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Stuttering
An Integrated Approach to Its
Nature and Treatment

FIFTH EDITION
Stuttering
An Integrated Approach to Its
Nature and Treatment

FIFTH EDITION

BARRY GUITAR, PhD

Professor
Department of Communication Sciences
University of Vermont
Burlington, Vermont
Acquisitions Editor: Matt Hauber
Development Editor: Amy Millholen
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Editorial Assistant: Parisa Saranj
Production Project Manager: Kim Cox
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Designer: Stephen Druding
Artist: Bot Roda
Compositor: SPi Global

5th Edition

Copyright © 2019 Wolters Kluwer

Copyright © 2014 Lippincott Williams & Wilkins, a Wolters Kluwer business.

Copyright © 2006 by Lippincott Williams & Wilkins. Copyright © 1999, 1991 by
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Library of Congress Cataloging-in-Publication Data

Names: Guitar, Barry, author.
Title: Stuttering : an integrated approach to its nature and treatment / Barry
Guitar.
Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2019] | Includes
bibliographical references and index.
Identifiers: LCCN 2018049600 | ISBN 9781496346124 (paperback)
Subjects: | MESH: Stuttering—therapy | Stuttering—etiology | Stuttering—
diagnosis
Classification: LCC RC424 | NLM WM 475.7 | DDC 616.85/54—dc23 LC record
available at https://lccn.loc.gov/2018049600
This work is provided “as is,” and the publisher disclaims any and all warranties,
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This work is no substitute for individual patient assessment based upon healthcare
professionals’ examination of each patient and consideration of, among other
things, age, weight, gender, current or prior medical conditions, medication
history, laboratory data and other factors unique to the patient. The publisher does
not provide medical advice or guidance and this work is merely a reference tool.
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 Preface

Stuttering is an intriguing and mysterious disorder. In the past 50

years, we have learned many secrets about what is different in the
brains of those of us who stutter. Yet many unanswered questions
remain. For example, we don’t know exactly how these brain
differences result in the speech disfluencies that we see in the onset
of stuttering in children. We also don’t know how the usually mild
beginnings of stuttering become—for some children—severe,
struggled behaviors accompanied by avoidance and emotional
turmoil.
This book is an attempt to present the latest scientific findings
and theoretical perspectives and integrate them with the best clinical
approaches for evaluating and treating stuttering. As I worked on
this new edition, I realized that my current thinking has been
influenced deeply by my own stuttering therapist, Charles Van Riper,
who summarized his final thoughts (1990) about stuttering in this
way:

Stuttering begins when the brain mistimes the complex

movements required for fluent speech.
The child’s responses to these mistimings are the repetitions
and prolongations that we observe as stuttering begins.
Most children recover from stuttering “because of maturation or
because they do not react to their lags, repetitions, or
prolongations by struggle or avoidance” (Van Riper, 1990, 317
[italics mine]).
The struggle and avoidance are learned and can be modified,
although the mistimings are always there.
Some of my thinking in this edition focuses on the children who do
not recover because they do react to their repetitions and
prolongations. I view our therapies for preschool children as
preventing these struggle and avoidance reactions and minimizing
the stuttering they would be reacting to. We do this by helping them
feel ok about their stuttering and teaching them how to talk more
fluently. I also think that once the struggle and avoidance reactions
are learned, they can be modified by reducing the (nonconscious)
threat and (conscious) fear of stuttering that trigger these reactions.
A combination of a strong, supportive client-clinician relationship and
a program of reducing fear and shame, and confronting and
tolerating the moment of stuttering to reduce tension, and then
easing out of it will diminish struggle and avoidance. The resulting
experience of feeling in control of stutters will further reduce
maladaptive behaviors and negative feelings.
Have I anything more to say? Yes. I hope if you have
suggestions for improving the next edition of this text, you’ll let me
know.
— Barry Guitar
bguitar@med.uvm.edu
 Acknowledgments

