An experimental treatment using verbal punishment with two preschool stutterers

OF FLUENCY

IOURNAL

225-233

(1977),

An Experimental

Treatment

Using Verbal

Punishment with Two Preschool Stutterers Charles

G. Reed

/ewish General Hospital,

Montreal,

Quebec

and

Anne 1. Godden McGill

Montreal, Quebec

University,

A multiple stuttering

base-line experimental children.

treatment was conducted with two preschool

Each child conversed 20 min with the experimenter

for 20

sessions. Treatment consisted of the presentation of the verbal stimulus “slow down” contingent upon a stuttering response. The percentage of words stuttered by both children decreased during the treatment sessions. Probe tape recordings conducted in each child’s home revealed a decrease in stuttering frequency.

INTRODUCTION

A prevalent

view

son et al., 1956; Riper,

in the literature Brutten

1971) suggested

stuttering

(Wischner,

and Shoemaker,

that punishment

in preschool children.

tal consequation child’s fluency.

1950; Sheehan, 1967;

is related

A potentially

Bloodstein,

1953; John1969;

Van

to the development

of

wide array of environmen-

has been considered to have an adverse effect on the Consequently,

the traditional

emphasis

in therapy with

the preschool child has often been placed on an indirect approach, via counseling

parents, aimed at reducing such consequation

as “stop and

start over, slow down, take a deep breath, etc.” However, Rosenthal,

several

1957;

and Martyn,

“spontaneous

Wingate,

1966)

1964;

recovery”

studies

Shearer and Williams,

indicated that direct environmental

(Glasner

and

1965; Sheehan consequation,

such as admonishment

to slow down, may be related to the cessation of

stuttering.

these results

Considering

@ Elsevier North-Holland, Inc., 1977

it was surprising

that there were so

225

226

Char/es C. Reed and Anne

few studies (1971)

involving

direct intervention

with

reported that positive reinforcement

ing in the majority

preschool

L. Ccdden

stutterers.

for fluency eliminated

Bar

stutter-

of his subjects but did not present data to substantiate

his claims. Martin et al. (1972) described the only reported experimental punishment The

procedure conducted with two stuttering preschool children.

experimental

task

response-contingent The stuttering

was

conversation

stimulus

was time-out

frequency of both children

with

a puppet,

from talking

and the

to the puppet.

was greatly reduced.

The purpose of this study was to investigate the effect of an experimental punishment children.

procedure

in reducing stuttering

in two preschool

It was decided that the effect of an environmental

stimulus,

one

that the child may encounter outside the clinic setting, should be investigated. Considering attributed

the reports that self-recovery

to having

contingent punisher

from stuttering was often

been told to speak more slowly,

the response-

chosen for this study was the verbal stimulus

“slow

down.” METHOD Apparatus All sessions

were conducted individually

in a quiet room in a hospi-

tal speech clinic. An audio recording (Sony, Model TC-252) each session

for word counts and reliability

was made of

checks. A variety of books

and pictures was used when necessary to stimulate

conversation.

Procedure Two

preschool

The response

children

classified

repetitions

and/or sound prolongations.

employed

to determine

for two 20-min

base-line design was

relationship

behaviors.

sessions

served as subjects.

of sound and syllable

A multiple

if a functional

treatment procedures and stuttering individually

as stutterers

class was defined as the emission

existed

Both children

between were seen

each week except session

6 for

subject A, which was 40 min in length. The children engaged in a spontaneous speech task with the experimenter baseline

had been established,

throughout all sessions.

the verbal stimulus

presented contingent upon a moment of stuttering.

“slow

down”

Once was

Experimental

Treatment with Verbal Punishment

227

Reliability Reliability

checks for word counts and judgments of stuttering were

conducted for each subject. An independent observer

recorded on a

protocol the number of words and amount of stuttering

emitted during

one randomly selected baserate recording for each child. Percentage of agreement was computed by dividing the number of agreements by the total number of judgments (agreements plus disagreement) and multiplying by 100. For subject A, the percentage of agreement for judgments of words spoken was 95%. sound and syllable

agreement was 98% syllable

repetitions,

The percentage of agreement for judgments

repetitions

was 97%.

of

For subject B, the percentage of

for word counts, 87% for judgments

of sound and

and 93% for judgments of sound prolongations.

