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Attention and stuttering: Do stutterers think too much about speech?
/OURNAL
OF FLUENCY
7 (1982),
DISORDERS
309
309-321
Attention and Stuttering: Do Stutterers Think Too Much About Speech? Alan C. Kamhi and Thomas G. McOsker Case Western
Reserve University,
In this investigation
C/eve/and,
Ohio
the ability of stutterers
and nonstutterers
to simultaneously
perform speech and nonspeech tasks was compared. Subjects were 10 stutterers and 10 nonstutterers.
Two
experiments
performed a non-attention-demanding the second, prehension)
subjects
performed
In the first,
subjects
task while they read aloud. In
an attention-demanding
during speech. Results
in the disfluency
were conducted.
gross-motor
task
(reading com-
indicated that there was no significant change
values of stutterers during the motor activity or as a result of the
reading comprehension
task. However,
cantly poorer than nonstutterers
stutterers
were found to perform signifi-
on the reading comprehension
was taken as evidence that stutterers
task. This finding
devote more attention to speech than do
nonstutterers.
INTRODUCTION It has often
amount comments
thinking
about
about
attention
research
Anecdotal how play
investigating
way
that its frequency
give
to their
reports
from
stuttering
or attending
might
stuttering
stutterers
1981).
Bloodstein,
One
been said about
of attention
decreases
there
the relationship
to evaluate
this
stutterers
to simultaneously
stutterers
devote
perform
task during
The previous
Address Pathology,
surprisingly
little
and stuttering. the
ability
task during
of attention
is not role that
speech,
to speech,
than nonstutterers
of If
such
performing
speech.
research
correspondence
Memphis
the
include
stutterer
attention
a nonspeech
studies should find that stutterers are poorer a nonspeech
the
is to determine
amount
with
invariably
has been
between
relationship
a disproportionate
stutterers
when
varies
(see, for example,
In light of the important
to speech.
in stuttering,
speech
in this area for the most part supports
to Alan G. Kamhi,
State University,
@Elsevier Science Publishing Co., Inc., 1982 52 Vanderbilt Ave., New York, NY 10017
Department
of Audiology
807 Jefferson Ave., Memphis,
TN
this
and Speech
38105.
0094-730x/82/030309-1
3$02.75
A.C. Kamhi and T.C. McOsker
310
view. For example, an early study by Herren (1931) found that stutterers had difficulty
voluntarily
speech. A correlation stuttering
extending
and flexing
their
hands
was noted between the duration
during
and severity
of
and stutterers’ ability to perform this motor action. Some years
later, Froeschels
and Rieber (1963)
noted that stutterers
had significantly
more trouble perceiving both visual and auditory stimuli than normal speakers. These findings affected perceptual functioning. studies (Perkins,
1969;
during speech
suggested that stuttering
Bloodstein
(1981),
however,
adversely cites two
Hugo, 1972) which did not confirm these findings
and suggested that perceptual difficulties
might be an extreme symptom
of stuttering. A study by Ringel
and Minifie
(1966)
productive and receptive communication
investigated
to estimate the passage of time, i.e., “protensity” Minifie
found
protensity with
that the severity
judgments
of stuttering
judgments.
(1967) found that writing
poorer
Ringel and
significantly
and suggested that it was stutterers’
speech that caused their
the effects of
activities on stutterers’ abilities
performance.
influenced
preoccupation
Finally,
Fransella
down a series of tape-recorded numbers while
reading aloud had no effect on stuttering. The
literature
than nonstutterers
in this area suggests that stutterers performing
are often poorer
speech and nonspeech tasks simultane-
ously. In these instances, stutterers apparently are not able to attend to the nonspeech task as well Hicks,
as nonstutterers.
It is known
1978) that humans possess only a limited
(Kinsbourne
attention and that efficiency on an attention-demanding when
this
task
is
performed
demanding task. Quite amount
of attention
simultaneously
possibly,
towards
stutterers
speech,
and
amount of functional
with
task is often lost
another
attention-
devote an abnormally
resulting
in a reduction
high of the
amount of attention that can be directed towards the nonspeech task. Alternatively,
attention towards speech might be excessive
only during
moments of stuttering. We are not entirely
comfortable
with the profile of stutterers
emerges from these studies and the implications relationship a group
between attention and stuttering.
of stutterers
who
that
this profile has for the
Although there might exist
have difficulty
coordinating
speech and
nonspeech activities and, therefore, probably are preoccupied attentively towards
speech,
we would
like
to believe
that this
difficulty
and
preoccupation are not representative of the entire stuttering population.
Attention
and Stuttering
311
To substantiate
this belief, two experiments
compared the ability
of stutterers
were conducted that
and nonstutterers
perform speech and nonspeech tasks.