Thank you to all my clients and students. You taught me as much as

I taught you.
And thanks to my colleagues in Communication Sciences and
Disorders and in Psychological Sciences whose writings and
conversations, in person and via e-mail, have helped me become
woke.
A round of applause for Andrea Klingler, Mike Nobel, Kerry
McShane, and Amy Millholen, whose editorial talents made this book
what it is.
Cheers for Bot Roda—the talented illustrator who gave life to all
my notions about what might be helpful to put in visual form.
Kudos to Adinarayanan Lakshmanan Sivakumar (Siva) and his
team who have done a wonderfully thorough job of compositing my
manuscript into the printed page.
Hooray! Rebecca McCauley and Charlie Barasch, who have edited
each chapter, making them more readable, updated, and cogent
than my original drafts.
As with all the earlier editions, I bestow love and appreciation to
my wife, Carroll. She has used her librarian and literary skills to edit,
find references, keep databases, get permissions, help with videos,
and keep me moving so this edition will finally see the light of day.
 Contents

Preface
Acknowledgments

Section I Nature of Stuttering

1. Introduction to Stuttering
Perspective
Overview of the Disorder
Definitions
The Human Face of Stuttering
Basic Facts about Stuttering and Their Implications for the
Nature of Stuttering
2. Primary Etiological Factors in Stuttering
What Do We Know About Constitutional Factors in Stuttering?
Hereditary Factors
Congenital and Early Childhood Trauma Studies
Brain Structure and Function
3. Sensorimotor, Emotional, and Language
Factors in Stuttering
Sensorimotor Factors
Language Factors
Emotional Factors
 4. Developmental and Environmental
Factors in Stuttering
Developmental Factors
Environmental Factors
5. Learning and Unlearning
Learning
Unlearning
6. Theories about Stuttering
Theoretical Perspectives About Constitutional Factors in
Stuttering
Theoretical Perspectives on Developmental and Environmental
Factors
Integration of Perspectives on Stuttering
7. Typical Disfluency and the Development
of Stuttering
Overview
Typical Disfluency
Younger Preschool Children: Borderline Stuttering
Older Preschool Children: Beginning Stuttering
School-Age Children: Intermediate Stuttering
Older Teens and Adults: Advanced Stuttering

Section II Assessment and Treatment of Stuttering

8. Preliminaries to Assessment
The Client’s Needs
Insurance Considerations
The Client’s Right to Privacy
Multicultural and Multilingual Considerations
 The Clinician’s Expertise
Assessing Stuttering Behavior
Assessing Speech Naturalness
Assessing Speaking and Reading Rate
FluencyBank
Assessing Feelings and Attitudes
Continuing Assessment
9. Assessment and Diagnosis
Preschool Child
School-age Child
Adolescent/Adult
10. Preliminaries to Treatment
Clinician’s Attributes
Clinician’s Beliefs
Treatment Goals
Therapy Procedures
11. Treatment of Younger Preschool Children:
Borderline Stuttering
An Integrated Approach
Other Clinicians
12. Treatment of Older Preschool Children:
Beginning Stuttering
An Integrated Approach
Another Clinician’s Approach: Sheryl Gottwald
Treatment of Concomitant Speech and Language Problems
13. Treatment of School-Age Children:
Intermediate Stuttering
An Integrated Approach
 Approaches of Other Clinicians
14. Treatment of Adolescents and Adults:
Advanced Stuttering
An Integrated Approach
Other Approaches
15. Related Disorders of Fluency
Neurogenic Acquired Stuttering
Psychogenic Acquired Stuttering
Malingering
Cluttering

References
Author Index
Subject Index
 I
Nature of Stuttering
 1
Introduction to Stuttering

