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ADVANCES IN STUTTERING THERAPY



                    Barbara L. Dahm CCC-SLP
            Board Recognized Specialist - Fluency Disorders




1935     1945      1965       1975       1985        1995     Today
PROGRESS

NT
 H




     1935   1945   1965    1975   1985   1995   Today
PROGRESS

                 TREATMENT          RESEARCH




1935   1945   1965    1975   1985   1995   Today
RESEARCH                                TREATMENT
   ‣ Assumptions without scientific proof


       Theory
       • Defect in the structure/function of
         speech mechanism
       • Constitutional problem caused by
         cerebral dominance of the wrong
         hemisphere
       • Symptom of psychopathology
       • Lack of harmony between thought
         and speech

Wendell
Johnson




1935
RESEARCH                                    TREATMENT
   ‣ Assumptions without scientific proof
                                               • Breathing exercises
       Theory                                  • Vocal and articulatory gymnastics
                                               • Psychoanalytic therapy
       • Defect in the structure/function of   • Solving environmental disturbances
         speech mechanism                      • Think about what you say before you
       • Constitutional problem caused by
                                                 say it
         cerebral dominance of the wrong       • Changing handedness
         hemisphere
       • Symptom of psychopathology
       • Lack of harmony between thought
         and speech

Wendell
Johnson




1935
1935
RESEARCH                                    TREATMENT
   ‣ Conditions that affect degree of stuttering
   ‣ Relationship between stuttering and……
   ‣ Personality characteristics of the person
     who stutters

       Theory
       •   Neurotic personality
       •   Learned behavior
       •   Outward symptom of inner conflict




       Charles Van Riper




1935            1945
RESEARCH                                    TREATMENT
                                                   •   Mental hygiene
   ‣ Conditions that affect degree of stuttering   •   Eliminate fear
   ‣ Relationship between stuttering and……         •   Building self confidence
   ‣ Personality characteristics of the person     •   Mental and physical relaxation
     who stutters                                  •   Desensitization

       Theory
       •   Neurotic personality
       •   Learned behavior
       •   Outward symptom of inner conflict




       Charles Van Riper




1935            1945
RESEARCH                                    TREATMENT
                                                   •   Mental hygiene
   ‣ Conditions that affect degree of stuttering   •   Eliminate fear
   ‣ Relationship between stuttering and……         •   Building self confidence
   ‣ Personality characteristics of the person     •   Mental and physical relaxation
     who stutters                                  •   Desensitization
                                                   •   Voluntary stuttering
       Theory                                      •   More relaxed stuttering
       •   Neurotic personality                    •   Cancellations
       •   Learned behavior                        •   Pullouts
       •   Outward symptom of inner conflict        •   Preparatory sets
                                                   •   Rhythmic coordination of speech



       Charles Van Riper




1935            1945
RESEARCH                                    TREATMENT
                                                   •   Mental hygiene
   ‣ Conditions that affect degree of stuttering   •   Eliminate fear
   ‣ Relationship between stuttering and……         •   Building self confidence
   ‣ Personality characteristics of the person     •   Mental and physical relaxation
     who stutters                                  •   Desensitization
                                                   •   Voluntary stuttering
       Theory                                      •   More relaxed stuttering
       •   Neurotic personality                    •   Cancellations
       •   Learned behavior                        •   Pullouts
       •   Outward symptom of inner conflict        •   Preparatory sets
                                                   •   Rhythmic coordination of speech
                                                   • Family   therapy

       Charles Van Riper




1935            1945
1935   1945
RESEARCH                                      TREATMENT
       ‣ How people learn to stutter
       ‣ Attempts to prove current theories
       ‣ Personality dynamics of related to
         stuttering
       ‣ Nature of stuttering
        Theory
        • Stuttering is interruptions in the
          forward flow of speech
        • Stuttering is determined by inner
          conflict, attitudes, self-perceptions and
          mode of self-protection
        • Communicative disorder characterized
          by fear

                       Joseph Sheehan




1935            1945          1965
RESEARCH                                      TREATMENT
       ‣ How people learn to stutter                  Psychological approaches
       ‣ Attempts to prove current theories          • Role Therapy
       ‣ Personality dynamics of related to          • Release anxiety
         stuttering                                  • Psychodynamic therapy
       ‣ Nature of stuttering
        Theory
        • Stuttering is interruptions in the
          forward flow of speech
        • Stuttering is determined by inner
          conflict, attitudes, self-perceptions and
          mode of self-protection
        • Communicative disorder characterized
          by fear

                       Joseph Sheehan




1935            1945          1965
RESEARCH                                      TREATMENT
       ‣ How people learn to stutter                  Psychological approaches
       ‣ Attempts to prove current theories          • Role Therapy
       ‣ Personality dynamics of related to          • Release anxiety
         stuttering                                  • Psychodynamic therapy
       ‣ Nature of stuttering
        Theory                                       Stuttering modification
        • Stuttering is interruptions in the         • Voluntary stuttering
          forward flow of speech                      • More relaxed stuttering
        • Stuttering is determined by inner          • Cancellations, pullouts, preparatory
          conflict, attitudes, self-perceptions and     sets
          mode of self-protection                    • Rhythmic coordination of speech
        • Communicative disorder characterized
          by fear