In the first
to simultaneously
experiment,
performed a simple,
repetitive gross-motor
It was hypothesized
that the speech of stutterers and nonstutterers
subjects
activity while readling aloud. would
not be adversely affected by the motor activity because the activity did not require higher-level most simple gross-motor
mental processes. Although to carry out even the activities some attention is required, the motor-
activity in this experiment was assumed to be a non-attention-demanding task since it did not involve higher-level experiment,
the same subjects,
task (reading comprehension)
while
mental processes. In the second also reading aloud, performed a
that required
higher-level
mental
cesses. It was predicted that this task, an attention-demanding
pro-
one, would
either adversely affect stutterers’ speech or itself be adversely affected by the speech task. In other words, we hypothesized
that stutterers
would
either experience a decrease in fluency or perform poorer than nonstutterers on the reading comprehension
task.
METHOD Subjects Subjects were ten stutterers, mean age of 31.9 yr (range 18-66
eight males and two females, with a yr) and ten nonstutterers,
six males and
four females, who had a mean age of 27.3 yr (range 19-45
yr). None of
the stutterers had any history of neurological problems or chronic hearing loss. At the time of testing, these subjects had just begun an intensive therapy program at the Cleveland Hearing and Speech Center. All testing was conducted during the first week of the program to control for the possible effects of therapy. Severity of stuttering
ranged in these subjects
from mild (4) to severe (2), based on frequency measures of stuttering oral reading and spontaneous speech. Finally,
in
none of the nonstutterers
evidenced any history of speech, language, or hearing problems. Experiment
1
In this experiment
subjects read portions
of the Rainbow
before, during, and after performing a simple gross-motor
Passage
activity. For all
A.C. Kamhi and T.C. McOsker
312
but four subjects, two stutterers
and two nonstutterers,
stepping up and down a IO-in
high, 4-ft square table. The other four
subjects performed less strenuous
“toe-raisers”
the activity was
either because they were
in poor physical condition or because of their age. Subjects,
seated, were tirst
asked to read the first
third
of the
Rainbow Passage aloud. Baseline fluency data were obtained from this reading. Subjects then familiarized one minute. instructed
Next,
subjects
themselves
were
with the motor activity for
handed the Rainbow
to read the second third of the passage while
perform
the motor activity.
The
experiment
concluded
Passage and continuing with
to
subjects
reading the final portion of the Rainbow
Passage. Each portion of the
Rainbow Passage contained approximately
110 words.
Disfluencies
were noted during the actual testing by two scorers, in
most cases the two authors.
In some instances,
however,
a graduate
student in speech pathology served as the second scorer. Since we were interested in measuring the increase in “stuttering,” have been shown to be characteristic of stutterers
only disfluencies
that
were scored (Williams
et al., 1968; Curran and Hood, 1977). These included sound and syllable repetitions, pauses,
prolongations,
inaudible and audible fixations,
and disrhythmic
interjections). resolved
by listening
inaudible fixations validation
phonations
Differences
Experiment
broken
scoring
to audio recordings
were initially
involving
(e.g.,
in the initial
agrammatical
words
and tense
of disfluencies
of the testing
sessions.
were All
marked as such and were not subject to
the audio recordings.
2
In this experiment, about the content
subjects
of four
were asked to respond to questions
reading passages after having
read these
passages aloud. An attempt was made to determine the effects of attention on reading comprehension variable. This
by experimentally
was done by not forewarning
manipulating
the attention
subjects that reading com-
prehension questions would be asked. instead, subjects were told that the experiment
was investigating
After the first questions
the effects of multiple
reading of the first
passage, six
were asked, much to the surprise
nonstutterers.
When
readings on speech.
reading comprehension
of both the stutterers
the reading comprehension
questions
and
were asked
Attention
and Stuttering
after the subsequent prised.
The
313
passages, subjects
knowledge
were of course no longer sur-
that reading comprehension
was going to be
evaluated presumably affected a subject’s attention to the content of the subsequent
passages read. Whereas
might be minimal
attention
to the reading content
for the first passage, it should be increased during the
reading of the subsequent passages. The design of this experiment
thus
made it possible to determine the effects that attention to a nonspeech task (reading comprehension)
had not only on the performance of the
nonspeech task but on speech as well. nonstutterers
If stutterers
are in fact inferior
to
on tasks performed during speech, then there should be an
inverse relationship
between their reading comprehension
scores and a
measure of fluency. As fluency improves, reading comprehension
should
become poorer and vice versa. As part of another study which stuttering,
examined
all subjects read four phonetically
three times each. Only
the first
the phonetic factor in
weighted passages at least
readings were analyzed in the current
study. The reading comprehension
questions were always presented after
the first reading. The presentation of the passages was counterbalanced for the two groups of subjects. Whether or not the phonetic factor affected subjects’ speech or reading comprehension
scores was considered in the
analyses of the data for this experiment. RESULTS Experiment
1
Data in the form of number of disfluencies stutterers
and nonstutterers
for each portion
were calculated for
of the Rainbow
Passage.
Recall that the first portion of the Rainbow Passage was read before the subjects began the motor activity, the second portion, during the motor activity, and the third portion, with subjects again seated. The data for this experiment are presented in Table 1. In examining these data, it is evident that performing nonstutterers,
the motor activity
as no nonstutterer
had little
effect on the speech of
had more than two disfluencies.
