484 JOURNAL OF SPEECH AND HEARING DISORDERS
den onset of sensory-neural hearing loss. ment in hearing sensitivity during the
The case is of special significance because
preaudiological findings were available to
be used as a basis for determining improve-
Received January 6, 1964
A Standard Definition of Stuttering
M. E. Wingate
University of Washington
In some measure the enigmatic character
of stuttering is enhanced by the semantic
problem embodied in the diversity of defi-
nitions of stuttering. Such diversity con-
tributes to equivocation and confusion
encountered particularly in the area of
theory and integration of research find-
ings, but it also creates problems at the
practical levels of teaching and of diag-
nosis and management.
Definitions of stuttering vary on several
dimensions: 1 one kind attempts a fairly
straightforward statement of speech char-
acteristics; another implies denial that such
a condition exists; others presumptively
define in terms of an etiology; others offer
a description of the full range of behav-
ioral features observed in only some stut-
terers; and there are those which are some
combination of the foregoing. In many
definitions the speech characteristics are
either taken for granted, compromised, or
minimized.
Since "to define" means "to determine
and state the nature and limits of," it may
seem presumptuous to attempt a standard
definition of stuttering at this time. Ho w-
1The latest edition of Stuttering Words
(1963) contains a good sample. See also Eisen-
son (1958) and Hahn (1956).
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period of medical therapy.
LYNN, G. E. and PInxzv, W. P., Deafness of s u d d e n
onset. 3". Speech Hearing Dis., 28, 1963, 295-299.
ever, the serious need for a workable defi-
nition of stuttering can be met by adher-
ing to certain criteria. The definition
should be one which: (a) identifies and
emphasizes discriminative features, (b) is
amenable to general application, and (c)
accords with our current state of knowl-
edge of stuttering.
At the outset several important consid-
erations should be kept in mind. First, the
cardinal features of stuttering are the
speech characteristics. A n y definition of
stuttering which treats inadequately with
speech characteristics contains a serious
fault, for such features are the sine qua
non of stuttering. Second, certain other
features are evident in some, perhaps
many, instances of stuttering but not in
all nor even most cases. A n y definition is
vitiated to the extent that it contains, as
integral parts and without qualification,
references to features which are not uni-
versally demonstrable. Third, we do not
know what causes stuttering. Conse-
quently, there is no license for including
a statement of etiology in a definition,
unless to acknowledge our ignorance of
etiology.
It seems evident that, in essence, we
must be content for some time to come
with a "phenotypic" definition of stutter-

ing; that is, a definition which sticks to
observable facts about stuttering and ex-
cludes hypothetical predilections. It seems
to me that a definition such as this is pre-
requisite to pursuing further rational and
reasoned inquiry into the nature of the dis-
order. However, at the present time even
such a definition is precluded by the loose
and indefinite quality of many terms em-
ployed in discussion and description of
stuttering. This paper presents an attempt
to resolve this problem by developing a
definition founded on a careful analysis of
elements identifiable in the observable
complex of stuttering. The analysis will
deal with three areas basic to an acceptable
definition of stuttering: the most impor-
tant one is (a) speech characteristics; the
other two are here referred to as (b) ac-
cessory features and (c) associated fea-
tures.
Analysis
Speech Characteristics. It is doubtful
that there would be any disagreement
that the fundamental observable charac-
teristic of stuttering is a disturbance in
the flow 2 of speech. Yet speech can be
nonfluent without meriting the designation
"stuttering," indicating that there are cer-
tain kinds of disfluency which can be iden-
tified as normal nonfluencies and others
which are identifiable as stuttering non-
fluencies. The existing means of classifying
nonfluencies is not very helpful in mal6ng
this distinction, as careful appraisal will
reveal.
T o review, the nonfluencies mentioned
in discussions of stuttering include the fol-
lowing: repetitions, prolongations, blocks
or blockings, hesitations or pauses, inter-
jections, broken words, revisions, and in-
complete phrases (for example, Eisenson,
1958; Hahn, 1956; Johnson et al., 1956;
Johnson et al., 1963; Van Riper, 1963;
Wingate, 1962). This is a straightforward
*'Flow" or "fluency" is preferable to
"rhythm," sometimes used in this context,
since "rhythm" has other more special con-
notations.