                       Joseph Sheehan




1935            1945          1965
RESEARCH                                      TREATMENT
       ‣ How people learn to stutter                  Psychological approaches
       ‣ Attempts to prove current theories          • Role Therapy
       ‣ Personality dynamics of related to          • Release anxiety
         stuttering                                  • Psychodynamic therapy
       ‣ Nature of stuttering
        Theory                                       Stuttering modification
        • Stuttering is interruptions in the         • Voluntary stuttering
          forward flow of speech                      • More relaxed stuttering
        • Stuttering is determined by inner          • Cancellations, pullouts, preparatory
          conflict, attitudes, self-perceptions and     sets
          mode of self-protection                    • Rhythmic coordination of speech
        • Communicative disorder characterized
          by fear                                    •   Group therapy

                       Joseph Sheehan




1935            1945          1965
1935   1945   1965
RESEARCH                                 TREATMENT
   ‣ Operant conditioning of fluency
   ‣ Learning theory
   ‣ Delayed auditory feedback
   ‣ Differences between stuttering and
     normal disfluency
   ‣ Relationship to communicative factors
       Theory
       • Stuttering is learned behavior
       • Distortions in speech breathing,
         vocal onsets, articulator movement
       • Fluency can be shaped



                                Ronald L. Webster




1935            1945       1965          1975
RESEARCH                                 TREATMENT
                                                 Fluency shaping techniques
   ‣ Operant conditioning of fluency             • Breathing exercises
   ‣ Learning theory                            • Gentle onsets
   ‣ Delayed auditory feedback                  • Light articulatory contacts
   ‣ Differences between stuttering and         • Constant monitoring
     normal disfluency                           • Rate control
   ‣ Relationship to communicative factors
       Theory
       • Stuttering is learned behavior
       • Distortions in speech breathing,
         vocal onsets, articulator movement
       • Fluency can be shaped



                                Ronald L. Webster




1935            1945       1965          1975
RESEARCH                                 TREATMENT
                                                 Fluency shaping techniques
   ‣ Operant conditioning of fluency             • Breathing exercises
   ‣ Learning theory                            • Gentle onsets
   ‣ Delayed auditory feedback                  • Light articulatory contacts
   ‣ Differences between stuttering and         • Constant monitoring
     normal disfluency                           • Rate control
   ‣ Relationship to communicative factors
       Theory                                   •   Psychological approaches

       • Stuttering is learned behavior
       • Distortions in speech breathing,
         vocal onsets, articulator movement
       • Fluency can be shaped



                                Ronald L. Webster




1935            1945       1965          1975
RESEARCH                                 TREATMENT
                                                 Fluency shaping techniques
   ‣ Operant conditioning of fluency             • Breathing exercises
   ‣ Learning theory                            • Gentle onsets
   ‣ Delayed auditory feedback                  • Light articulatory contacts
   ‣ Differences between stuttering and         • Constant monitoring
     normal disfluency                           • Rate control
   ‣ Relationship to communicative factors
       Theory                                   •   Psychological approaches

       • Stuttering is learned behavior         Stuttering modification
       • Distortions in speech breathing,       • Voluntary stuttering
         vocal onsets, articulator movement     • Advertising stuttering
       • Fluency can be shaped



                                Ronald L. Webster




1935            1945       1965          1975
RESEARCH                                 TREATMENT
                                                 Fluency shaping techniques
   ‣ Operant conditioning of fluency             • Breathing exercises
   ‣ Learning theory                            • Gentle onsets
   ‣ Delayed auditory feedback                  • Light articulatory contacts
   ‣ Differences between stuttering and         • Constant monitoring
     normal disfluency                           • Rate control
   ‣ Relationship to communicative factors
       Theory                                   •   Psychological approaches

       • Stuttering is learned behavior         Stuttering modification
       • Distortions in speech breathing,       • Voluntary stuttering
         vocal onsets, articulator movement     • Advertising stuttering
       • Fluency can be shaped
                                                •   Intensive group therapy programs


                                Ronald L. Webster




1935            1945       1965          1975
1935   1945   1965   1975
RESEARCH                                      TREATMENT
   ‣ Speech Motor Control
   ‣ Measure stuttering
   ‣ Criteria for successful therapy
   ‣ Causes of stuttering
   ‣ Naturalness of speech after treatment
   ‣ Relationship between stuttering and
     language development
     Theory
       •   Disorder of speech motor control
       •   Stuttering cannot be cured
       •   Stuttering is a problem of control
       •   Stuttering begins as language develops


                                                    Nijmegen




1935             1945          1965         1975      1985
RESEARCH                                      TREATMENT
   ‣ Speech Motor Control                              Fluency shaping techniques
   ‣ Measure stuttering                               • Breathing exercises
   ‣ Criteria for successful therapy                  • Gentle onsets
   ‣ Causes of stuttering                             • Light articulatory contacts
   ‣ Naturalness of speech after treatment            • Constant monitoring
   ‣ Relationship between stuttering and              • Rate control
     language development
     Theory
       •   Disorder of speech motor control
       •   Stuttering cannot be cured
       •   Stuttering is a problem of control
       •   Stuttering begins as language develops


                                                    Nijmegen




1935             1945          1965         1975      1985
RESEARCH                                      TREATMENT
   ‣ Speech Motor Control                              Fluency shaping techniques
   ‣ Measure stuttering                               • Breathing exercises
   ‣ Criteria for successful therapy                  • Gentle onsets
   ‣ Causes of stuttering                             • Light articulatory contacts
   ‣ Naturalness of speech after treatment            • Constant monitoring
   ‣ Relationship between stuttering and              • Rate control
     language development
     Theory
                                                      •   Psychological approaches

       •   Disorder of speech motor control
       •   Stuttering cannot be cured
       •   Stuttering is a problem of control
       •   Stuttering begins as language develops


