We can think about stuttering in terms of overt and covert behaviors. Overt behaviors (those that are observable) include the "speech" components or the core features of stuttering and related behaviors or secondary characteristics of stuttering -- things the person who stutters does as a reaction to his or her stuttering. Covert behaviors include things the person who stutters does that may not be readily observable -- like avoiding words they feel they will stutter on, substituting another word. Additionally, there are the feelings, emotions, and beliefs about their stuttering that often accompany and complicate the situation.

The Overt (Core) Features of Stuttering
These include repetitions, prolongations, blocks, and tremors. Repetitions are among the most common elements of stuttering; PWS may repeat sounds, syllables, single-syllable words, and part-words. Repetitions of elements greater in length than a word are not usually considered to be stuttering, but are thought to be a "normal disfluency". A prolongation is the continuation of voicing or airflow which results when the movement of the articulators stops briefly during speech production. The prolongation usually lasts from a fraction to a few seconds. Blocks are a total stoppage of voicing and airflow; they may occur at the level of the vocal folds or articulators. There is excessive muscular tension which restricts the movement of the vocal folds (laryngeal block) or the articulators (lingual or labial blocks). Laryngeal blocks tense the vocal folds to the degree that no air can escape, or sometimes escapes in uncontrolled bursts. Lingual and labial blocks "freeze" the articulators; sound is sometimes present, but the client appears "stuck" and has difficulty moving on. Sometimes there is so much muscular tension in the articulators that the jaw begins to quiver at a very rapid rate; this is referred to as a tremor.

Each client has a unique habit pattern of overt stuttering behaviors. Clients differ in the core features that comprise their stuttering -- repetitions are perhaps the most common behavior and are often thought to be how stuttering begins.

The Covert Features of Stuttering
It seems to be human nature for people who stutter to try to force their way through disfluent moments. Additionally, most PWS try to hurry their speaking rate. Though neither strategy is effective, struggle, quick rate, and abrupt speaking onset appear to be very difficult habits to break. Escape behaviors are the person's attempts to break out of a stuttering moment complete the word. Escape behaviors usually are physical attempts, such as head jerking or eye blinking, to break free. These "concomitant behaviors" are very visible and serve to make the stuttering appear more severe. Many who stutter attempt to avoid stuttering. Frequently seen avoidances include word substitutions and pausing before initiating words perceived to be difficult. Many people who stutter try to mask the overt features of their stuttering in these (and other) ways.

People who stutter are usually embarrassed by their stuttering because it draws unwanted attention and seems both unavoidable and uncontrollable. This often leads to a fear stuttering and anxiety about speaking in general. Unmanaged and excessive anxiety significantly complicate stuttering in that the bodily responses to it commonly serve to increase muscle tension and reduce cognitive abilities. Anxiety also serves to accentuate the negative feelings and memories of past stuttering.

Most people who stutter develop beliefs about their stuttering; such as "I can never say my own name" or "I can't say words that begin with the letter 'b'". The construct their lives around these beliefs and, when at a restaurant, order a food they can say, rather than what they might really want. These beliefs are usually held quite firmly and can be difficult to modify and change. However, changing them is one of the main ingredients in overcoming stuttering.

Learning your client's feeling and beliefs about their stuttering usually takes a fair amount of time and is facilitated by their trust in the clinician. Learning to listen to your client and facilitate discussion of these "difficult" topics is an important quality of an effective clinician. The sections of Counseling and Emotions are designed to help clinicians develop understanding and skills in this area.

© Rentschler, 2004