Perspective
The Words We Use
People Who Stutter
Disfluency
Overview of the Disorder
Do All Cultures Have Stuttering?
What Causes People to Stutter?
Can Stuttering Be Cured?
Definitions
Fluency
Stuttering
General Description
Core Behaviors
Secondary Behaviors
Feelings and Attitudes
Functioning, Disability, and Health
The Human Face of Stuttering
Basic Facts about Stuttering and Their Implications for the
Nature of Stuttering
Onset
Prevalence
Incidence
 Recovery from Stuttering
Recovery versus Persistence of Stuttering
Sex Ratio
Variability and Predictability of Stuttering
Anticipation, Consistency, and Adaptation
Language Factors
Fluency-Inducing Conditions
An Integration

Chapter Objectives
After studying this chapter, readers should be able to:

Explain why it is good practice to use the term “person who

stutters” rather than “stutterer”
Describe factors that may (1) predispose a child to stutter, (2)
precipitate stuttering, and (3) make stuttering persistent
Name and describe the core behaviors of stuttering
Name and describe the two major categories of secondary
stuttering behaviors
Name and describe different feelings and attitudes that can
accompany stuttering
Describe the elements of the new International Classification of
Functioning, Disability, and Health (ICF) system that are most
relevant to stuttering
Discuss the age range of stuttering onset and the types of
onset, and explain why the onset of stuttering is often difficult
to pinpoint
Describe the meanings of the terms “prevalence” and
“incidence,” and give current best estimates of each of these
characteristics for stuttering
Give an estimate of the number of children who recover without
treatment, and describe factors that predict this recovery
 Give an estimate of the sex ratio in stuttering at onset and in
the school-age population
Explain what is meant by “anticipation,” “consistency,” and
“adaptation” in stuttering
Explain some relationships between stuttering and language,
and suggest what they mean about the nature of the disorder
Describe several conditions under which stuttering is usually
reduced or absent, and suggest why this may be so

Key Terms
Adaptation: The tendency for speakers to stutter less and less
(up to a point) when repeatedly reading a passage
Anticipation: An individual’s ability to predict on which words
or sounds he or she will stutter
Attitude: A feeling that has become a pervasive part of a
person’s beliefs
Avoidance behavior: A speaker’s attempt to prevent stuttering
when he or she anticipates stuttering on a word or in a
situation. Word-based avoidances are commonly
interjections of extra sounds, like “uh,” said before the word
on which stuttering is expected.
Block: A disfluency that is an inappropriate stoppage of the flow
of air or voice and often the movement of articulators as well
Consistency: The tendency for speakers to stutter on the same
words when reading a passage several times
Core behaviors: The basic speech behaviors of stuttering—
repetition, prolongation, and block
Developmental stuttering: A term used to denote the most
common form of stuttering that develops during childhood
(in contrast to stuttering that develops in response to a
neurological event or trauma or emotional stress)
 Disfluency: An interruption of speech—such as a repetition,
hesitancy, or prolongation of sound—that may occur in both
individuals who are developing typically and those who
stutter
Escape behavior: A speaker’s attempts to terminate a stutter
and finish the word. This occurs when the speaker is already
in a moment of stuttering.
Fluency: The effortless flow of speech
Heterogeneity: Differences among various types of a disorder
Incidence: An index of how many people have stuttered at
some time in their lives
Normal disfluency: An interruption of speech in a typically
developing individual
Prevalence: A term used to indicate how widespread a disorder
is over a relatively limited period of time
Prolongation: A disfluency in which sound or air flow continues
but movement of the articulators is stopped
Repetition: A sound, syllable, or single-syllable word that is
repeated several times. The speaker is apparently “stuck” on
that sound or syllable and continues repeating it until the
following sound can be produced.
Secondary behaviors: A speaker’s reactions to his or her
repetitions, prolongations, and blocks in an attempt to end
them quickly or avoid them altogether. Such reactions may
begin as random struggle but soon turn into well-learned
patterns. Secondary behaviors can be divided into two broad
classes: escape and avoidance behaviors.