                                                    Nijmegen




1935             1945          1965         1975      1985
RESEARCH                                      TREATMENT
   ‣ Speech Motor Control                              Fluency shaping techniques
   ‣ Measure stuttering                               • Breathing exercises
   ‣ Criteria for successful therapy                  • Gentle onsets
   ‣ Causes of stuttering                             • Light articulatory contacts
   ‣ Naturalness of speech after treatment            • Constant monitoring
   ‣ Relationship between stuttering and              • Rate control
     language development
     Theory
                                                      •   Psychological approaches

       •   Disorder of speech motor control           Stuttering modification
       •   Stuttering cannot be cured                 • Voluntary stuttering
       •   Stuttering is a problem of control         • Advertising stuttering
       •   Stuttering begins as language develops


                                                    Nijmegen




1935             1945          1965         1975      1985
RESEARCH                                      TREATMENT
   ‣ Speech Motor Control                              Fluency shaping techniques
   ‣ Measure stuttering                               • Breathing exercises
   ‣ Criteria for successful therapy                  • Gentle onsets
   ‣ Causes of stuttering                             • Light articulatory contacts
   ‣ Naturalness of speech after treatment            • Constant monitoring
   ‣ Relationship between stuttering and              • Rate control
     language development
     Theory
                                                      •   Psychological approaches

       •   Disorder of speech motor control           Stuttering modification
       •   Stuttering cannot be cured                 • Voluntary stuttering
       •   Stuttering is a problem of control         • Advertising stuttering
       •   Stuttering begins as language develops
                                                      •   Self-help movement developed


                                                    Nijmegen




1935             1945          1965         1975      1985
1935   1945   1965   1975   1985
RESEARCH                                     TREATMENT
   ‣ Brain Imaging Research
   ‣ Genetic research
   ‣ Coordination of speech processes
   ‣ Comparison of stuttering to normal
     models of speech production
     Theory

       • Differences of brain function related to
         stuttering
       • Motor control and neurological
         processing interact
       • Dynamic multifactorial model emerges



                                                           Peter Fox




1935           1945          1965          1975     1985     1995
RESEARCH                                     TREATMENT
   ‣ Brain Imaging Research                         •   Interaction between affect, behavior
   ‣ Genetic research                                   and cognition
   ‣ Coordination of speech processes
   ‣ Comparison of stuttering to normal
     models of speech production
     Theory

       • Differences of brain function related to
         stuttering
       • Motor control and neurological
         processing interact
       • Dynamic multifactorial model emerges



                                                                Peter Fox




1935           1945          1965          1975     1985            1995
RESEARCH                                     TREATMENT
   ‣ Brain Imaging Research                         •   Interaction between affect, behavior
   ‣ Genetic research                                   and cognition
   ‣ Coordination of speech processes
   ‣ Comparison of stuttering to normal             •   Modification of stuttering
     models of speech production                    •   Desensitization
                                                    •   Voluntary Stuttering
     Theory
                                                    •   Pausing
       • Differences of brain function related to
         stuttering
       • Motor control and neurological
         processing interact
       • Dynamic multifactorial model emerges



                                                                Peter Fox




1935           1945          1965          1975     1985            1995
RESEARCH                                     TREATMENT
   ‣ Brain Imaging Research                         •   Interaction between affect, behavior
   ‣ Genetic research                                   and cognition
   ‣ Coordination of speech processes
   ‣ Comparison of stuttering to normal             •   Modification of stuttering
     models of speech production                    •   Desensitization
                                                    •   Voluntary Stuttering
     Theory
                                                    •   Pausing
       • Differences of brain function related to   • Tolerance to disfluency
         stuttering                                 • Enhance self-esteem
       • Motor control and neurological
         processing interact
       • Dynamic multifactorial model emerges



                                                                Peter Fox




1935           1945          1965          1975     1985            1995
RESEARCH                                     TREATMENT
   ‣ Brain Imaging Research                         •   Interaction between affect, behavior
   ‣ Genetic research                                   and cognition
   ‣ Coordination of speech processes
   ‣ Comparison of stuttering to normal             •   Modification of stuttering
     models of speech production                    •   Desensitization
                                                    •   Voluntary Stuttering
     Theory
                                                    •   Pausing
       • Differences of brain function related to   • Tolerance to disfluency
         stuttering                                 • Enhance self-esteem
       • Motor control and neurological
         processing interact                        • Fluency controls
       • Dynamic multifactorial model emerges       • Slow smooth speech
                                                    • Continuous phonation


                                                                Peter Fox




1935           1945          1965          1975     1985            1995
1935   1945   1965   1975   1985   1995
RESEARCH                                 TREATMENT
    ‣ Brain Research
    ‣ Genetic Research
    ‣ Pharmacology
    ‣ Auditory feedback
    Theory
   • Unclear genetic factor
   • Differences in brain function and
     possibly structure between people
     who do and do not stutter
   • Relates to a dynamic system
     involving elements of speech and
     language production, emotional
     reactivity and learning

                                                              Ed Conture




1935       1945         1965             1975   1985   1995      Today
RESEARCH                                 TREATMENT
    ‣ Brain Research
                                                •   Integration of stuttering
    ‣ Genetic Research
                                                    modification and fluency shaping
    ‣ Pharmacology
                                                    with affective component
    ‣ Auditory feedback
    Theory
   • Unclear genetic factor
   • Differences in brain function and
     possibly structure between people
     who do and do not stutter
   • Relates to a dynamic system
     involving elements of speech and
     language production, emotional
     reactivity and learning

