COMPONENT 8. REDUCTION OF (WORD) AVOIDANCE BEHAVIORS
Rationale: Avoidance behaviors must be eliminated as they facilitate the progressive growth of the fear of stuttering.
Research:
Bloodstein (1993) - suggests that the client who thinks of himself as a "stutterer" expects to stutter. This anticipation to stutter is, at times, enough to produce stuttering. "Almost every stutterer has his or her own private list of difficult words" (pg. 5).
Perkins (1973) - stated that awareness of the specific stuttering behaviors that must be managed is crucial to the maintenance of fluent, "normal sounding" speech.
Peters and Guitar (1991) - emphasize the importance of reducing the child's negative feelings about his speech and toward eliminating any avoidance behaviors.
Van Riper (1973) - suggests that the clinician model an easier type of stuttering, and incorporate "easy" stuttering games into the speech play. Showing the child a different way of stuttering, without struggle and tension, helps to reduce expectancy, negative emotionality, and struggle and tension behavior. Van Riper cautions, however, not to make the dysfluent child sound or word conscious because each child demonstrates marked variation in the words and sounds he will have difficulty on at any given point in time.
Williams (1971) - encourages the attitude that stuttering (getting stuck) is only a simple mistake and compares it to simple mistakes in everyday things.
Activities/Techniques:
1. The clinician and older client (ages 15-17) can discuss the characteristics of word and sound avoidance behaviors, as well as why the client feels it is necessary to avoid.
2. Have the older client (ages 15-17) keep a log book of specific words and sounds he/she avoids and in what situations these avoidances occurred.
3. To eliminate "uhÕs" and "um's" used as avoidance behaviors, the clinician may use an abacus or counter to identify and count these behaviors. The client is then encouraged that he/she has the ability to say the work without the interjection and is requested to do so.
4. Playing games in which the client/clinician insert "uh" and "uhm" as often as possible while the other person "catches them" may assist the child in identifying this avoidance behavior. Once the child has identified this feature in their own speech, they are reading to practice elimination the use of interjections. The client must become comfortable and "feel safe" with his stuttering through the use of voluntary stuttering, "triad" drills, and easy bounces and slides. As he confronts the moment of stuttering openly and without fear, the use of this type of avoidance behavior will gradually decline.
5. Discussing the consequences for using "avoidance behaviors" may also help the client to understand the importance of elimination them. Problem solving with the client by noting all the possible outcomes of avoidance behaviors, regarding of their positive or negative affect. The clinician then lists these consequences, and together with the client, assigns a value to their impact on communication.
6. The clinician should observe any secondary of avoidance behavior specific to the child's pattern. All such behaviors should be eliminated through increasing the childÕs awareness of the behavior, discussing itÕs occurrence, and demonstrating how the child doesnÕt need them to talk.
7. Any specific avoidance, such as the client's name, which the client reports, must be dealt with directly.