RESULTS Subject A The subject was a 5-year, lo-month-old behaviors

consisted

male child whose stuttering

of frequent sound and syllable

repetitions

accom-

panied by facial tension. According to the parents’ report, subject A had been exhibiting

the stuttering behaviors for approximately

3 months prior

to treatment.

Treatment The first five sessions served as base-line sessions subject and experimenter

during which the

talked for 20 min. Subject A’s stuttering

fre-

quency varied from 6% to 9%, with a mean of 7%. After the first initiated.

10 min of session

Each time subject

down.” The verbal stimulus

6, the treatment procedure was

A stuttered,

the experimenter

ing behavior. After 20 min of treatment, extinction

was introduced, and

the verbal consequence “slow down” was discontinued min of the session. remaining

sessions.

during session

said “slow

was delivered contingent upon each stutterfor the final 10

The treatment procedure only was employed for the A graph of the frequency

of stuttering

per 2 min

6 (40 min) is shown in Fig. 1.

During the lo-min

base-line period, the mean percentage of words

228

Charles C. Reed and Anne L. Codden

BASELINE

4

j

‘SLOW

12

8

16

DOWN’

20

24

EXTINCTION

28

32

36

40

MINUTES

Percentage of words stuttered by subject a each two minutes during

Figure 1.

session 6. stuttered was 8%. “slow down,”

Coincident with the introduction

of the verbal stimulus

stuttering frequency decreased and remained below base-

rate level during the remainder of the treatment period. The mean percentage of words reduction

stuttered during

in stuttering

verbal stimulus

treatment was 4%,

frequency.

representing

a 50%

Removal of the response contingent

during the final 10 min of the session resulted in a gradual

increase in stuttering

frequency,

with

11% disfluency

during the final 2

min of the session. Results of the treatment program are presented in Fig. 2. Stuttering frequency decreased with the beginning of treatment, and gradually declined

during

the 15 treatment

reached a level of l%, sessions.

sessions.

This

reduction

which remained stable throughout

in stuttering the final three

Facial tension had disappeared.

Word

counts

revealed that the reduction

in percentage of words

stuttered during the treatment condition was paralleled by reduced word output. The mean number of words spoken each session during baseline was 1,198.60,

while the mean number of words spoken during treatment

sessions

1,039.46.

was

This

represented

a change of 13.27%

from

baseline to treatment. So that carry-over conversation

could be assessed, tape recordings

of a 20-min

at home were obtained after sessions 6, 11, 16, and 20. The

Experimental

Treatment

229

with Verbal Punishment

child’s mother recorded the sessions.

The data appear in Fig. 2. Stuttering

frequency remained above treatment session level, but declined to a level of 3% subsequent to session months following session

was 1%.

termination

20. A final probe session was conducted 8 of treatment. Subject A’s stuttering

for the

The second probe recording lasted 11 min; the others

were all 20 min in length. Subject

B

Subject B was a 3-year, 9-month-old

female child whose stuttering

behaviors were more severe than those of subject A. Stuttering of sound and syllable

repetitions

and sound prolongations

“SLOW

BASELINE 1Or 0 6 4 2

consisted

accompanied

DOWN”

A

Y,/’

\

./* u: .-.\ %-.

/

se c I I ,/A / -*:

.-.

CLINK SESSIONS

SESSIONS

Figure 2. session

Percentage of words stuttered by subject a and subject b each clinic

(closed circles) and (open circles).

C. Reedand

Charles

230

by marked muscular effort. Parental interview been stuttering

1 month before initiation

Anne

L. Codden

revealed that the child had

of the experimental

procedures.

Treatment The procedure followed for subject A. However,

with subject 6 was essentially

base-line

conditions

sions. The treatment procedure was employed for sessions and “slow

down”

was contingent

the same as

were in effect for 10 ses-

upon the emission

11 through 20

of stuttering

be-

havior. A graph of stuttering

frequency during base-line and treatment ses-

sions is shown in Fig. 2. Subject B’s stuttering

frequency during baseline

was greater and more variable than that of subject A. The percentage of words stuttered varied from 11% Upon

introduction

to 27%,

down” at the beginning of session 11%.

with a mean of 18%.

of the response-contingent 11, stuttering

The percentage of words containing

during session sions.