                                                                       Ed Conture




1935       1945         1965             1975   1985           1995        Today
RESEARCH                                 TREATMENT
    ‣ Brain Research
                                                •   Integration of stuttering
    ‣ Genetic Research
                                                    modification and fluency shaping
    ‣ Pharmacology
                                                    with affective component
    ‣ Auditory feedback
    Theory
   • Unclear genetic factor                     •   Positive reinforcement for fluency
   • Differences in brain function and              in young children (Lidcombe)
     possibly structure between people
     who do and do not stutter
   • Relates to a dynamic system
     involving elements of speech and
     language production, emotional
     reactivity and learning

                                                                         Ed Conture




1935       1945         1965             1975   1985            1995         Today
RESEARCH                                 TREATMENT
    ‣ Brain Research
                                                •   Integration of stuttering
    ‣ Genetic Research
                                                    modification and fluency shaping
    ‣ Pharmacology
                                                    with affective component
    ‣ Auditory feedback
    Theory
   • Unclear genetic factor                     •   Positive reinforcement for fluency
   • Differences in brain function and              in young children (Lidcombe)
     possibly structure between people
     who do and do not stutter
   • Relates to a dynamic system
                                                •   Auditory feedback devices
     involving elements of speech and
     language production, emotional
     reactivity and learning

                                                                         Ed Conture




1935       1945         1965             1975   1985            1995         Today
RESEARCH                                 TREATMENT
    ‣ Brain Research
                                                •   Integration of stuttering
    ‣ Genetic Research
                                                    modification and fluency shaping
    ‣ Pharmacology
                                                    with affective component
    ‣ Auditory feedback
    Theory
   • Unclear genetic factor                     •   Positive reinforcement for fluency
   • Differences in brain function and              in young children (Lidcombe)
     possibly structure between people
     who do and do not stutter
   • Relates to a dynamic system
                                                •   Auditory feedback devices
     involving elements of speech and
     language production, emotional             •   Pharmaceuticals (Pagaclone)
     reactivity and learning

                                                                         Ed Conture




1935       1945         1965             1975   1985            1995         Today
1900   1945   1965   1975   1985   1995   Today
Instead of looking at the trees
                 We need to look at the
                    BIG PICTURE




1900   1945      1965    1975     1985    1995   Today
1935   1945   1965   1975   1985   1995   Today
ecosystem




1935   1945   1965   1975    1985   1995   Today
DYNAMIC STUTTERING THERAPY




1935      1945   1965   1975   1985   1995   Today
DYNAMIC STUTTERING THERAPY
                                                            Ideas



                                                            imagination
                                                 habits
                                                     experience        perspective
                               Language                                                Articulation
                                            emotions                   intentions
                                                           self-talk

                                                 beliefs                genetics
                                                           behavior

                                     Feedback                                       Phonation




                                                                          Barbara Dahm




1935      1945   1965   1975              1985                1995                   Today
DYNAMIC STUTTERING THERAPY
                                                                           Ideas


       Theory                                                              imagination
                                                                habits
                                                                                      perspective
   • Stuttering is one symptom of a           Language              experience                        Articulation
     malfunctioning integrated system that                 emotions
                                                                          self-talk
                                                                                      intentions
     includes elements of speech-language
                                                                beliefs                genetics
     planning and production.
   • Reflects brain processing                                             behavior

   • Over-control of an automatic system
                                                    Feedback                                       Phonation




                                                                                         Barbara Dahm




1935       1945          1965          1975              1985                1995                   Today
CHANGING THE SYSTEM
                                               Ideas



                                               imagination
                                habits
                                       experience         perspective
                   Language                                               Articulation
                              emotions                    intentions
                                              self-talk

                                    beliefs                genetics
                                              behavior

                         Feedback                                      Phonation




Before Therapy    During Therapy                           After Therapy                 Long After Therapy
CHANGING THE SYSTEM


                     Developing new brain map for
                               speaking
                 Developing a mind that supports change
                           and development




Before Therapy      During Therapy       After Therapy    Long After Therapy
GOALS FOR CHANGING THE SYSTEM




Before Therapy   During Therapy   After Therapy   Long After Therapy
GOALS FOR CHANGING THE SYSTEM
developing ideas
     •   To focus on the preverbal message




Before Therapy           During Therapy      After Therapy   Long After Therapy
GOALS FOR CHANGING THE SYSTEM
developing ideas
     •   To focus on the preverbal message


language formulation
     •   To formulate internal speech automatically as a
         developing sequence of sounds (syllables)




Before Therapy            During Therapy              After Therapy   Long After Therapy
GOALS FOR CHANGING THE SYSTEM
developing ideas
     •   To focus on the preverbal message


language formulation
     •   To formulate internal speech automatically as a
         developing sequence of sounds (syllables)

phonation
     •   To generate a natural voice that supports intonation
         as an automatic reflection of internal speech




Before Therapy            During Therapy              After Therapy   Long After Therapy
GOALS FOR CHANGING THE SYSTEM
developing ideas
     •   To focus on the preverbal message


language formulation
     •   To formulate internal speech automatically as a
         developing sequence of sounds (syllables)

phonation
     •   To generate a natural voice that supports intonation
         as an automatic reflection of internal speech

articulation
     •   To allow the articulators to function automatically and
         without awareness as a reflection of the phonetic plan




Before Therapy            During Therapy              After Therapy   Long After Therapy
GOALS FOR CHANGING THE SYSTEM
developing ideas
     •   To focus on the preverbal message


language formulation
     •   To formulate internal speech automatically as a
         developing sequence of sounds (syllables)

phonation
     •   To generate a natural voice that supports intonation
         as an automatic reflection of internal speech

articulation
     •   To allow the articulators to function automatically and
         without awareness as a reflection of the phonetic plan

monitoring
     •   To allow sub-conscious monitoring - without (listening)
         to speech fluency or how the speech sounds