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THE FORUM 485
classification, based on what is readily ob-
served in speech; it lacks refinement and
discrimination. In particular, the categories
of "repetitions" and "hesitations" serve to
obscure certain important differences
whose significance is discussed below.
The following analysis will endeavor to
derive a more efficient classification of
speech nonfluencies from the categories
listed above; to distinguish stuttering non-
fluencies from normal ones; and, in par-
ticular, to identify two kinds of non-
fluency which appear to be the "kernel"
characteristics of stuttering.
Repetitions. The term "repetitions" is a
class word, confusing and misleading if
used in this general sense (as it often is)
since it obscures the fact that there are
very different kinds of repetition. Some
refinement of this class is contained in lit-
erature sources which distinguish repeti-
tions of: a sound, a syllable 8, a word, or a
phrase. Among these, however, the cate-
gory of "word repetitions" is another
source of confusion since this term does
not permit a distinction between words
having one syllable and words having
more than one syllable-a distinction which
seems to be of cardinal significance.
A more systematic and refined classifi-
cation can be achieved by recognizing
only two types of repetition: (a) unitary,
and (b) multiple-unit. On this basis repeti-
tions of a sound, syllable, or one-syllable
words are instances of the first type; repe-
titions of phrases and words of more than
one syllable are of the second type.
It is suggested here that only the unitary
repetitions are fundamental characteristics
of stuttering. This contention is supported
by a recent review (Wingate, 1962) of
pertinent research which indicates that, in
respect to repetitions, sound and syllable
repetitions are characteristic of stuttering
whereas phrase repetitions are more char-
acteristic of normal f u e n c y irregularity.
*Sound and syllable repetitions are some-
times combined into a single category of
"part-word" repetitions (Johnson, 1956 p.
204), dismissing the possibly unimportant dif-
ference between sound (s...s...s...saddle)
and syllable (sa...sa...sa...saddle) repeti-
tions.
 486 JOURNAL OF SPEECH AND HEARING DISORDERS
Previous research has little to offer regard-
ing the significance of word repetitions,
evidently because of the confounded char-
acter of this term. However, on an empiri-
cal basis we observe stuttering to involve
repetition of such (unitary) words as "to,"
"he," or "an" in contrast to (multiple-unit)
words like "tubular," "heater," or "ana-
gram." The matter of one-syllable word
repetitions presents a potential problem in
that sometimes we do observe them in
certain samples of speech but disregard
them as not significant. However, we do
so by implicit reference to certain criteria,
namely, if they: (a) do not occur in con-
currence with part-word repetitions or
prolongations, (b) appear infrequently,
(c) are of brief duration, and (d) are not
associated with other signs which we
identify as "struggle."
Repetition of phrases and words of more
than one syllable do occur as part of the
total performance in certain instances of
stuttered speech, yet to the extent that
they may be involved in an actual instance
of stuttering they would appear to be a
kind of accessory feature, which will be
discussed later.
It should be added that (unitary) repeti-
tions, while ordinarily audible, may be
silent and detectable only visually, as in
repeated lip movements forming (b) prior
to saying "boy." Thus we have unitary
repetitions which may be silent or audible;
the present analysis identifies such non-
fluencies as one of the two types of "ker-
neF' characteristics of stuttering.
Hesitations. The terms "hesitations" and
"pauses," like "repetitions," are also gen-
eral terms which are confounding because
they permit no internal distinctions.