PERSPECTIVE
No one is sure what causes stuttering, but it is an age-old problem
that may have its origins in the way our brains evolved to produce
speech and language. Its sudden appearance in some children is
triggered when they try to talk using their just-emerging speech and
language skills. Its many variations and manifestations are
determined by individual brain structure and function, learning
patterns, personality, and temperament. It also provides lessons
about human nature: the variety of responses that stuttering
provokes in cultures around the world is a reflection of the many
ways in which humans deal with individual differences.
This description of stuttering makes it seem like a very
complicated problem—one that will take a long time to learn about.
It’s true that you could spend a lifetime and still not know everything
there is to know about stuttering. But you don’t need to understand
everything in order to help people who stutter. If you read this book
critically and carefully, you will get a basic understanding of stuttering
and a foundation for evaluating and treating people who stutter and
their families. And once you start working with people who stutter,
your understanding and ability will expand exponentially.
If you continue to work with stuttering, you will soon outgrow this
book and begin to make your own discoveries. You will experience the
satisfaction of helping children, adolescents, and adults regain an
ability to communicate easily. Someday you may even write about
your therapy procedures and measure their effectiveness. Those of us
who have spent many years engaged in stuttering research and
treatment all began where you are right now, at the threshold of an
exciting and rewarding profession that can have a major impact on
others’ lives.

The Words We Use

In any field—whether it’s education, medicine, or speech-language
pathology—words may be used in specific ways. Definitions of many
of the specialized terms used in our field are provided in the Key
Terms list at the beginning of each chapter. But some words and
phrases deserve to be discussed at the beginning.

People Who Stutter

Until recently, it was common practice to refer to people who stutter
as “stutterers.” In fact, some of us who stutter refer to ourselves as
stutterers and feel some pride in this term. It reminds me that a
friend of mine who has Parkinson’s disease is happy to call himself a
“parkie” and even “a mover and shaker.” However, many people
prefer not to be labeled “a stutterer” and prefer instead to be called
“a person who stutters.” They feel, and rightly so, that stuttering is
only a small part of who they are.
Adults who stutter often say that changing the way they think of
themselves—as people who happen to stutter but with many more
important attributes—was one of the most significant things they did
to break free of the bonds of stuttering. Such reports remind us that
clients are far more than people who stutter. They are people, each
with a huge array of characteristics, only one of which happens to be
that they stutter. This way of thinking enables us to help both our
clients and their families. When we use the phrase “child who
stutters” rather than “stutterer,” families listen beyond the sounds of
stuttering to the thoughts and feelings that their children are
communicating. It helps everyone view disfluencies in perspective as
only a small part of the whole child.
Some authors abbreviate “people who stutter” as “PWS.”
Personally, I feel that substituting an acronym that highlights
stuttering is not really different from using “stutterer.” In fact it may
be even more demeaning. So I won’t employ “PWS” as an acronym.
However, I know that the language in this book would grow stale and
cumbersome if I were to use “person who stutters” over and over. So
I often refer to the “adult . . .,” “child . . .,” or “adolescent you are
working with.”

Disfluency
In our literature, “disfluency” is used to denote interruptions of
speech that may be either normal or abnormal. That is, it can apply
to pauses, repetitions, and other hesitancies in individuals who are
typical speakers. It can also apply to moments of stuttering. This
makes it a handy term to use when describing the speech of young
children whose diagnosis is unclear.
When someone’s speech hesitancies are unequivocally not
stuttering, I’ll use the term “typical disfluency.” I won’t use the older
term for the abnormal hesitations in stuttering—“dysfluency” with a
“y”—because it can easily be mistaken for “disfluency” when you see
it on the page and because the two are indistinguishable when
spoken.

OVERVIEW OF THE DISORDER

This section previews the next few chapters on the nature of
stuttering and gives me a chance to reveal my own slant on the
disorder. I think this may be helpful for anyone, but especially for
those readers who have not had a course in stuttering and who may,
therefore, know few details of its nature.