Before Therapy            During Therapy              After Therapy   Long After Therapy
DYNAMIC STUTTERING THERAPY CLIENTS




Before Therapy   During Therapy   After Therapy   Long After Therapy
DYNAMIC STUTTERING THERAPY CLIENTS




Before Therapy   During Therapy   After Therapy   Long After Therapy

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The Evolution of Stuttering Therapy: Part 1

  • 1. ADVANCES IN STUTTERING THERAPY Barbara L. Dahm CCC-SLP Board Recognized Specialist - Fluency Disorders 1935 1945 1965 1975 1985 1995 Today
  • 2. PROGRESS NT H 1935 1945 1965 1975 1985 1995 Today
  • 3. PROGRESS TREATMENT RESEARCH 1935 1945 1965 1975 1985 1995 Today
  • 4.
  • 5. RESEARCH TREATMENT ‣ Assumptions without scientific proof Theory • Defect in the structure/function of speech mechanism • Constitutional problem caused by cerebral dominance of the wrong hemisphere • Symptom of psychopathology • Lack of harmony between thought and speech Wendell Johnson 1935
  • 6. RESEARCH TREATMENT ‣ Assumptions without scientific proof • Breathing exercises Theory • Vocal and articulatory gymnastics • Psychoanalytic therapy • Defect in the structure/function of • Solving environmental disturbances speech mechanism • Think about what you say before you • Constitutional problem caused by say it cerebral dominance of the wrong • Changing handedness hemisphere • Symptom of psychopathology • Lack of harmony between thought and speech Wendell Johnson 1935
  • 8. RESEARCH TREATMENT ‣ Conditions that affect degree of stuttering ‣ Relationship between stuttering and…… ‣ Personality characteristics of the person who stutters Theory • Neurotic personality • Learned behavior • Outward symptom of inner conflict Charles Van Riper 1935 1945
  • 9. RESEARCH TREATMENT • Mental hygiene ‣ Conditions that affect degree of stuttering • Eliminate fear ‣ Relationship between stuttering and…… • Building self confidence ‣ Personality characteristics of the person • Mental and physical relaxation who stutters • Desensitization Theory • Neurotic personality • Learned behavior • Outward symptom of inner conflict Charles Van Riper 1935 1945
  • 10. RESEARCH TREATMENT • Mental hygiene ‣ Conditions that affect degree of stuttering • Eliminate fear ‣ Relationship between stuttering and…… • Building self confidence ‣ Personality characteristics of the person • Mental and physical relaxation who stutters • Desensitization • Voluntary stuttering Theory • More relaxed stuttering • Neurotic personality • Cancellations • Learned behavior • Pullouts • Outward symptom of inner conflict • Preparatory sets • Rhythmic coordination of speech Charles Van Riper 1935 1945
  • 11. RESEARCH TREATMENT • Mental hygiene ‣ Conditions that affect degree of stuttering • Eliminate fear ‣ Relationship between stuttering and…… • Building self confidence ‣ Personality characteristics of the person • Mental and physical relaxation who stutters • Desensitization • Voluntary stuttering Theory • More relaxed stuttering • Neurotic personality • Cancellations • Learned behavior • Pullouts • Outward symptom of inner conflict • Preparatory sets • Rhythmic coordination of speech • Family therapy Charles Van Riper 1935 1945
  • 12. 1935 1945
  • 13. RESEARCH TREATMENT ‣ How people learn to stutter ‣ Attempts to prove current theories ‣ Personality dynamics of related to stuttering ‣ Nature of stuttering Theory • Stuttering is interruptions in the forward flow of speech • Stuttering is determined by inner conflict, attitudes, self-perceptions and mode of self-protection • Communicative disorder characterized by fear Joseph Sheehan 1935 1945 1965
  • 14. RESEARCH TREATMENT ‣ How people learn to stutter Psychological approaches ‣ Attempts to prove current theories • Role Therapy ‣ Personality dynamics of related to • Release anxiety stuttering • Psychodynamic therapy ‣ Nature of stuttering Theory • Stuttering is interruptions in the forward flow of speech • Stuttering is determined by inner conflict, attitudes, self-perceptions and mode of self-protection • Communicative disorder characterized by fear Joseph Sheehan 1935 1945 1965
  • 15. RESEARCH TREATMENT ‣ How people learn to stutter Psychological approaches ‣ Attempts to prove current theories • Role Therapy ‣ Personality dynamics of related to • Release anxiety stuttering • Psychodynamic therapy ‣ Nature of stuttering Theory Stuttering modification • Stuttering is interruptions in the • Voluntary stuttering forward flow of speech • More relaxed stuttering • Stuttering is determined by inner • Cancellations, pullouts, preparatory conflict, attitudes, self-perceptions and sets mode of self-protection • Rhythmic coordination of speech • Communicative disorder characterized by fear Joseph Sheehan 1935 1945 1965
  • 16. RESEARCH TREATMENT ‣ How people learn to stutter Psychological approaches ‣ Attempts to prove current theories • Role Therapy ‣ Personality dynamics of related to • Release anxiety stuttering • Psychodynamic therapy ‣ Nature of stuttering Theory Stuttering modification • Stuttering is interruptions in the • Voluntary stuttering forward flow of speech • More relaxed stuttering • Stuttering is determined by inner • Cancellations, pullouts, preparatory conflict, attitudes, self-perceptions and sets mode of self-protection • Rhythmic coordination of speech • Communicative disorder characterized by fear • Group therapy Joseph Sheehan 1935 1945 1965
  • 17. 1935 1945 1965
  • 18. RESEARCH TREATMENT ‣ Operant conditioning of fluency ‣ Learning theory ‣ Delayed auditory feedback ‣ Differences between stuttering and normal disfluency ‣ Relationship to communicative factors Theory • Stuttering is learned behavior • Distortions in speech breathing, vocal onsets, articulator movement • Fluency can be shaped Ronald L. Webster 1935 1945 1965 1975
  • 19. RESEARCH TREATMENT Fluency shaping techniques ‣ Operant conditioning of fluency • Breathing exercises ‣ Learning theory • Gentle onsets ‣ Delayed auditory feedback • Light articulatory contacts ‣ Differences between stuttering and • Constant monitoring normal disfluency • Rate control ‣ Relationship to communicative factors Theory • Stuttering is learned behavior • Distortions in speech breathing, vocal onsets, articulator movement • Fluency can be shaped Ronald L. Webster 1935 1945 1965 1975
