# Speech-Language Pathology/Stuttering/Belief-Related Changes
## Adaptation and Anticipation

In 1937, Wendell Johnson conducted a series of tests of adaptation and anticipation, in which stutterers repeatedly read a passage out loud:
* Johnson marked the stuttered words in the first reading. In the second reading, of an unmarked copy, the stutterer was asked to read only words on which he did not expect to stutter. This eliminated 98% of stuttering. The 2% of stuttering was on words which were stuttered in the first reading. In most cases, the stutterer afterwards said he knew he would stutter on the word, but failed to follow the instructions not to read it.
* The stutterer marked the words in the text on which he expected to stutter. He then read the passage out loud 15 minutes later, and a second time the next day. In both cases stuttering occurred on about 50% of the marked words, and on about 10% of the unmarked words. In 1975, Wingate repeated this experiment but altered the sequence of the words, and found little relationship between anticipated and stuttered words.
* Johnson noted the stuttered words as each stutterer read a passage ten times repeatedly. Most subjects stuttered on the same words in each reading. This showed that developmental stutterers stutter on certain words, and say other words fluently. In contrast, some forms of neurogenic stuttering may have random stuttering on any word. Later researchers tried to make the subjects forget which words they'd stuttered on, by reading other material, or by waiting several weeks between readings. Stutterers continued to stutter on the same words.
* Johnson increased stuttering by having the person read to an audience or by other means. Later, the person read out loud to one person. Stuttering increased on passages with cues associated with the audience reading, such a colored border on the page or a similar subject matter. Johnson theorized that the colored border reminded the person of previous stuttering.
* Johnson blacked out the stuttered words in heavy pencil, and the stutterer skipped those words. For some subjects, this eliminated stuttering, but most subjects then stuttered on new words. These new stuttered words were adjacent to the blacked-out words.
* Johnson had stutterers silently read a passage twice, several weeks apart, and mark words they expected to stutter on. Stutterers marked the same words each time.
Johnson theorized that stutterers associate a word with past stuttering or failure (a cue). These studies show that certain words are stuttering cues for individual stutterers, just as certain speaking situations can cue an individual to stutter.
In 1971, Rappaport and Bloodstein repeated Johnson's fifth experiment, but divided subjects into two groups, and added a second test. In the second test, random words had been blacked out. The subjects who did Johnson's test first and then read the random test stuttered on the words adjacent to the blacked-out words. The subjects who read the random test first did not stutter on adjacent words. The stutterers were trained to stutter to a new cue—blacked-out words.

## Does Distraction Reduce Stuttering?

According to some speech pathologists, "Distraction methods can be used to eliminate stuttering temporarily". But if distraction worked, stutterers would work a Rubik's cube or play a pocket video game whenever they wanted to talk fluently. Distraction does not reduce stuttering:
* Distraction from speech-production muscle tension. This is believed to be the origin of secondary symptoms. Tensing non-speech muscles (e.g., eye blinking, foot-stamping) distracts attention from vocal tension. The stutterer may relax his speech muscles momentarily and the word pops out. But he will soon block again, and if he continues to do the secondary behavior it will become habitual. It will also become ineffective. Distraction from vocal tension is ineffective.
* Distraction from anticipation of stuttering. Wendell Johnson showed that stutterers know which words they will stutter on. If this anticipation could be distracted, maybe the person wouldn't stutter on those words? 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. Another study had nine adult stutterers take a 10-second "time-out" after disfluencies, while a control group of nine stutterers got random 10-second "time-outs." "Time-outs" after disfluencies reduced stuttering 46%. Random "time-outs" had no effect on stuttering, proving that "time-outs" do not reduce stuttering via "distraction." These three studies show that distraction from anticipation is ineffective.
* Distraction from the fear of stuttering. There are many stories of a stutterer being "too scared" to stutter (see the section below "Does Stress Increase Stuttering?"). This is a real and fascinating phenomenon, but has no practical value as a therapy for stuttering. For example, we could train a Rottweiler to attack you whenever you stutter. If you brought the dog with you everywhere you went, this might cure you of stuttering, but it would be a cure worse than the disorder.
* Increasing attention to one aspect of speech may reduce attention to other aspects of speech. For example, speaking in a foreign accent requires careful attention to your articulation. Other examples of increased attention may be to relaxed breathing or to speaking slower. These techniques can be effective, but the effectiveness is from increased attention to a fluency-enhancing aspect of speech, not due to distraction or decreased attention to fluency-inhibiting aspects of speech.
* Distraction causes stuttering, when stutterers use therapy techniques. When learning to use a new motor skill, the inhibition of other neuronal linkages is as important as the development of the target neural linkage: "Each motor engram is a pathway of excitation surrounded by a wall of inhibition." A golfer must keep her eye on the ball. Tennis pros are infamous for demanding silence from fans. Stutterers often say that they can use therapy skills in a clinical environment, but the distractions of normal conversations make fluent speech difficult.

### References

* ^ Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.
* ^ Kuehn, Donald (1994). Ofﬁcial correspondence from the National Institute of Deafness and Communication Disorders.
* ^ Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.
* ^ Bloodstein, Oliver (1995) A Handbook On Stuttering, 5th edition, San Diego: Singular Press.
* ^ James, J.E. "Punishment of stuttering: Contingency and stimulus parameters." Journal of Communication Disorders, 1981, 14, 375-386.
* ^ Kottke, F.J., Halpern, D., Easton, J.K.M., Ozel, A.T., Burrill, C.A. “The Training of Coordination.” Archives of Physical Medicine and Rehabilitation, Vol 59, December 1978, 567-572.