Stuttering

Stuttering is defined as dysfluencies in speech including wholeand part-word repetitions, sound and syllable prolongations, and silent or audible blocking (i.e., inability to move lips and/or vocal folds to produce meaningful sounds). Fluent speakers exhibit 3% or less stuttered syllables (Caron & Ladouceur, 1989); therefore, a diagnosis of stuttering would not be appropriate unless the individual exceeds this level. Specifically, the formal diagnosis is based on an evaluation of oral reading and/or speaking that includes the determination of the percentage of stuttered words or syllables, the average duration of the stuttered events, and evidence of nonspeech sounds and physical concomitants such as facial grimaces, head movements, and movements of the extremities (Bray & Kehle, 1996).

The prevalence rate for stuttering is approximately 1% of the population, and males are diagnosed at a rate three times greater than females (American Psychiatric Association, 2000). Approximately 66% of all onsets of stuttering begin gradually during the preschool years and correspond with children beginning to use complete sentences in their speech (Karniol, 1995). Further, although the reasons are not completely understood, more than half of the children diagnosed in early childhood recover without intervention (Onslow & colleagues, 1994). In addition, the recovery rate is higher for females, again suggesting that stuttering is probably gender-linked (Ardila, 1994).

Determination of the causes of stuttering has been difficult. Tenable explanations include genetic factors, emotional states, cognitive and linguistic processes, learning factors, speech motor deficits, and neurological abnormalities. Effective intervention strategies that can be employed by school psychologists within the school setting include successive approximation, self-monitoring, and self-modeling. In addition, speech [Page 544]pathologists may employ interventions based on techniques that reduce speech rate such as prolonging words or sounds, continuous vocalization, and breath management. Finally, pharmacological agents are also beneficial. Although all of these techniques, to some degree, are effective in reducing stuttering (Ingham & Andrews, 1973), with the possible exception of selfmodeling, they tend not to result in lasting changes beyond a year (Bray & Kehle, 1996, 1998a, 2001).

Self-modeling is defined as the attitudinal and behavioral gains made as a result of several spaced viewings of oneself on edited videotapes that depict fluent speech. Self-modeling is derived from research on observational learning. The extent to which a child identifies with the model determines whether or not that child chooses to imitate the model. Self-modeling maximizes the degree of observer identification. In concert with social learning theory, changes in fluency that result from observing oneself speaking fluently may influence cognitive processes such that these cognitions become consistent with the newly acquired observed behaviors. For example, in addition to acquiring more fluent speech as a result of modeling oneself, feelings of self-efficacy may also be promoted.

In summary, the primary role of the school psychologist, in collaboration with the speech-language pathologist, would be to design, implement, and evaluate treatment programs for stuttering. It is important to note that stuttering is associated with academic and social deficits, anxiety, depression, and other emotional problems; it, therefore, should be considered in the assessment process (Bray & colleagues, 2002). Although behavioral, cognitive–behavioral, and prolonged speech interventions appear to be effective, self-modeling is probably the most enduring (Bray & Kehle, 1998b). However, self-modeling requires considerable expertise, time, and relatively expensive equipment.

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