  • 20. RESEARCH TREATMENT Fluency shaping techniques ‣ Operant conditioning of fluency • Breathing exercises ‣ Learning theory • Gentle onsets ‣ Delayed auditory feedback • Light articulatory contacts ‣ Differences between stuttering and • Constant monitoring normal disfluency • Rate control ‣ Relationship to communicative factors Theory • Psychological approaches • Stuttering is learned behavior • Distortions in speech breathing, vocal onsets, articulator movement • Fluency can be shaped Ronald L. Webster 1935 1945 1965 1975
  • 21. RESEARCH TREATMENT Fluency shaping techniques ‣ Operant conditioning of fluency • Breathing exercises ‣ Learning theory • Gentle onsets ‣ Delayed auditory feedback • Light articulatory contacts ‣ Differences between stuttering and • Constant monitoring normal disfluency • Rate control ‣ Relationship to communicative factors Theory • Psychological approaches • Stuttering is learned behavior Stuttering modification • Distortions in speech breathing, • Voluntary stuttering vocal onsets, articulator movement • Advertising stuttering • Fluency can be shaped Ronald L. Webster 1935 1945 1965 1975
  • 22. RESEARCH TREATMENT Fluency shaping techniques ‣ Operant conditioning of fluency • Breathing exercises ‣ Learning theory • Gentle onsets ‣ Delayed auditory feedback • Light articulatory contacts ‣ Differences between stuttering and • Constant monitoring normal disfluency • Rate control ‣ Relationship to communicative factors Theory • Psychological approaches • Stuttering is learned behavior Stuttering modification • Distortions in speech breathing, • Voluntary stuttering vocal onsets, articulator movement • Advertising stuttering • Fluency can be shaped • Intensive group therapy programs Ronald L. Webster 1935 1945 1965 1975
  • 23. 1935 1945 1965 1975
  • 24. RESEARCH TREATMENT ‣ Speech Motor Control ‣ Measure stuttering ‣ Criteria for successful therapy ‣ Causes of stuttering ‣ Naturalness of speech after treatment ‣ Relationship between stuttering and language development Theory • Disorder of speech motor control • Stuttering cannot be cured • Stuttering is a problem of control • Stuttering begins as language develops Nijmegen 1935 1945 1965 1975 1985
  • 25. RESEARCH TREATMENT ‣ Speech Motor Control Fluency shaping techniques ‣ Measure stuttering • Breathing exercises ‣ Criteria for successful therapy • Gentle onsets ‣ Causes of stuttering • Light articulatory contacts ‣ Naturalness of speech after treatment • Constant monitoring ‣ Relationship between stuttering and • Rate control language development Theory • Disorder of speech motor control • Stuttering cannot be cured • Stuttering is a problem of control • Stuttering begins as language develops Nijmegen 1935 1945 1965 1975 1985
  • 26. RESEARCH TREATMENT ‣ Speech Motor Control Fluency shaping techniques ‣ Measure stuttering • Breathing exercises ‣ Criteria for successful therapy • Gentle onsets ‣ Causes of stuttering • Light articulatory contacts ‣ Naturalness of speech after treatment • Constant monitoring ‣ Relationship between stuttering and • Rate control language development Theory • Psychological approaches • Disorder of speech motor control • Stuttering cannot be cured • Stuttering is a problem of control • Stuttering begins as language develops Nijmegen 1935 1945 1965 1975 1985
  • 27. RESEARCH TREATMENT ‣ Speech Motor Control Fluency shaping techniques ‣ Measure stuttering • Breathing exercises ‣ Criteria for successful therapy • Gentle onsets ‣ Causes of stuttering • Light articulatory contacts ‣ Naturalness of speech after treatment • Constant monitoring ‣ Relationship between stuttering and • Rate control language development Theory • Psychological approaches • Disorder of speech motor control Stuttering modification • Stuttering cannot be cured • Voluntary stuttering • Stuttering is a problem of control • Advertising stuttering • Stuttering begins as language develops Nijmegen 1935 1945 1965 1975 1985
  • 28. RESEARCH TREATMENT ‣ Speech Motor Control Fluency shaping techniques ‣ Measure stuttering • Breathing exercises ‣ Criteria for successful therapy • Gentle onsets ‣ Causes of stuttering • Light articulatory contacts ‣ Naturalness of speech after treatment • Constant monitoring ‣ Relationship between stuttering and • Rate control language development Theory • Psychological approaches • Disorder of speech motor control Stuttering modification • Stuttering cannot be cured • Voluntary stuttering • Stuttering is a problem of control • Advertising stuttering • Stuttering begins as language develops • Self-help movement developed Nijmegen 1935 1945 1965 1975 1985
  • 29. 1935 1945 1965 1975 1985
  • 30. RESEARCH TREATMENT ‣ Brain Imaging Research ‣ Genetic research ‣ Coordination of speech processes ‣ Comparison of stuttering to normal models of speech production Theory • Differences of brain function related to stuttering • Motor control and neurological processing interact • Dynamic multifactorial model emerges Peter Fox 1935 1945 1965 1975 1985 1995
  • 31. RESEARCH TREATMENT ‣ Brain Imaging Research • Interaction between affect, behavior ‣ Genetic research and cognition ‣ Coordination of speech processes ‣ Comparison of stuttering to normal models of speech production Theory • Differences of brain function related to stuttering • Motor control and neurological processing interact • Dynamic multifactorial model emerges Peter Fox 1935 1945 1965 1975 1985 1995
  • 32. RESEARCH TREATMENT ‣ Brain Imaging Research • Interaction between affect, behavior ‣ Genetic research and cognition ‣ Coordination of speech processes ‣ Comparison of stuttering to normal • Modification of stuttering models of speech production • Desensitization • Voluntary Stuttering Theory • Pausing • Differences of brain function related to stuttering • Motor control and neurological processing interact • Dynamic multifactorial model emerges Peter Fox 1935 1945 1965 1975 1985 1995
  • 33. RESEARCH TREATMENT ‣ Brain Imaging Research • Interaction between affect, behavior ‣ Genetic research and cognition ‣ Coordination of speech processes ‣ Comparison of stuttering to normal • Modification of stuttering models of speech production • Desensitization • Voluntary Stuttering Theory • Pausing • Differences of brain function related to • Tolerance to disfluency stuttering • Enhance self-esteem • Motor control and neurological processing interact • Dynamic multifactorial model emerges Peter Fox 1935 1945 1965 1975 1985 1995
