One commonly accepted view on stuttering is that it takes three forms: repetitions (like bu-bu-burger), prolongations (like sssssssssstuttering), and blocks, where voicing/sound is absent. I would like to suggest that it is possible that in many cases,“blocks'' are not actually stuttering, but rather the body’s way of avoiding an overt, noticeable stutter. Hear me out!
When young children first start to stutter, it tends to be comprised primarily of repetitions of sounds and syllables, with prolongations coming next. While a small percentage of children show blocks very early on, the majority only develop blocks over time, and only after they have started to have some awareness that something is different about their speech.
Once the child has received negative reactions to their overt stuttering, it is as if the body instinctively reacts by successfully “silencing” the stutter; hence, a block. The mind begins forming a core belief that stuttering is not good, and the body responds by making sure the stuttering isn’theard.
In Avoidance Reduction Therapy for Stuttering (ARTS), an approach developed by Vivian Sisskin, we assess situational and word avoidances, and also examine the crutches (e.g. eye blinking, facial tension, lip quivering, hand tapping, etc.) that the individual has developed over time. These secondary behaviors are not considered stuttering. Instead, they are ‘tricks’ the body has discovered to break through stuttering moments.
In an ARTS framework, avoidance behaviors include postponements such as “running back” to repeat a sound or word, and using circumlocutions or word substitutions. These behaviors initially helped the person move through a stutter, and that reinforcement (reward) made the behavior become a new habit. For example, some people add starters such as “um” to build the momentum to get over the stuttering ‘hump’.
Similarly, others avoid an audible stutter by coming to a dead stop before a stuttered word. This “block”/cessation of voicing is how the body waits for the moment of disfluency to pass. We may not be able to differentiate this “dead stop” from a stuttering block.
Why Call It An Avoidance? Isn't It Just A Form of Stuttering?
You might be questioning applying the term “avoidance behavior” to blocks because it implies that the speaker is actively trying to avoid the stuttering moment by shutting down voicing. I propose that an avoidance behavior can become such a strongly conditioned, ingrained response to the anticipation of a stutter, that this instinctive behavior seems to actually be the stutter. But, just as your arms extend reflexively when you trip so you don’t hit your face, reactions to stuttering happen without consciousness. Unlike reflexes, with some conscious attention, blocks can often be changed.
Anecdotal reports add more evidence. People who stutter often describe feeling like when they detect a potential stutter, a “red light” comes on and there is silence until the light changes to green as fluency is regained. If you observe people’s stuttering patterns, you will notice that once a hard block is over, the word comes out fluently. The fluency that follows blocks becomes the very reinforcement (reward) that leads to this ingrained habit.
Most people who stutter show variability when it comes to their stuttering. Many describe their stuttering as generally forward-moving (and audible) in situations where they are ‘comfortable’ speaking and more ‘blocky’ (and silent) in situations where they are not. This further suggests that when people are in situations where they do not feel comfortable stuttering openly and/or have been triggered to feel a desperate need to be fluent, they are more likely to revert to avoidance behaviors in general, blocking being the physical manifestation.
All of this is in line with the physiology of fear. As a species, we evolved to display protective reactions in response to perceived threats. We have both a ‘freeze’ response, and a “fight or flight” response. These responses involve blood rushing to areas of the body that bring about speed and strength, and away from those involved in rational thought and decision making.
If you stutter, your body doesn’t know the difference between the danger of being attacked and the danger of stuttering. The vocal cords tighten as adrenaline increases along with overall muscle tension and physiologic activity. All people are prone to feeling a “lump in their throat,” reflecting the tightening in and around the vocal cords. For those who stutter, when the ‘danger’ of stuttering becomes excessive, the cords slam shut, making air flow/phonation (sound) impossible to produce. Doesn’t this sound like a block?
This dynamic can be explored therapeutically. For the individual whose blocks may be at least in part related to automatic stuttering avoidance, we strive to help them work toward stuttering more openly. At AIS, we use cognitive therapy to shift core beliefs that precipitate tense blocks such as “If others hear me stutter, they will think less of me” or “I must work to hide my stuttering.”
In addition, referencing avoidance reduction therapy, we would establish a hierarchy for changing avoidance behaviors including “showing up” to challenging speaking situations and, later, saying what one really wants to say, without changing words. As individuals work on desensitization to stuttering - changing unhelpful core beliefs, abandoning stuttering avoidance behaviors, and accepting themselves unconditionally - they come to stutter with more flow and less struggle.
Here are some possible steps you can take to explore these ideas:
Create a list of specific speaking situations that you avoid, with lower-stakes situations at the bottom and highly stressful ones at the top. Start with a situation that would be a challenge but not overly emotionally draining for you and make a point to allow yourself to stutter while you complete the task. Congratulate yourself for completing the challenge, regardless of your fluency.
Try self-disclosing that you are a person who stutters at the beginning of several conversations. Notice how you feel after you self-disclose. You will likely find that some of the pressure is reduced, which often leads to easier stuttering.
Try to add some sound back to those silent blocks. You DO NOT need to say words fluently and you DO NOT need to make sure others don’t see or hear tension. The point of this exercise is to give yourself permission to touch the moment of stuttering without recoil. Over time, many people find that their blocks are naturally reduced over time.
Of course, these are very nuanced concepts and not easy to incorporate independently. At AIS, we are available to assist you in this journey to understanding your unique stuttering pattern. We also encourage you to connect with others who stutter. For many people who stutter, learning that it really is ok to stutter and connecting with other amazing people who do is what makes all the difference in the world.
The American Institute for Stuttering is a leading non-profit organization whose primary mission is to provide universally affordable, state-of-the-art speech therapy to people of all ages who stutter, guidance to their families, and much-needed clinical training to speech professionals wishing to gain expertise in stuttering. Offices are located in New York, NY, Atlanta, GA, and Los Angeles, CA, and services are also available online. Our mission extends to advancing public and scholarly understanding of this often misunderstood disorder.
Executive Director, Board-Certified Specialist in Fluency Disorders
Dr. Heather Grossman is one of a small number of speech language pathologists holding a PhD in fluency disorders who works primarily in a clinical setting. For more than 25 years, she’s worked tirelessly to help people who stutter to speak freely and live fearlessly.