In
contrast, performing the motor activity appeared to have some effect on the speech of several stutterers,
though group differences
values across the three conditions
in disfluency
proved to be insignificant
[Wilcoxon
4.C. Kamhi and J.C. McOsker
314
TABLE 1 Data for ExDeriment
1 Disfluencies
Subject
Sex
Age
Before
After
During
Stutlerers
1.
la
M
0
4
2.
19
M
5
28
ia
4
3.
20
M
11
14
19
4.
24
M
1
0
0
5.
25
M
I
2
6.
25
F
1 0
0
1
7.
30
M
6
4
6
33
F
24
35
46
60
M
9
6
16
66
M
12
17
a.2 9. 10.”
15
Mean
6.9
10.9
12.7
SD
7.5
12.4
13.8
Nonstutterers
1.
19
M
0
0
0
2.
19
M
0
2
0
3.
21
M
0
2
0
4.
22
F
0
2
0
5.
24
F
0
0
0
6.
29
M
0
0
0
7.
30
F
0
0
0
a.
31
M
0
2
0
9.a 10.”
33
F
0
0
0
45
M
1
0
0
Mean
0.1
0.8
0.0
SD
0.3
I.0
0.0
‘Performed “toe-raisers.”
Matched standard stutterers.
Pairs
Signed-Rank
deviations The
or toe-raisers)
type of action appeared
who
performed
jects
in the study.
Test,
indicated
p>O.lO
considerable performed
not to contribute
toe-raisers
had disfluency
(Siegel,
1956)J.
variability
(stepping
up and down
to this variability values
in this
The
high
group
of
the table
as the subjects
resembling
other
sub-
Attention
and Stuttering
The individual disfluencies
315
subject data indicated that six stutterers
in the reading following
had more
the motor activity than in the reading
during the motor activity. Only one stutterer (No. 2) clearly was affected adversely by the motor activity, his frequency of stuttering
increasing by
more than five times during the motor action. When the motor activity was terminated,
however,
his frequency
of disfluencies
decreased by
almost half. In contrast to this subject, three subjects (Nos. substantially
more disfluencies
after the motor activity
3,8,9)
had
than during
it,
indicating that their speech was influenced not only by the motor activity but by some indeterminable
factor as well (e.g., increased blood pressure
or pulse rate, fatigue, relaxation of speech controls, etc.). Experiment Withinexperiment.
2
and between-group First
comprehension the stutterers
examined
comparisons
was the effect knowledge
task had on each group’s comprehension
nor the nonstutterers
their reading comprehension
of the reading scores. Neither
were found to significantly
xon Matched Pairs Signed-Rank
Test, p>O.lO). comprehension
nonstutterers’
in this
increase
scores with knowledge of the task (Wilco-
of the
reading
knowledge of the comprehension stutterers’
were possible
Nevertheless, scores
all but one
improved
with
task (see Table 2). In contrast, only two
reading comprehension
scores improved with knowledge of
the task. Clearly, most of the stutterers were not affected in the same way as nonstutterers
by knowledge of the reading comprehension
task.
Our next analyses compared the two groups’ performance on the reading comprehension tween stutterers
task. No significant
and nonstutterers’
initial
difference was found be-
reading comprehension
scores
(i.e., without knowledge of the task). The fact that there was no difference between these scores can be taken as evidence that the two groups had comparable reading comprehension
abilities. This initial comparability
the two groups’ reading comprehension significant
abilities
is important
of
because
differences between the two groups were found once subjects
had knowledge
of the task (Mann-Whitney
U Test,
p
These
differences were maintained throughout the remainder of the experiment, such that the overall reading comprehension significantly pCO.01).
better than those
of stutterers
scores of nonstutterers (Mann-Whitney
U
were Test,
Passage 1
Subjects
Comprehension
2 3 3 2 3 3 4 3 3
3
4
3
3
4
4
4
3
2
3.4
0.7
3.
4.
5.
6.
7.
8.
9.
10.
Mean
SD 1.13
3.2
6
4
1.
Passage 2
Reading
2.
Stutterers
2
Data for Experiment
TABLE 2
Al
5
3.4 0.67
8.3
8.4
16
3.75 2.5
26
6
4.75 3.5
2
7.6
6.8
7
5
23
8.8
7.9
7.0
7.25
29.75
4.25
0.63 5
4.0 1
0.25
13.0
11.38
1.75
All Passages
2
0 3
8 1
12
3
Passage 2
10
3.5
2.55
3.75
3.5
0 15
3.25
Passage 1
3.0
I Passages
Disfluencies
4 6 4 4 4 4 6 5
4.5 0.85
5
3
1
6
2
5
4
3
3.5
1.5
3.
4.
5. 6.
7.
8.
9.
10.
Mean
SD
4
4
3
3
1.
2.
Nonstutterers
0.79
4.48
4.25
5.0
5.75
4.0
5.5
3.0
4.5
4.5
4.0
4.25 0 0 0 0 0 0 0 0
0 1 0 0 1 1 0 0
0.48
0
0
0
0
0.3
0
0
0.17
0.15
0.25
0
0.5
0.25
0
0
0.25
0.25
0
0
318
Kamhi and T.C. McOsker
AC.