"Hesitation" refers to a silent interval in
the flow of speech, of which four types
can be identified. There are: (a) voluntary
hesitations, which might be produced for
some effect, or awaiting an auditor's atten-
tion, etc.; (b) circumstantial hesitations,
occasioned by some momentary external
or internal distraction; (c) meditative hesi-
tations, when a speaker reflects on his
topic, or thought at the moment, or word
choice; and (d) involuntary hesitations,
which occur for unknown reasons. The
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latter type of hesitation differs from the
others in that the speaker did not intend
to pause and is unable to continue in spite
of his intention to do so. At the level of
observation this type of hesitation may be
distinguished from the other three by one
or more of the following: (a) inappropri-
ate site of occurrence in an expression; (b)
associated auditory cues, attendant upon
eventual initiation of sound, such as a slight
repetition, or audible prolongation, or ex-
cessive loudness, etc.; and (c) associated
visual cues, such as exaggerated or inap-
propriate facial movements and the like. 4
The first three types of hesitation noted
above are regarded as normal. The last
type can be identified as a silent prolon-
gation; it would include what are referred
to in the old classification as "blocks" or
"blockings." The place of this type of
"hesitation" in the present scheme will be
evident in the following section.
Prolongations. Ordinarily "prolonga-
tion" refers to the audible extension of a
sound beyond its appropriate duration, as
in saying "baaatter." As such, this speech
feature is quite readily identified, and rele-
vant research findings to date (Wingate,
1962) indicate that it is the other distinc-
tive characteristic of stuttering. The cate-
gory of "prolongations" should include si-
lent prolongations as identified above.
Prolongations can have only a unitary
character; thus we have (unitary) pro-
longations which may be silent or audible.
The present analysis identifies such non-
fluencies as the second of the taro types
of "kernel" characteristics of stuttering.
Interjections. This category refers to ex-
traneous utterances 5 in the flow of con-
nected speech. In ordinary usage this term
is also confounding since different kinds
of interjection can be identified. In one
sense, interjections may be considered as
essentially sound-filled pauses. As such,
they are audible hesitations and can be
shown to have subcategories similar to si-
'Frequently occurring features of (audible)
prolongations as well.
~Sounds ("uh"), words ("well"), brief
phrases "lemme see"),

lent hesitations, namely, the normal "vol-
untary," "circumstantial," and "medita-
tive," and the abnormal "involuntary."
The latter type of interjection, always
simple (unitary) in form, is essentially an
audible prolongation. Another kind of in-
terjection, as in saying "uh, uh, uh," is a
form of unitary audible repetition. Thus,
among interjections we can discern those
which are in actuality (audible) unitary
repetitions and prolongations-identifiable
as stutterings. Longer interjections, when
they occur as an aspect of stuttering, are
best considered as accessory features, to be
discussed later.
Broken Words. This type of fluency
disturbance is exemplified in the sentence,
"I was g(pause)oing home." It seems clear
that the inappropriate site of the pause is
the distinctive characteristic in this fluency
irregularity and that it is an instance of a
silent prolongation.
Revisions and Incomplete Phrases. These
kinds of fluency irregularity represent
changes in pronunciation, wording, gram-
matical structure, or content of an expres-
sion. There is no support in the research
to indicate that such features are in any
way distinctive of stuttering nor more f r e -
quently associated with stuttering than
with normal speech. In practice it seems
evident that they are accepted generally
as normal disfluencies. Sometimes stutter-
ers report revising in order to avoid a
feared word but neither the initial attempt
nor the revision is considered to be "stut-
tering" by either the stutterer or his
auditor.
Summary. The foregoing analysis indi-
cates that two "kernel" characteristics of
stuttering speech can be discriminated: (a)
repetitions (audible or silent) of single-
unit speech elements; and (b) prolonga-
tions (audible or silent). Other disfluencies
mentioned in discussions of stuttering can
be either reduced to these characteristics,
assigned to an ancillary role, or eliminated
as not pertinent. One or the other, or both,
of these kernel characteristics are found in
all eases of stuttering; in effect, it is by
virtue of these characteristics that certain
types of disfluent speech are called "stut-
tering." It is pertinent to recall here the
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THE FORUM 487
elassie descriptive terms of "elonie" (re-
petitive) and "tonic" (prolonged) fluency
disturbance as denoting the distinctive fea-
tures of stuttering. The crux of a defini-
tion of stuttering, then, should center on
these elements.