12, and then declined

Reduced stuttering

sessions

frequency

stimulus

“slow

frequency decreased to

disfluencies

increased again

steadily during the remaining remained

relatively

ses-

stable during

14 to 18, with the percentage of words stuttered varying from 4%

to 6%, and decreasing to 1% during session 20. Excessive muscular

effort

had gradually disappeared. Word counts revealed a slight increase in word output from baseline to treatment.

The

mean number of words

baseline was 489.80,

while

treatment was 532.44.

This

spoken each session

during

the mean number of words spoken during represented a change of 8.70%

from baseline

to treatment. Twenty-minute

tape recordings

of conversation

tained by the subject’s mother following data appear in Fig. 2. Stuttering 22%

sessions

at home were ob-

6, 11, 16, and 20. The

frequency decreased dramatically

from

in the first tape to 8% in the second, remained at that level during

the third

recording,

follow-up

probe 8 months subsequent

vealed stuttering

and decreased to 2%

for the fourth

recording.

to the final treatment session

A re-

of 0.60%.

DISCUSSION The results of this study indicate that presentation “slow

down”

contingent

upon a stuttering

of the verbal stimulus

response

served as punish-

Experimental

ment

Treatment

with Verbal

Punishment

231

in that it suppressed the frequency of the behavior. Data obtained

from analysis of the home probe tape recordings suggest that the subjects were becoming more fluent outside the clinic. The finding that stuttering can be manipulated by a response-contingent

stimulus

lends support to

the operant paradigm postulated by Shames and Sherrick At the conclusion

of their report on a time-out

(1963).

procedure with two

preschool stuttering children, Martin et al. (1972) considered the possibility that the children’s maturation,

stuttering

or as a result

many sessions.

may have reduced simply

They argued against these explanations,

tering frequency was relatively decreased dramatically

as a result of

of talking with the puppet and others for so stating that stut-

stable in the baserate session,

and then

coincident with the onset of the time-out

dure. The use of a multiple

proce-

base-line procedure in this study provided

further verification

that the reduction of stuttering frequency was a result

of the introduction

of the response-contingent

tation of “slow subject

B had five additional

frequency

stimulus.

While

base-line

sessions.

Subject

remained at a high level during these sessions,

A’s stuttering

the presen-

down” began for subject A after five base-line sessions,

behaviors

steadily

quency did not systematically

decreased. Subject

B’s stuttering while subject

B’s stuttering

decrease until after session

fre-

11, when the

“slow down” treatment procedure was introduced. The efficacy of the treatment procedure is demonstrated not only by the multiple

base-line design, but also by the design of subject A’s first

treatment session. The stable frequency of stuttering during baseline, the steady reduction during the treatment period, and the increase in stuttering during extinction

demonstrated that the reduction was in fact brought

about by presentation of “slow down” contingent upon the occurrence of a d isfluency. Brutten

and Shoemaker

havioral disintegration

lated that the responses fluency

conditioning.

They

described

argued that primary

act like operant responses

failure

as be-

and the associated dis-

a process of classical stuttering

are resistant to intrumental

tained in the experiment

fluency

from negative emotional ity, and postu-

of negative emotion

are learned through

and prolongations,

(1967)

resulting

under punishment contradict their

behaviors,

manipulation conditions.

hypotheses.

exhibited by the children consisted of repetitions were reduced by response-contingent

rather than operant

punishment.

repetitions and do not

The data ob-

The disfluencies

and prolongations

and

Charles C. Reed and Anne 1. Codden

232

Johnson (19611,

Luper and Mulder

advised against direct intervention

(1964),

and recommended an indirect or environmental These

authors

emphasized

(1969) stutterer,

approach to treatment.

that efforts should

child from becoming self-conscious

and Bloodstein

with the young, beginning

be made to prevent the

or aware of his disfluency.

According

to their arguments, calling a child’s attention to his stuttering,

by correct-

ing him with suggestions

such as “slow down,”

can only serve to make

the child anxious about his speech, and bring about an increase in stuttering frequency. ments,

Martin et al. (1972) questioned the validity

observing

that in their

of these argu-

study a marked reduction

in stuttering

occurred despite the fact that the attention of both children was directed toward their stuttering.

