Monday, January 11, 2010

Stuttering As Hunt-And-Peck Speech

Thomas David Kehoe is the author of the book Stuttering: Science, Therapy and Practice, subtitled The Most Complete Book About Stuttering. The book runs over 300 pages, and covers research, therapy and practical advice for stutterers. The book provides both an overview of stuttering topics and Kehoe’s commentary and personal beliefs. I’d like to comment on one particular point that the author makes, based on his own understanding of the nature of stuttering.

In the chapter Motor Learning Theory, Kehoe makes a distinction between bad habits and maladaptive motor skills. He does this through an analogy with typing. Kehoe is a four-finger typist, which limits his typing speed, but to significantly improve his speed, he would have to learn touch typing properly from the beginning, and temporarily type very slowly while learning proper technique. He goes on “Stutterers can talk, but not as well as they could if they had learned to speak fluently when they were children.” Later in the book, he says .“Stutterers can talk, but not as well as they could if they had learned to speak fluently when they were children.”

This is where my head explodes. We learn to stutter analogously to the way we learn typing? It boggles the mind. Is there something about stuttering that fogs people’s minds? And this from a stutterer.

Where do I start? Stuttering is not a maladaptive, suboptimal motor skill. To the degree that stuttering requires a particular set of motor skills, those skills are insignificant byproducts of the stuttering impulse. Stuttering is not a motor skill, it is the intermittent loss of normal speech motor skill.

As children, stutterers certainly learn maladaptive behaviors. Stutterers learn to increase tension in their speech muscles, to fidget and to lose eye contact. Those behaviors are not part of normal speaking, subtract from normal communication, and feed back to increase stuttering severity. They are not, however, essential parts of the primary stuttering impulse or behavior. Those secondary elements of stuttering can be stripped away entirely, but the primary stuttering impulse and behavior will remain - which is just an observation of the notorious persistence of stuttering.

Four-finger typing is sub-optimal because it does not take advantage of all available fingers, as intended by the keyboard. It is not sub-optimal because sudden cramps in the hands cause four rather than eight fingers to be used. Any hunt-and-peck typist can learn to touch type with sufficient effort. Would that it was so for stutterers. Human children are wired to learn speech, without conscious teaching or effort - it comes naturally, like songs in birds. Stutterers are not people who fell into poor technique as children. Stutterers encounter interruption of proper technique, recognize the failure of their natural speech, and respond the only ways they can - sometimes maladaptively - as children.

Typists can be taught a new method of typing by simply dropping the old method entirely and replacing it with a new one. The maladaptive behaviors of stuttering can be pointed out and removed from a stutterers’ speech - with great effort - but replacement of all stuttering with fluent, natural speech is another matter entirely. Unlike typing, stuttering comes with the impulse to stutter, which is notoriously resistant to suppression by simple motor practice. The neurological impulse, which was never part of the behavior, is not dealt with directly by speech practice.

Speech therapy can certainly decrease stuttering disfluency in many people, typically by slowing down and otherwise altering speech to the point that it is volitional - and disfluent, in a controlled way, by rate, rather than in an uncontrolled way by interruption and repetition. Kehoe claims that fluency can, in fact, be reached and retained by such practice, but then says that most stutterers just won't stuck with the process long enough to be successful. I would suggest that his misunderstanding of the nature of stuttering is a better explanation for the lack of truly fluent, natural speech success stories than his behavioral model of stuttering.

The more I read, the more I wonder: is there something about stuttering that causes fuzzy thinking?

I'll add that this is not a book review, and the book has plenty of good information in it. This one analogy - which Kehoe uses to justify his therapy beliefs, just stuck out like a sore thumb. Or typing finger.

1 comment:

  1. Another good one Mark! Why the hell is it so hard to understand that stuttering is NOT a learned behavior. It is a neurological malfunction. If society didn't attach a stigma to it and if they didn't think we could just stop if we wanted to then maybe all the other behaviors would never develop. I guess it is going to be a cold day in hell when people will actually understand and accept stuttering as just a different, not wrong, not bad, way of speaking. I bet if the negative feedback didn't exist, most stutterers would just let it flow without struggle.

    Just my two cents