Accessory Features. N o t infrequently
one can observe in stuttering certain char-
acteristics beyond those of the speech
anomalies. In current parlance these are
the so-called "secondary mannerisms."
The term "accessory features" is used here
to avoid the implications of both "second-
ary" and "mannerism," which at the pres-
ent time have a widely accepted theoreti-
cal significance that is of questionable
validity. The so-called "secondary man-
nerisms" are commonly assumed to be
learned behaviors. It would seem advisable,
however, to consider that "secondary"
should neither mean that these features
necessarily occur secondly 6 nor imply that
they are learned, but simply that they
stand second in significance because they
are not universal in the observable symp-
tom picture of stuttering. These features
vary considerably in their expression, be-
ing much more pronounced or extensive
in some individuals than in others. T h e y
appear to show a gross correlation with
age, yet some young stutterers may mani-
fest them dramatically and some older
stutterers are quite free of them.
For purposes of discussion these acces-
sory features may be classed under the
headings of (a) speech-related movements,
(b) ancillary body movements, and (e)
verbal features.
Speech-Related Movements. This cate-
gory embraces those exaggerated or inap-
propriate movements of the peripheral
speech mechanism associated with the dif-
ficulty in uttering speech. Examples would
include: pursing the lips, protruding the
tongue, clenching the teeth, etc.-move-
ments which may or may not be consistent
eMost experienced clinicians should be able
to recall cases in which a young child's stut-
tering was described as having certain of the
"seeonda.ry" features from the time of onset
of stuttering.
 488 JOURNAL OF SPEECH AND HEARING DISORDERS
with the sound being attempted. ~,Vhile it
seems to be widely accepted that such
characteristics are learned, it is by no
means certain that they are. It remains
conceivable that they, are essentially
spasms, which the stutterer can learn to
control.
Ancillary Body Movements. This cate-
gory includes all other kinds of body ac-
tion occurring in association with diffi-
culty in uttering speech, such as eye blink,
snorting, jerking the head, clenching fists,
etc. Often these features give the appear-
anee of intentional struggle and thus are
assumed to be learned reactions. It may
be that some are learned, but again the
possibility remains that some of them may
well represent "overflow" expression of a
spasm.
Verbal Features. These consist of verbal
expressions of one to several words in
length which are notable in the sense that
they either appear at relatively inappro-
priate points in the context of a message,
are unduly repetitive, associated with signs
of struggle, or followed by a repetition or
prolongation. Sometimes they appear to
occur voluntarily, and some stutterers re-
port their use to avoid or "get through ''7
a word. As mentioned earlier, certain kinds
of interjections, repetitions of phrases and
words of more than one syllable, and even
some single-unit word repetitions are class-
ifiable as verbal accessories. T h e y are not
basically integral parts of the stuttering.
Associated Features. In a proportion of
eases of stuttering one may be aware of
certain accompanying features of a more
or less general or vague nature which in-
clude such things as indications or report
of excitement, tension, personal reactions,
feelings, or attitudes. The nature and ex-
tent of such features show considerable
variation and their relationship to stutter-
ing is not ve D, well known (that is, causal,
reactive, interactive, or concurrent). Thus,
while mention of them in a definition of
stuttering seems warranted, they should
be assigned a subsidiary status.
~Supplying the rationale for the term
"starters."
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Etiology. As noted earlier, we do not
know what causes stuttering. It can be said
that the immediate source is an evident in-
coordination, but beyond this a statement
of presumed etiology is improper in a defi-
nition of stuttering. Rather, it would seem
that an acceptable definition should ac-
knowledge our ignorance of etiology.
The Definition
On the basis of the foregoing analysis
the following three-part definition is of-
fered as a statement which appears to meet
the criteria of an acceptable standard defi-
nition of stuttering. The first part denotes
the core features of stuttering which have
universal applicability; the second and
third parts identify other features which
deserve mention.
