WHAT IS A PULL-OUT?
- A speech tool used in the moment of a disfluency
- This strategy is considered a "stuttering modification" tool.
- It requires you to catch a word that you are stuttering on and slide/stretch out of it (AKA “get on the sound”).
A pull-out is a speech tool I use with clients as they gain the ability to monitor and change their stuttering. Once a client demonstrates the ability to use cancellations, I will introduce the idea of pull-outs. It is important to note that a person does not "graduate" from using cancellations to pull-outs, but will rather integrate the two strategies. A person will call upon one tool over the other depending on how quickly they "catch" a particular disfluency.
WHAT IS A PULL-OUT?
After spending the entirety of this week telling clients and colleagues about Katherine Preston's book, "Out With It: How Stuttering Helped Me Find My Voice", I figured it only made sense to shamelessly plug it on my website! Besides being beautifully written, I found this book to be a wonderful resource in informing people who stutter (PWS) and parents of PWS on the trials and tribulations often experienced in a person's search for fluency.
For much of my childhood I made promises. I promised myself that I would change, that I would rid myself of my stutter. For much of my life I believed, unfairly, that it was simply a matter of willpower. Over the years I would watch myself fail at fluency, and every morning I would wake up with the dangerously impractical resolution that today would be different, that I would be stronger, that I would force my speech into submission. I stubbornly clung to that hope that one day I would wake up and the stutter would have simply disappeared. (excerpt from "Out with It: How Stuttering Helped Me Find My Voice" by Katherine Preston)
Developmental stuttering affects 1% of the population and over 3 million individuals in the USA. However, there are other, lesser known fluency disorders that include neurogenic stuttering and cluttering. Today's blog will turn its focus to cluttering and take a brief look at the process of identification and treatment.
Complex Definition Alert!
Currently, the International Cluttering Association defines cluttering as "...a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular or both for the speaker. These rate abnormalities further are manifest in one or more of the following symptoms: an excessive number of disfluencies, the majority of which are not typical of people who stutter; the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words. " (St. Louis, Myers, Bakker, & Raphael, 2007).
So what does cluttering look/sound like?
1. Often people who clutter have what I (and many other SLPs) refer to as "machine-gun" speech. Their speech comes out in rapid bursts, which is described above as "irregular rate", and may include pauses where it doesn't feel appropriate.
2. A person who clutters may also demonstrate disfluencies that are unlike what we see in people who stutter. Some examples of disfluencies that are more typical of a person who clutters is excessive phrase repetitions and revisions, whole word repetitions, unfinished words, and interjections (i.e. um, well, etc.)
3. Coarticulation refers to when a person collapses or omits a syllable of a word (i.e. "wuffel" for "wonderful").
4. People who clutter may also omit words altogether (i.e. I went the park yesterday)
"Trick" is defined by the Merriam-Webster Dictionary as "a crafty procedure or practice meant to deceive or defraud." So it makes sense why speech pathologists have used the word "tricks" (AKA secondary behaviors) to describe the behaviors a person who stutters (PWS) uses to avoid, hide or get out of a moment of stuttering. The clip above is an interview with the actor, Samuel L. Jackson, as he discusses one of his "tricks" as a child to hide his stuttering. Some common tricks I see amongst my clients are eye blinks, tensing up the face or mouth, pretending to think, yawning, and using a silly voice. It is very important not to confuse "tricks" with strategies (i.e. easy speech, cancellations, etc.) Strategies are voluntary and intentional changes made to one's speech that work to assist a PWS in creating more forward-moving speech and reducing the frequency and severity of disfluencies. "Tricks" may initially disguise themselves as helpful strategies, but with time, PWS learn that the very behavior that initially helped them, may actually be causing more harm then good! Let's walk you through how "tricks" begin and where they go wrong!
For the sake of example, let's use the behavior of eye blinks.
Although researchers are gradually learning more about stuttering and its cause/s, there is still a lot that remains a mystery. With "the unknown" comes room for parents to try and fill in the gaps with their own guesses as to what caused their child to begin stuttering. One of the questions I most often hear from parents is "Is it something I did?" The answer is a resounding "NO!"
What We Know:
1. Genetics- approximately 60% of people who stutter have a close family member that stutters as well. In addition, recent research by Dr. Dennis Drayna has identified three genes as a source of stuttering in families studied.
2. Neurophysiology- brain imaging studies have indicated that people who stutter may process language in different areas of the brain than people who do not stutter.
3. Child development- children with developmental delays or other speech/language disorders are more likely to stutter. (Note: By no means, is this implying that all people who stutter have delays in other areas. There is simply an increased likelihood of stuttering in children with developmental delays and language disorders.)
4. Family dynamics- high expectations and fast-paced lifestyles may play a role in stuttering
Family Dynamics?? I Thought I Wasn't the Cause??
You're not! There are plenty of "fast-paced" families out there that do not have children that stutter. However, there are certain environments that may exacerbate disfluencies in a child who already has the increased propensity to stutter.
DISCLAIMER: The purpose of this website is to act as an educational aid and address common topics associated with stuttering. It is not intended to replace the need for services provided by a licensed speech pathologist who can tailor treatment to an individual's needs.