  • 34. RESEARCH TREATMENT ‣ Brain Imaging Research • Interaction between affect, behavior ‣ Genetic research and cognition ‣ Coordination of speech processes ‣ Comparison of stuttering to normal • Modification of stuttering models of speech production • Desensitization • Voluntary Stuttering Theory • Pausing • Differences of brain function related to • Tolerance to disfluency stuttering • Enhance self-esteem • Motor control and neurological processing interact • Fluency controls • Dynamic multifactorial model emerges • Slow smooth speech • Continuous phonation Peter Fox 1935 1945 1965 1975 1985 1995
  • 35. 1935 1945 1965 1975 1985 1995
  • 36. RESEARCH TREATMENT ‣ Brain Research ‣ Genetic Research ‣ Pharmacology ‣ Auditory feedback Theory • Unclear genetic factor • Differences in brain function and possibly structure between people who do and do not stutter • Relates to a dynamic system involving elements of speech and language production, emotional reactivity and learning Ed Conture 1935 1945 1965 1975 1985 1995 Today
  • 37. RESEARCH TREATMENT ‣ Brain Research • Integration of stuttering ‣ Genetic Research modification and fluency shaping ‣ Pharmacology with affective component ‣ Auditory feedback Theory • Unclear genetic factor • Differences in brain function and possibly structure between people who do and do not stutter • Relates to a dynamic system involving elements of speech and language production, emotional reactivity and learning Ed Conture 1935 1945 1965 1975 1985 1995 Today
  • 38. RESEARCH TREATMENT ‣ Brain Research • Integration of stuttering ‣ Genetic Research modification and fluency shaping ‣ Pharmacology with affective component ‣ Auditory feedback Theory • Unclear genetic factor • Positive reinforcement for fluency • Differences in brain function and in young children (Lidcombe) possibly structure between people who do and do not stutter • Relates to a dynamic system involving elements of speech and language production, emotional reactivity and learning Ed Conture 1935 1945 1965 1975 1985 1995 Today
  • 39. RESEARCH TREATMENT ‣ Brain Research • Integration of stuttering ‣ Genetic Research modification and fluency shaping ‣ Pharmacology with affective component ‣ Auditory feedback Theory • Unclear genetic factor • Positive reinforcement for fluency • Differences in brain function and in young children (Lidcombe) possibly structure between people who do and do not stutter • Relates to a dynamic system • Auditory feedback devices involving elements of speech and language production, emotional reactivity and learning Ed Conture 1935 1945 1965 1975 1985 1995 Today
  • 40. RESEARCH TREATMENT ‣ Brain Research • Integration of stuttering ‣ Genetic Research modification and fluency shaping ‣ Pharmacology with affective component ‣ Auditory feedback Theory • Unclear genetic factor • Positive reinforcement for fluency • Differences in brain function and in young children (Lidcombe) possibly structure between people who do and do not stutter • Relates to a dynamic system • Auditory feedback devices involving elements of speech and language production, emotional • Pharmaceuticals (Pagaclone) reactivity and learning Ed Conture 1935 1945 1965 1975 1985 1995 Today
  • 41. 1900 1945 1965 1975 1985 1995 Today
  • 42. Instead of looking at the trees We need to look at the BIG PICTURE 1900 1945 1965 1975 1985 1995 Today
  • 43. 1935 1945 1965 1975 1985 1995 Today
  • 44. ecosystem 1935 1945 1965 1975 1985 1995 Today
  • 45. DYNAMIC STUTTERING THERAPY 1935 1945 1965 1975 1985 1995 Today
  • 46. DYNAMIC STUTTERING THERAPY Ideas imagination habits experience perspective Language Articulation emotions intentions self-talk beliefs genetics behavior Feedback Phonation Barbara Dahm 1935 1945 1965 1975 1985 1995 Today
  • 47. DYNAMIC STUTTERING THERAPY Ideas Theory imagination habits perspective • Stuttering is one symptom of a Language experience Articulation malfunctioning integrated system that emotions self-talk intentions includes elements of speech-language beliefs genetics planning and production. • Reflects brain processing behavior • Over-control of an automatic system Feedback Phonation Barbara Dahm 1935 1945 1965 1975 1985 1995 Today
  • 48. CHANGING THE SYSTEM Ideas imagination habits experience perspective Language Articulation emotions intentions self-talk beliefs genetics behavior Feedback Phonation Before Therapy During Therapy After Therapy Long After Therapy
  • 49. CHANGING THE SYSTEM Developing new brain map for speaking Developing a mind that supports change and development Before Therapy During Therapy After Therapy Long After Therapy
  • 50. GOALS FOR CHANGING THE SYSTEM Before Therapy During Therapy After Therapy Long After Therapy
  • 51. GOALS FOR CHANGING THE SYSTEM developing ideas • To focus on the preverbal message Before Therapy During Therapy After Therapy Long After Therapy
  • 52. GOALS FOR CHANGING THE SYSTEM developing ideas • To focus on the preverbal message language formulation • To formulate internal speech automatically as a developing sequence of sounds (syllables) Before Therapy During Therapy After Therapy Long After Therapy
  • 53. GOALS FOR CHANGING THE SYSTEM developing ideas • To focus on the preverbal message language formulation • To formulate internal speech automatically as a developing sequence of sounds (syllables) phonation • To generate a natural voice that supports intonation as an automatic reflection of internal speech Before Therapy During Therapy After Therapy Long After Therapy
  • 54. GOALS FOR CHANGING THE SYSTEM developing ideas • To focus on the preverbal message language formulation • To formulate internal speech automatically as a developing sequence of sounds (syllables) phonation • To generate a natural voice that supports intonation as an automatic reflection of internal speech articulation • To allow the articulators to function automatically and without awareness as a reflection of the phonetic plan Before Therapy During Therapy After Therapy Long After Therapy
  • 55. GOALS FOR CHANGING THE SYSTEM developing ideas • To focus on the preverbal message language formulation • To formulate internal speech automatically as a developing sequence of sounds (syllables) phonation • To generate a natural voice that supports intonation as an automatic reflection of internal speech articulation • To allow the articulators to function automatically and without awareness as a reflection of the phonetic plan monitoring • To allow sub-conscious monitoring - without (listening) to speech fluency or how the speech sounds Before Therapy During Therapy After Therapy Long After Therapy
  • 56. DYNAMIC STUTTERING THERAPY CLIENTS Before Therapy During Therapy After Therapy Long After Therapy
  • 57. DYNAMIC STUTTERING THERAPY CLIENTS Before Therapy During Therapy After Therapy Long After Therapy