Our final analyses examined the relationship reading comprehension some
proficiency
reading difficulty
reading
since it was possible for passages to cause more
than others. For this reason, the presentation of the four
passages was counterbalanced. Test
in stutterers,
of the phonetically-weighted
between fluency and
A Wilcoxon
indicated that no significant
comprehension
Matched Pairs Signed-Rank
differences
existed
either
scores or in the frequency of disfluency
in reading
associated with
the four passages. DISCUSSION In order to better understand
the relationship
between attention
and
stuttering this study examined the ability of stutterers and nonstutterers simultaneously
perform a non-attention-demanding
and an attention-demanding initial
hypothesis,
general,
task during
the data in the first
the speech of stutterers
adversely by the simultaneously ently, the majority
of stutterers
speech. Consistent
action during
with
our
experiment
indicated that, in
and nonstutterers
was not affected
performed gross-motor
activity.
Appar-
in this study were not so preoccupied or
attentive to their speech that they could not perform a simple, gross-motor
to
task during speech
speech without
a concomitant
repetitive
increase
in
disfluencies. The findings our
initial
perform
from the second experiment
predictions. significantly
In this poorer
experiment, than
demanding reading comprehension quite
remarkable
stutterers
finding
actually
from
nonstutterers
were
on
the
with
found
to
attention-
task, given knowledge of the task. A
this
obtained lower
were also consistent stutterers
experiment
was that half of the
reading comprehension
scores with
knowledge of the task, while three others obtained the same scores. In contrast, all but one nonstutterer
increased his or her reading comprehen-
sion score with knowledge of the task. It was as if the stutterers knew that they would not be able to attend both to the speaking task and the reading comprehension important
task.
Deciding
that the speech task
one of the two, attention
speech task to the reading comprehension significant prehension
change either
was the
was not reapportioned
in frequency
scores. Some postexperiment
more
from
the
task. As a result, there was no
of disfluencies
or reading com-
probing revealed that some of
Attention
and Stuttering
the stutterers
319
had preconceived notions
case, inability)
Let us summarize ments. First
regarding their
at this point the findings
task nor an attention-
demanding task had an effect on the speech of stutterers. was no significant change in the disfluency from the second experiment
devoted more attention functional
Given
attention,
stutterers
attention to speech necessarily attention-demanding
possess
who
The relatively prehension typically
1963;
than did amount
of
devote an increased
amount
of
have less attention to devote to another
task that accompanies speech. Thus, the third major poorer than nonstutterers
reading comprehension previous
Ringel
perform poorer than nonstutterers
accompanying speech. The findings
on the reading com-
research (Herren,
and Minifie,
on the
task.
poor performance of stutterers
task supports
and Rieber,
only
process
a limited
finding: stutterers performed significantly attention-demanding
task. Second,
indicated that most stutterers
to the speech production
that humans
That is, there
values of stutterers during the
motor activity or as a result of the reading comprehension
nonstutterers.
(in this
from the two experi-
neither the non-attention-demanding
the findings
ability
to read aloud while attending to reading content.
1966)
1931;
showing
Froeschels
that stutterers
on attention-demanding
tasks
in this study also are consistent with
stutterers’ reports that they attend too much to speech. What has not been answered in this study or in previous ones is why stutterers often devote a disproportionate
amount of attention to the speech production process. In
the remainder of this paper, we offer some speculative thoughts on this subject. The traditional answer given to this question is that stutterers pay too much attention to speech because they stutter. Conversely, hear that stutterers
stutter
speech or speech-related
phenomena.
somewhat
are in part correct.
contradictory,
we sometimes
because they devote too much attention to Both of these reasons, They
though
are both correct
because of developmental changes that occur in the relationship
between
stuttering
devote a
and attention.
disproportionate
It is our view that initially
Just as language-disordered, individuals
stutterers
amount of attention to their speech because they stutter. reading-disordered,
must devote additional
and other handicapped
attention to their deficiencies,
inci-
pient stutterers must devote increased attention to the speech production process because they are simply not as good as nonstutterers
in tempo-
320
A.C.
Kamhi
McOsker
and T.C.
rally coordinating these processes (cf. Van Riper, 1971). When the young stutterer apportions more attention to speech, he is doing so to increase the efficiency stutterers,
of the speech production
movements
often diminishes
some stutterers, tion
mechanism.
In many young
devoting more attention towards the coordination
process
or eliminates
the stuttering
of speech
problem.
For
however, devoting more attention to the speech produc-
does not permanently
eliminate
the problem.
In these
instances, the amount of attention devoted to speech production probably decreases as the stutterer begins to devote more and more attention to planning and executing avoidance and escape behaviors that have been developed to cope with the negative aversive stuttering.
What begins, then, in the incipient
stimuli
associated with
stutterer as an apportion-
ment of attention to improve an inefficient speech production mechanism ends up in the mature stutterer as an apportionment as much on the various the processes surprising
of attention focused
learned escape and avoidance behaviors as on
of speech production.