Do All Cultures Have Stuttering?

Stuttering is found in all parts of the world and in all cultures and
races. It is indiscriminate of occupation, intelligence, and income; it
affects both sexes and people of all ages, from toddlers to the elderly.
It is an old curse, and there is evidence that it was present in
Chinese, Egyptian, and Mesopotamian cultures more than 40
centuries ago (Van Riper, 1982). Moses was said to have stuttered
(Garfinkel, 1995) and to have used a trick typical of many of us who
stutter—getting his brother to speak for him. I did something similar
when I was asked to read a prayer aloud in Sunday school.

What Causes People to Stutter?

The cause of stuttering is still something of a mystery. Scientists have
yet to discover what causes stuttering, but they have many clues.
First, there is strong evidence that stuttering often has a genetic basis
—that is, something is inherited that makes it more likely a child will
stutter. This genetic “something” has to do with the way a child’s
brain develops its neural pathways for speech and language. For
example, the neural pathways for talking may be less dense and less
well developed in those who stutter. This could impede the rapid flow
of information needed to precisely sequence the movements of many
muscles needed for fluent speech. What’s more, the commands to
muscles must be coordinated with the many components of language,
including word choice, syntax, and semantics. The pathways may also
be vulnerable to disruption by other brain activity, such as emotions.
Isn’t it amazing that many of us learn to talk at 200 syllables per
minute, using huge vocabularies and complicated syntax and suiting
what we say to every particular situation!
Another clue about the nature of stuttering is that most stuttering
begins in children between ages 2 and 5. Thus, the onset of
stuttering occurs at about the same time that many typical stresses of
early childhood are occurring. One child may begin to stutter during a
dramatic growth in vocabulary and syntax. Another’s stuttering may
first appear when the family moves to a new home. Still another child
may start soon after a baby brother or sister is born. Many different
factors, acting singly or in combination, may precipitate the onset of
stuttering in a child who has a neurophysiological predisposition, or
inborn tendency, for stuttering.
Once stuttering starts, it may disappear within a few months, or it
may get gradually worse. When it gets worse, learned reactions may
be an important factor in its severity. Playmates at school or adults
who don’t know how to correctly respond may cause a child to
become highly self-conscious about his stuttering. The child will
quickly learn that by pushing hard, he can get traction on a word that
has been stuck. He may find that an eye blink or an “um” said quickly
before trying to say a hard word may avoid stuttering temporarily. By
the time a child is a teenager, learned reactions influence many of the
symptoms. He has learned to anticipate stuttering and may thrash
around in a panic when he speaks, trying to escape or avoid it. By
adulthood, his fear of stuttering and his desire to avoid it can
permeate his lifestyle. An adult who stutters often copes with it by
limiting his work, friends, and fun to those situations and people that
put few demands on speech. Figure 1.1 provides an overview of many
of the contributing factors in the evolution of stuttering. In this and
the subsequent four chapters, I’ll describe in detail our current
understanding of these influences.
Figure 1.1 Factors contributing to the development
of stuttering.

Can Stuttering Be Cured?

As implied above, it often cures itself. Many young children who begin
to stutter recover without treatment. For others, early intervention
may be needed to help the child develop typical fluency and prevent
the development of a chronic problem. Once stuttering has become
firmly established, however, and the child has developed many
learned reactions, a concerted treatment effort is needed. Good
treatment of mild and moderate stuttering in preschool and early
elementary school children may leave them with little trace of
stuttering, except perhaps when they are stressed, fatigued, or ill.
Most of those who stutter severely for a long time or who are not
treated until after puberty achieve only a partial recovery. Some of
these people are able to learn to speak more slowly or stutter more
easily and to be less bothered by their stuttering. Some, however, will
not improve, despite our best efforts.

