOC files suit or issues a "right to sue" letter.

For publications about ADA, call the EEOC ADA Helpline at (800) 669- EEOC. Request the publication A Technical Assistance Manual on the Employment Provisions (Title I) of the Americans with Disabilities Act.


Recent research by Martin Schwartz found that stutterers earn approxi- mately $7200 less per year than nonstutterers. Two groups of 25 persons were examined. The groups were matched for age, sex, IQ, race, education, and socioeconomic background. The subjects were contacted 10 years after graduating from college. They were asked a number of questions relating to levels of achievement. The difference did not appear to be the result of employer discrimination. Rather, the stutterers were reluctant to accept promotions that involved making presentations to groups of people.


Talk about stuttering first. Your first impression on the interviewer will be that you stutter -- and many people feel uncomfortable talking to a person who stutters. Educate them about stuttering to make them feel comfortable. Explain what you are doing to overcome stuttering. Explain that you have excellent communication skills, and give specific examples.

Employers may not make any pre-employment inquiries regarding disability, but may ask questions about the ability to perform specific job functions. In other words, an interviewer may not ask you about your stuttering. An interviewer may ask if you have experience making telephone calls to customers, or about your experiences in public speaking, if these are essential job functions.

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Subject: The Last Word

"Stuttering is frustrating and can feel demeaning, but if understood, and confronted, it need not change the quality of one's life. I would even say, that it can enhance one's life experience. You know the expression, 'What doesn't kill us makes us stronger'? Stuttering is a chronic problem, but it is also a chronic challenge which calls on us to be more than we might normally be." -- John Ahlbach, former Executive Director of the National Stuttering Project

END OF STUTTERING FAQ -- This document is provided as is without any express or implied warranties. While every effort has been taken to ensure the accuracy of the information contained in this article, the author and contributors assume no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein.

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by Thomas David Kehoe

put into html format by Judy Kuster and added June 12, 1996

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web weaver Judy Kuster