In light of these points,
it is not
that the most successful therapies, through various means, have
eliminated
the attention
stutterers
direct
towards
the planning
and
execution of escape and avoidance behaviors, thus allowing stutterers focus the majority
of their attention on coordinating
to
the speech produc-
tion processes. In conclusion,
the experiments
reported in this paper have com-
pared the ability of stutterers and nonstutterers nonspeech tasks during speech. Stutterers than nonstutterers speech. This
on an attention-demanding
finding
to simultaneously
task which accompanied
was taken as evidence that stutterers
attention to speech than nonstutterers.
perform
were found to perform poorer devote more
It was speculated that the relation-
ship between attention and stuttering appears to be contradictory at times because of developmental
changes that affect the nature of this relation-
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Behavioral
OF FLUENCY
7 (1982),
DISORDERS
309
309-321
Attention and Stuttering: Do Stutterers Think Too Much About Speech? Alan C. Kamhi and Thomas G. McOsker Case Western
Reserve University,
In this investigation
C/eve/and,
Ohio
the ability of stutterers
and nonstutterers
to simultaneously
perform speech and nonspeech tasks was compared. Subjects were 10 stutterers and 10 nonstutterers.
Two
experiments
performed a non-attention-demanding the second, prehension)
subjects
performed
In the first,
subjects
task while they read aloud. In
an attention-demanding
during speech. Results
in the disfluency
were conducted.
gross-motor
task
(reading com-
indicated that there was no significant change
values of stutterers during the motor activity or as a result of the
reading comprehension
task. However,
cantly poorer than nonstutterers
stutterers
were found to perform signifi-
on the reading comprehension
was taken as evidence that stutterers
task. This finding
devote more attention to speech than do
nonstutterers.
INTRODUCTION It has often
amount comments
thinking
about
about
attention
research
Anecdotal how play
investigating
way
that its frequency
give
to their
reports
from
stuttering
or attending
might
stuttering
stutterers
1981).
Bloodstein,
One
been said about
of attention
decreases
there
the relationship
to evaluate
this
stutterers
to simultaneously
stutterers
devote
perform
task during
The previous
Address Pathology,
surprisingly
little
and stuttering. the
ability
task during
of attention
is not role that
speech,
to speech,
than nonstutterers
of If
such
performing
speech.
research
correspondence
Memphis
the
include
stutterer
attention
a nonspeech
studies should find that stutterers are poorer a nonspeech
the
is to determine
amount
with
invariably
has been
between
relationship
a disproportionate
stutterers
when
varies
(see, for example,
In light of the important
to speech.
in stuttering,
speech
in this area for the most part supports
to Alan G. Kamhi,
State University,
@Elsevier Science Publishing Co., Inc., 1982 52 Vanderbilt Ave., New York, NY 10017
Department
of Audiology
807 Jefferson Ave., Memphis,
TN
this
and Speech
38105.
0094-730x/82/030309-1
3$02.75
A.C. Kamhi and T.C. McOsker
310
view. For example, an early study by Herren (1931) found that stutterers had difficulty
voluntarily
speech. A correlation stuttering
extending
and flexing
their
hands
was noted between the duration
during
and severity
of
and stutterers’ ability to perform this motor action. Some years
later, Froeschels
and Rieber (1963)
noted that stutterers
had significantly
more trouble perceiving both visual and auditory stimuli than normal speakers. These findings affected perceptual functioning. studies (Perkins,
1969;
during speech
suggested that stuttering
Bloodstein
(1981),
however,
adversely cites two
Hugo, 1972) which did not confirm these findings
and suggested that perceptual difficulties
might be an extreme symptom
of stuttering. A study by Ringel
and Minifie
(1966)
productive and receptive communication
investigated
to estimate the passage of time, i.e., “protensity” Minifie
found
protensity with
that the severity
judgments
of stuttering
judgments.
(1967) found that writing
poorer
Ringel and
significantly
and suggested that it was stutterers’
speech that caused their
the effects of
activities on stutterers’ abilities
performance.
influenced
preoccupation
Finally,
Fransella
down a series of tape-recorded numbers while
reading aloud had no effect on stuttering. The
literature
than nonstutterers
in this area suggests that stutterers performing
are often poorer
speech and nonspeech tasks simultane-
ously. In these instances, stutterers apparently are not able to attend to the nonspeech task as well Hicks,
as nonstutterers.
It is known
1978) that humans possess only a limited
(Kinsbourne
attention and that efficiency on an attention-demanding when
this
task
is
performed
demanding task. Quite amount
of attention
simultaneously
possibly,
towards
stutterers
speech,
and
amount of functional
with
task is often lost
another
attention-
devote an abnormally
resulting
in a reduction
high of the
amount of attention that can be directed towards the nonspeech task. Alternatively,
attention towards speech might be excessive
only during
moments of stuttering. We are not entirely
comfortable
with the profile of stutterers
emerges from these studies and the implications relationship a group
between attention and stuttering.
of stutterers
who
that
this profile has for the
Although there might exist
have difficulty
coordinating
speech and
nonspeech activities and, therefore, probably are preoccupied attentively towards
speech,
we would
like
to believe
that this
difficulty
and
preoccupation are not representative of the entire stuttering population.