Editor's Notes

  1. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  2. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  3. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  4. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  5. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  6. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  7. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  8. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  9. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  10. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  11. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  12. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  13. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  14. He believed the nature of the stuttered event would reveal the nature of the disorder and the pathway to treatment Came to see stuttering as an anxiety-motivated avoidant response that becomes conditioned to cues associated with its occurrence. Speakers learn to react abnormally to normal disfluencies
  15. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  16. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  17. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  18. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  19. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  20. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  21. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  22. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  23. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  24. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  25. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  26. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  27. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  28. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  29. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  30. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  31. Research consisted of studies concerning the variation of the stuttered event under different experimental conditions Found that stuttering behaves like a response to to some cues Van thought stuttering was a reaction to words improperly patterned SM seeks to normalize reactions to stuttered events - react calmly without struggle Neither believed in trying to get people to be fluent Developed procedures and tried to justify them
  32. anticipatory struggle behavior - defensive behavior
  33. anticipatory struggle behavior - defensive behavior
  34. anticipatory struggle behavior - defensive behavior
  35. anticipatory struggle behavior - defensive behavior
  36. anticipatory struggle behavior - defensive behavior
  37. anticipatory struggle behavior - defensive behavior
  38. anticipatory struggle behavior - defensive behavior
  39. anticipatory struggle behavior - defensive behavior
  40. anticipatory struggle behavior - defensive behavior
  41. anticipatory struggle behavior - defensive behavior
  42. anticipatory struggle behavior - defensive behavior
  43. anticipatory struggle behavior - defensive behavior
  44. anticipatory struggle behavior - defensive behavior
  45. anticipatory struggle behavior - defensive behavior
  46. anticipatory struggle behavior - defensive behavior
  47. anticipatory struggle behavior - defensive behavior
  48. anticipatory struggle behavior - defensive behavior
  49. anticipatory struggle behavior - defensive behavior
  50. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  51. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  52. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  53. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  54. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  55. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  56. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  57. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  58. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  59. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  60. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  61. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  62. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  63. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  64. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  65. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  66. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  67. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  68. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  69. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  70. No need to understand the nature of stuttered events. They could be changed by stimulus control. Looked for procedures that could reliably reduce stuttering in the lab. FS seeks to reduce or eliminate the occurrence of stuttering events Speak in a way so there won’t have interruptions
  71. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  72. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  73. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  74. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  75. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  76. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  77. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  78. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  79. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  80. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  81. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  82. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  83. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  84. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  85. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  86. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  87. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  88. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  89. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  90. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  91. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency
  92. Both FS and SM focus on altering behavior associated with the occurrence of stutter events Concern is largely centered on the speaker’s reaction to disfluency