One child was obviously

aware that the puppet

stopped talking because he had stuttered. The results of this study support the suggestion of Martin et al. (1972) that drawing a child’s attention to his stuttering does not necessarily in an increase reduction. “slow

in stuttering

The children

behavior,

result

and may in fact bring about a

were not informed

that they would

down” each time they emitted a disfluency.

demonstrated awareness of the contingency.

However,

be told to subject A

His mother, a stutterer her-

self, reported that subject A began to tell her to slow down each time she was disfluent.

The experimenter

observed this on several occasions. Al-

though no objective measure of anxiety was taken, the experimenter’s subjective impression

is that there was no negative reaction to the punish-

ing stimulus. Interview stuttering

data obtained in studies

revealed that a number

bn spontaneous

of individuals

recovery from

who recovered spon-

taneously attributed their recovery to having reduced their speaking rate. In this study, telling the children

to “slow down” was effective in reduc-

ing stuttering frequency. Records of word counts per session were kept in order to investigate the degree to which the subjects actually did decrease their rate of speaking. The mean number of words spoken by subject A decreased during treatment, while the mean number of words spoken by subject B increased. The data for subject

B suggest that an actual rate

reduction was not necessarily

for the fluency

responsible

changes.

The data presented in this study indicate that verbal punishment stuttering

in two young children was not detrimental,

reduction of stuttering

frequency. The findings

of

and did result in a

raise intriguing

questions

Experimental

Treatment

concerning

theories

and

contradict

with Verbal Punishment

of the development

currently

held

233

of stuttering

beliefs

about

in young

therapy

children,

for the beginning

stutterer. References Bar, A., The shaping of fluency 1971,

Dis., Bloodstein,

O., A Handbook

for Crippled Children Brutten,

/. Speech

Johnson, W., Brown, Johnson,

Luper, H., and Mulder,

Dis.,

and What

Hearing

1965,

Sheehan, J., Theory Sheehan,

1953, Hearing

Van Riper,

Harper

of stuttering

in young

& Row, 1956. It. Danville,

Ill.:

Interstate

Englewood Cliffs, N.J.:

S. An experimental

/. Speech

C., A discussion Dis.,

15, 743-752.

of nonfluency and stuttering as operant

1963,

J. D.,

treatment with two

Res., 1972,

Hearing

28, 3-18.

Self-recovery

from

stuttering.

/. Speech

30, 288-290.

and treatment of stuttering as approach-avoidance conflict. 1. 36, 2749.

J. G., and Martyn,

Speech

diagnosis

22, 288-295.

Therapy for Children.

children.

and Williams,

Dis.,

Psycho/.,

1957,

P., and Haroldson,

stuttering

M.,

Englewood Cliffs,

inc., 1961.

behavior. /. Speech Hearing W.

of Stuttering.

You Can Do About

R.,Stuttering

Shames, G., and Sherrick, Shearer,

Easter Seal Society

1964.

R. R., Kulh,

preschool

D. J. Parental

(rev. ed.). New York:

and Publishers,

Prentice-Hall,

Chicago: National

1969.

D., The Modification

Hearing

W., Stuttering

Printers

/. Commun.

S., Curtis, J., Edney, C., and Keaster, J.,Speech Handicapped

Children

School

of stuttering.

1967.

P. J., and Rosenthal,

children.

Martin,

on Stuttering.

and Adults,

E., and Shoemaker,

N. J.: Prentice-Hall, Glasner,

not the modification

4, l-8.

M. M.,

Res., 1966,

Spontaneous

recovery

from

stuttering.

1.

9, 121-135.

C., The Nature of Stuttering.

Englewood

Cliffs,

N.J.:

Prentice-Hall,

1967. Wingate,

M. E., Recovery

from

stuttering.

/. Speech

Hearing

Dis.,

1964,

29,

312-321. Wischner,

G., Stuttering behaviour and learning: a preliminary

lation. 1. Speech

Hearing

Dis.,

1950,

15, 324-335.

theoretical formu-