Attention
and Stuttering
311
To substantiate
this belief, two experiments
compared the ability
of stutterers
were conducted that
and nonstutterers
perform speech and nonspeech tasks.
In the first
to simultaneously
experiment,
performed a simple,
repetitive gross-motor
It was hypothesized
that the speech of stutterers and nonstutterers
subjects
activity while readling aloud. would
not be adversely affected by the motor activity because the activity did not require higher-level most simple gross-motor
mental processes. Although to carry out even the activities some attention is required, the motor-
activity in this experiment was assumed to be a non-attention-demanding task since it did not involve higher-level experiment,
the same subjects,
task (reading comprehension)
while
mental processes. In the second also reading aloud, performed a
that required
higher-level
mental
cesses. It was predicted that this task, an attention-demanding
pro-
one, would
either adversely affect stutterers’ speech or itself be adversely affected by the speech task. In other words, we hypothesized
that stutterers
would
either experience a decrease in fluency or perform poorer than nonstutterers on the reading comprehension
task.
METHOD Subjects Subjects were ten stutterers, mean age of 31.9 yr (range 18-66
eight males and two females, with a yr) and ten nonstutterers,
six males and
four females, who had a mean age of 27.3 yr (range 19-45
yr). None of
the stutterers had any history of neurological problems or chronic hearing loss. At the time of testing, these subjects had just begun an intensive therapy program at the Cleveland Hearing and Speech Center. All testing was conducted during the first week of the program to control for the possible effects of therapy. Severity of stuttering
ranged in these subjects
from mild (4) to severe (2), based on frequency measures of stuttering oral reading and spontaneous speech. Finally,
in
none of the nonstutterers
evidenced any history of speech, language, or hearing problems. Experiment
1
In this experiment
subjects read portions
of the Rainbow
before, during, and after performing a simple gross-motor
Passage
activity. For all
A.C. Kamhi and T.C. McOsker
312
but four subjects, two stutterers
and two nonstutterers,
stepping up and down a IO-in
high, 4-ft square table. The other four
subjects performed less strenuous
“toe-raisers”
the activity was
either because they were
in poor physical condition or because of their age. Subjects,
seated, were tirst
asked to read the first
third
of the
Rainbow Passage aloud. Baseline fluency data were obtained from this reading. Subjects then familiarized one minute. instructed
Next,
subjects
themselves
were
with the motor activity for
handed the Rainbow
to read the second third of the passage while
perform
the motor activity.
The
experiment
concluded
Passage and continuing with
to
subjects
reading the final portion of the Rainbow
Passage. Each portion of the
Rainbow Passage contained approximately
110 words.
Disfluencies
were noted during the actual testing by two scorers, in
most cases the two authors.
In some instances,
however,
a graduate
student in speech pathology served as the second scorer. Since we were interested in measuring the increase in “stuttering,” have been shown to be characteristic of stutterers
only disfluencies
that
were scored (Williams
et al., 1968; Curran and Hood, 1977). These included sound and syllable repetitions, pauses,
prolongations,
inaudible and audible fixations,
and disrhythmic
interjections). resolved
by listening
inaudible fixations validation
phonations
Differences
Experiment
broken
scoring
to audio recordings
were initially
involving
(e.g.,
in the initial
agrammatical
words
and tense
of disfluencies
of the testing
sessions.
were All
marked as such and were not subject to
the audio recordings.
2
In this experiment, about the content
subjects
of four
were asked to respond to questions
reading passages after having
read these
passages aloud. An attempt was made to determine the effects of attention on reading comprehension variable. This
by experimentally
was done by not forewarning
manipulating
the attention
subjects that reading com-
prehension questions would be asked. instead, subjects were told that the experiment
was investigating
After the first questions
the effects of multiple
reading of the first
passage, six
were asked, much to the surprise
nonstutterers.
When
readings on speech.
reading comprehension
of both the stutterers
the reading comprehension
questions
and
were asked
Attention
and Stuttering
after the subsequent prised.
The
313
passages, subjects
knowledge
were of course no longer sur-
that reading comprehension
was going to be
evaluated presumably affected a subject’s attention to the content of the subsequent
passages read. Whereas
might be minimal
attention
to the reading content
for the first passage, it should be increased during the
reading of the subsequent passages. The design of this experiment
thus
made it possible to determine the effects that attention to a nonspeech task (reading comprehension)
had not only on the performance of the
nonspeech task but on speech as well. nonstutterers
If stutterers
are in fact inferior
to
on tasks performed during speech, then there should be an
inverse relationship
between their reading comprehension
scores and a
measure of fluency. As fluency improves, reading comprehension
should
become poorer and vice versa. As part of another study which stuttering,
examined
all subjects read four phonetically
three times each. Only
the first
the phonetic factor in
weighted passages at least
readings were analyzed in the current
study. The reading comprehension
questions were always presented after
the first reading. The presentation of the passages was counterbalanced for the two groups of subjects. Whether or not the phonetic factor affected subjects’ speech or reading comprehension
scores was considered in the
analyses of the data for this experiment. RESULTS Experiment
1
Data in the form of number of disfluencies stutterers
and nonstutterers
for each portion
were calculated for
of the Rainbow
Passage.