The term "stuttering" means:
1. (a) Disruption in the fluency of ver-
bal expression, which is (b) characterized
by involuntary, audible or silent, repeti-
tions or prolongations in the utterance of
short speech elements, namely: sounds,
syllables, and words of one syllable. These
disruptions (c) usually occur frequently
or are marked in character and (d) are not
readily controllable.
2. Sometimes the disruptions are (e)
accompanied by accessory activities in-
volving the speech apparatus, related or
unrelated body structures, or stereotyped
speech utterances. These activities give
the appearance of being speech-related
struggle.
3. Also, there are not infrequently (f)
indications or report of the presence of an
emotional state, ranging from a general
condition of "excitement" or "tension" to
more specific emotions of a negative na-
ture such as fear, embarrassment, irrita-
tion, or the like. (g) The immediate source
of stuttering is some incoordination ex-
pressed in the peripheral speech mecha-
nism; the ultimate cause is presently un-
known and may be complex or compound.
It is believed that a definition such as
this can serve as a stable and veridical
frame of reference, to re-orient and per-

haps reduce some amount of the contro-
versy in the area of stuttering, and to
provide a basis for a more systematic and
efficient approach in the study of stut-
tering.
EISENSON, J. (Ed.), Stuttering: A Symposium. New
York: Harper & Bros., 1958.
HAHN, E. F., Stutterino: Sionificant Theories and
Received January 16, 1964
Continuous Palatography
William L. Kydd
Donald A. Belt
University of Washington
Palatography is the recording of contacts
made by the tongue with the teeth and
palate during speech. The pictorial record
of the particular contact is called a palato-
gram. Palatography has been used as a
means of identifying the physiological
characteristics of speech sounds, both with
regard to those individuals considered to
have normal speech as well as those who
demonstrate aberrant speech. With major
modifications such as those delineated
within this paper, the palatographic tech-
nique can serve many purposes including
investigations of speech and deglutition.
The primary limitation of the traditional
palatographie technique is that it permits
only one measurement to be made at a
time and the subject's response is not rep-
resentative of continuous speech.
At present there is no reliable method of
sequentially determining where the tongue
contacts the hard palate during connected
speech and deglutition. Cinefluorography
and x-ray cephalametrics have been used
but although these methods demonstrate
that the tongue is in eontaet with the pal-
ate, they give no indication as to the area
of tongue contact. Most important though,
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THE FORUM 489
Therapies. Palo Alto: Stanford Univ., 1956.
J'OHNSON, W., DARLEY, F. L., and SVRIES'rERSBAC~,
D. C., Diagnostic Methods in Speech Pathology.
New York: Harper & Row, 1963.
Joit~rsou, W. et al, Speech Handicapped School Chil-
dren. New York: Harper & Bros., 1956.
Stuttering Words (Revised). Memphis, Tenn. : Speech
Foundation of America, 1963.
VA~ RIVER, C., Speech Correction: Principles and
Methods. New York: Prentice-Hall, 1963.
WINGATE, M. E., Evaluation and stuttering, part I.:
speech characteristics of young children, or. Speech
Hearing Dis., 27, 1962, 106-115.
these methods do not show the lateral
areas of the tongue in contact with the
palate and dentition. Conventional pala-
tography will show only one contact of
the tongue and no more.
The need for a device to delineate the
continuous movement of the tongue in
a temporal and spatial-oriented manner
would be of importance to many disci-
plines of speech and to the oral physiolo-
gist. Previous attempts to obtain sequential
recordings of lingua-palatal contact have
been met by inherent technical probIems
that have limited the usefulness of these
techniques as practical tools of measure-
ment (Koepp-Baker, 1938; Kuzmin, 1962).
The purpose of this paper is to describe
a system that will: (a) record the area of
tongue contacts with the hard palate dur-
ing connected speech and deglutition, (b)
provide a means by which the recorded
data can be compared with the acoustic
characteristics of the subject's speech, and
(c) record the observable characteristics
of the subject's face, lips, and mouth.
Historical Aspects of Palatography. Two
methods of palatography, both originated
by dental surgeons, have provided the basis