DEFINITIONS
Fluency
By beginning with a definition of fluency rather than stuttering, I am
pointing out how many elements must be maintained in the flow of
speech if a speaker is to be considered fluent. It is an impressive
balancing act. Little wonder that everyone slips and stumbles from
time to time when they talk.
Fluency is hard to define. In fact, most researchers have focused
on its opposite, disfluency. (As I mentioned earlier in this chapter, I
use the term disfluency to apply both to stuttering and to typical
hesitations, making it easier to refer to hesitations that could be
either typical or abnormal.) One of the early fluency researchers,
Freida Goldman-Eisler (1968), showed that typical speech is filled
with hesitations. Other researchers have acknowledged this and
expanded the study of fluent speech by contrasting it with disfluent
speech. Dalton and Hardcastle (1977), for example, distinguished
fluent from disfluent speech by differences in the variables listed in
Table 1.1. Inclusion of intonation and stress in this list may seem
unusual. It could be said that speakers who reduce stuttering by
using a monotone are not really fluent. We would argue that it is not
their fluency but the “naturalness” of their speech that is affected.
Nonetheless, both aspects will be of interest to the clinician working
to help clients with all areas of their communication.

TABLE 1.1 Variables Useful in Distinguishing

between Fluent and Disfluent Speech*

*Suggested by Dalton and Hardcastle (1977).

Starkweather (1980, 1987) suggested that many of the variables that

determine fluency reflect temporal aspects of speech production.
These include such variables as pauses, rhythm, intonation, stress,
and rate that are controlled by when and how fast we move our
speech structures. So, our temporal control of the movements of
these structures determines our fluency. Starkweather also noted that
the rate of information flow, not just sound flow, is an important
aspect of fluency. Thus, a person who speaks without hesitations but
has difficulty conveying information in a timely and orderly fashion
might not be considered a fluent speaker.
In his description of fluency, Starkweather (1987) also included
the effort with which a person speaks. By effort, he means both the
mental and physical work a speaker exerts when speaking. This is
difficult to measure, but it may turn out that trained listeners can
make such judgments reliably. Moreover, mental and physical effort
may reflect important components of what it feels like to be a person
who stutters.
In essence, fluency can be thought of simply as the effortless flow
of speech. Thus, a speaker who is judged to be “fluent” appears to
use little effort when speaking. However, the components of such
apparently effortless speech flow are hard to pin down. As
researchers analyze fluency more carefully, they may find that the
appearance of excess effort may give rise to judgments that a person
is stuttering. However, other elements, such as unusual rhythm or
slow rate of information flow, may result in judgments that a person
is not a fluent speaker, but is not a stutterer either. I will discuss
aspects of fluency again when I relate some of the elements of
fluency, such as rate and naturalness, to various therapy approaches.

Stuttering
General Description
At first, stuttering may appear to be complex and mysterious, but
much of it is based on human nature and can be easily understood if
you think about your own experiences. In some ways, it is like a
problem you might have with a cell phone.
Imagine that you have a cell phone with intermittent problems,
such as not holding a charge, dropping calls, and dropping words in
the middle of a conversation. The listener may say, in an impatient
voice, “What did you say? I can hardly hear you.” Then momentarily
the connection may clear up and you feel relief, only to be followed
by exasperation when the call gets noisy again or is completely
dropped (Fig. 1.2).

Figure 1.2 Stuttering can be like having a cell phone

that doesn’t always work.