Recall that the first portion of the Rainbow Passage was read before the subjects began the motor activity, the second portion, during the motor activity, and the third portion, with subjects again seated. The data for this experiment are presented in Table 1. In examining these data, it is evident that performing nonstutterers,
the motor activity
as no nonstutterer
had little
effect on the speech of
had more than two disfluencies.
In
contrast, performing the motor activity appeared to have some effect on the speech of several stutterers,
though group differences
values across the three conditions
in disfluency
proved to be insignificant
[Wilcoxon
4.C. Kamhi and J.C. McOsker
314
TABLE 1 Data for ExDeriment
1 Disfluencies
Subject
Sex
Age
Before
After
During
Stutlerers
1.
la
M
0
4
2.
19
M
5
28
ia
4
3.
20
M
11
14
19
4.
24
M
1
0
0
5.
25
M
I
2
6.
25
F
1 0
0
1
7.
30
M
6
4
6
33
F
24
35
46
60
M
9
6
16
66
M
12
17
a.2 9. 10.”
15
Mean
6.9
10.9
12.7
SD
7.5
12.4
13.8
Nonstutterers
1.
19
M
0
0
0
2.
19
M
0
2
0
3.
21
M
0
2
0
4.
22
F
0
2
0
5.
24
F
0
0
0
6.
29
M
0
0
0
7.
30
F
0
0
0
a.
31
M
0
2
0
9.a 10.”
33
F
0
0
0
45
M
1
0
0
Mean
0.1
0.8
0.0
SD
0.3
I.0
0.0
‘Performed “toe-raisers.”
Matched standard stutterers.
Pairs
Signed-Rank
deviations The
or toe-raisers)
type of action appeared
who
performed
jects
in the study.
Test,
indicated
p>O.lO
considerable performed
not to contribute
toe-raisers
had disfluency
(Siegel,
1956)J.
variability
(stepping
up and down
to this variability values
in this
The
high
group
of
the table
as the subjects
resembling
other
sub-
Attention
and Stuttering
The individual disfluencies
315
subject data indicated that six stutterers
in the reading following
had more
the motor activity than in the reading
during the motor activity. Only one stutterer (No. 2) clearly was affected adversely by the motor activity, his frequency of stuttering
increasing by
more than five times during the motor action. When the motor activity was terminated,
however,
his frequency
of disfluencies
decreased by
almost half. In contrast to this subject, three subjects (Nos. substantially
more disfluencies
after the motor activity
3,8,9)
had
than during
it,
indicating that their speech was influenced not only by the motor activity but by some indeterminable
factor as well (e.g., increased blood pressure
or pulse rate, fatigue, relaxation of speech controls, etc.). Experiment Withinexperiment.
2
and between-group First
comprehension the stutterers
examined
comparisons
was the effect knowledge
task had on each group’s comprehension
nor the nonstutterers
their reading comprehension
of the reading scores. Neither
were found to significantly
xon Matched Pairs Signed-Rank
Test, p>O.lO). comprehension
nonstutterers’
in this
increase
scores with knowledge of the task (Wilco-
of the
reading
knowledge of the comprehension stutterers’
were possible
Nevertheless, scores
all but one
improved
with
task (see Table 2). In contrast, only two
reading comprehension
scores improved with knowledge of
the task. Clearly, most of the stutterers were not affected in the same way as nonstutterers
by knowledge of the reading comprehension
task.
Our next analyses compared the two groups’ performance on the reading comprehension tween stutterers
task. No significant
and nonstutterers’
initial
difference was found be-
reading comprehension
scores
(i.e., without knowledge of the task). The fact that there was no difference between these scores can be taken as evidence that the two groups had comparable reading comprehension
abilities. This initial comparability
the two groups’ reading comprehension significant
abilities
is important
of
because
differences between the two groups were found once subjects
had knowledge
of the task (Mann-Whitney
U Test,
p
These
differences were maintained throughout the remainder of the experiment, such that the overall reading comprehension significantly pCO.01).
better than those
of stutterers
scores of nonstutterers (Mann-Whitney
U
were Test,
Passage 1
Subjects
Comprehension
2 3 3 2 3 3 4 3 3
3
4
3
3
4
4
4
3
2
3.4
0.7
3.
4.
5.
6.
7.
8.
9.
10.
Mean
SD 1.13
3.2
6
4
1.
Passage 2
Reading
2.
Stutterers
2
Data for Experiment
TABLE 2
Al
5
3.4 0.67
8.3
8.4
16
3.75 2.5
26
6
4.75 3.5
2
7.6
6.8
7
5
23
8.8
7.9
7.0
7.25
29.75
4.25
0.63 5
4.0 1
0.25
13.0
11.38
1.75
All Passages
2
0 3
8 1
12
3
Passage 2
10
3.5
2.55
3.75
3.5
0 15
3.25
Passage 1
3.0
I Passages
Disfluencies
4 6 4 4 4 4 6 5
4.5 0.85
5
3
1
6
2
5
4
3
3.5
1.5
3.