Compare this with the interruptions in communication caused by

stuttering. The typical behaviors of stuttering—repetitions,
prolongations, and blocks—often interfere with the smooth flow of
information. It’s not unusual, in my experience, for a listener to
respond to my stuttering by asking, “What did you say?”
Returning to the cell phone analogy: When you realize the listener
isn’t hearing you, you might resort to talking louder or slower or just
giving up and calling back later. Similarly, speakers who are stuttering
usually react to their repetitions, prolongations, or blocks by trying to
force words out or by using extra sounds, words, or movements in
their efforts to become “unstuck” or to avoid getting stuck.
Sometimes they just give up and say “Never mind.”
 If your cell phone calls were often hard to understand and calls
were often dropped, you would probably develop some bad feelings
about your phone. The first time it happened, you would be
surprised. Then, as it happened more and more, surprise would give
way to frustration. If you frequently had poor connections, dropped
calls, and not holding a charge, you would begin to anticipate
problems and become afraid they would happen whenever you tried
to make an important call.
The person who stutters goes through many of the same feelings
—surprise, frustration, dread. These feelings—in combination with the
actual difficulty in speaking—may cause the stutterer to limit himself
in school, in social situations, and at work. This might be similar to
your responses to a troublesome cell phone. After months of
problems, you would probably use a landline, e-mail, or other forms
of communication.
Another aspect of any description of stuttering involves specifying
what it is not. For example, an important distinction must be made
between the stuttering behaviors just described and typical
hesitations. Children whose speech and language are developing
typically often display repetitions, revisions, and pauses—which are
not stuttering. Neither are the brief repetitions, revisions, and pauses
in the speech of most nonstuttering adults when they are in a hurry
or uncertain. Chapter 7 describes the differences between typical
disfluency and stuttering in more detail to prepare you for the task of
differential diagnosis of stuttering in children.
A distinction should also be made between stuttering and certain
other fluency disorders. Disfluency resulting from cerebral damage or
disease or psychological trauma differs from stuttering that begins in
childhood. In addition, stuttering differs from cluttering, another
fluency disorder, which is characterized by rapid, sometimes
unintelligible speech. These other fluency disorders may be treated
somewhat differently than stuttering, although some of the same
techniques that clinicians use with stuttering are also useful with
these disorders. These other disorders are discussed in Chapter 15.
Core Behaviors
I have adopted the term “core behaviors” from Van Riper (1971,
1982), who used it to describe the basic speech behaviors of
stuttering: repetitions, prolongations, and blocks. These behaviors
seem involuntary to the person who stutters, as if they are out of her
control. They differ from the “secondary behaviors” that a stutterer
acquires as learned reactions to the basic core behaviors.
Repetitions are the core behaviors observed most frequently
among children who are just beginning to stutter. Repetitions consist
of a sound, syllable, or single-syllable word that is repeated several
times. The speaker is apparently “stuck” on that sound and continues
repeating it until the following sound can be produced. In children
who have not been stuttering for long, single-syllable word repetitions
and part-word repetitions are much more common than multisyllabic
word repetitions. Moreover, children who stutter will frequently repeat
a word or syllable more than twice per instance, li-li-li-li-like this
(Yairi, 1983; Yairi & Lewis, 1984).
Prolongations of voiced or voiceless sounds also appear in the
speech of children beginning to stutter. They usually appear
somewhat later than repetitions (Van Riper, 1982), although both
Johnson and associates (1959) and Yairi (1982). In contrast to my
use of the term, earlier writers include stutters with no sound or
airflow as well as stopped movement of the articulators in their
definitions of prolongations (e.g., Van Riper, 1982; Wingate, 1964).
Repetitions and sound prolongations are usually part of the core
behaviors of more advanced stutterers, as well as of children just
beginning to stutter. Sheehan (1974) found that repetitive stutters
occurred in every speech sample of 20 adults who stuttered. Indeed,
66 percent of their stutters were repetitions. Although many of their
stutters were also prolongations, as defined above, how many is not
clear, because Sheehan’s definition of prolongations seems to differ
from mine.
Blocks are typically the last core behavior to appear. However, as
with prolongations, some investigators (Johnson and associates,
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 TRANSCRIBER’S NOTES:
Obvious typographical errors have been corrected.
Inconsistencies in hyphenation have been
standardized.
Archaic or variant spelling has been retained.
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