4.
5. 6.
7.
8.
9.
10.
Mean
SD
4
4
3
3
1.
2.
Nonstutterers
0.79
4.48
4.25
5.0
5.75
4.0
5.5
3.0
4.5
4.5
4.0
4.25 0 0 0 0 0 0 0 0
0 1 0 0 1 1 0 0
0.48
0
0
0
0
0.3
0
0
0.17
0.15
0.25
0
0.5
0.25
0
0
0.25
0.25
0
0
318
Kamhi and T.C. McOsker
AC.
Our final analyses examined the relationship reading comprehension some
proficiency
reading difficulty
reading
since it was possible for passages to cause more
than others. For this reason, the presentation of the four
passages was counterbalanced. Test
in stutterers,
of the phonetically-weighted
between fluency and
A Wilcoxon
indicated that no significant
comprehension
Matched Pairs Signed-Rank
differences
existed
either
scores or in the frequency of disfluency
in reading
associated with
the four passages. DISCUSSION In order to better understand
the relationship
between attention
and
stuttering this study examined the ability of stutterers and nonstutterers simultaneously
perform a non-attention-demanding
and an attention-demanding initial
hypothesis,
general,
task during
the data in the first
the speech of stutterers
adversely by the simultaneously ently, the majority
of stutterers
speech. Consistent
action during
with
our
experiment
indicated that, in
and nonstutterers
was not affected
performed gross-motor
activity.
Appar-
in this study were not so preoccupied or
attentive to their speech that they could not perform a simple, gross-motor
to
task during speech
speech without
a concomitant
repetitive
increase
in
disfluencies. The findings our
initial
perform
from the second experiment
predictions. significantly
In this poorer
experiment, than
demanding reading comprehension quite
remarkable
stutterers
finding
actually
from
nonstutterers
were
on
the
with
found
to
attention-
task, given knowledge of the task. A
this
obtained lower
were also consistent stutterers
experiment
was that half of the
reading comprehension
scores with
knowledge of the task, while three others obtained the same scores. In contrast, all but one nonstutterer
increased his or her reading comprehen-
sion score with knowledge of the task. It was as if the stutterers knew that they would not be able to attend both to the speaking task and the reading comprehension important
task.
Deciding
that the speech task
one of the two, attention
speech task to the reading comprehension significant prehension
change either
was the
was not reapportioned
in frequency
scores. Some postexperiment
more
from
the
task. As a result, there was no
of disfluencies
or reading com-
probing revealed that some of
Attention
and Stuttering
the stutterers
319
had preconceived notions
case, inability)
Let us summarize ments. First
regarding their
at this point the findings
task nor an attention-
demanding task had an effect on the speech of stutterers. was no significant change in the disfluency from the second experiment
devoted more attention functional
Given
attention,
stutterers
attention to speech necessarily attention-demanding
possess
who
The relatively prehension typically
1963;
than did amount
of
devote an increased
amount
of
have less attention to devote to another
task that accompanies speech. Thus, the third major poorer than nonstutterers
reading comprehension previous
Ringel
perform poorer than nonstutterers
accompanying speech. The findings
on the reading com-
research (Herren,
and Minifie,
on the
task.
poor performance of stutterers
task supports
and Rieber,
only
process
a limited
finding: stutterers performed significantly attention-demanding
task. Second,
indicated that most stutterers
to the speech production
that humans
That is, there
values of stutterers during the
motor activity or as a result of the reading comprehension
nonstutterers.
(in this
from the two experi-
neither the non-attention-demanding
the findings
ability
to read aloud while attending to reading content.
1966)
1931;
showing
Froeschels
that stutterers
on attention-demanding
tasks
in this study also are consistent with
stutterers’ reports that they attend too much to speech. What has not been answered in this study or in previous ones is why stutterers often devote a disproportionate
amount of attention to the speech production process. In
the remainder of this paper, we offer some speculative thoughts on this subject. The traditional answer given to this question is that stutterers pay too much attention to speech because they stutter. Conversely, hear that stutterers
stutter
speech or speech-related
phenomena.
somewhat
are in part correct.
contradictory,
we sometimes
because they devote too much attention to Both of these reasons, They
though
are both correct
because of developmental changes that occur in the relationship
between
stuttering
devote a
and attention.
disproportionate
It is our view that initially
Just as language-disordered, individuals
stutterers
amount of attention to their speech because they stutter. reading-disordered,
must devote additional
and other handicapped
attention to their deficiencies,
inci-
pient stutterers must devote increased attention to the speech production process because they are simply not as good as nonstutterers
in tempo-
320
A.C.
Kamhi
McOsker
and T.C.
rally coordinating these processes (cf. Van Riper, 1971). When the young stutterer apportions more attention to speech, he is doing so to increase the efficiency stutterers,
of the speech production
movements
often diminishes
some stutterers, tion
mechanism.
In many young
devoting more attention towards the coordination
process
or eliminates
the stuttering
of speech
problem.
For
however, devoting more attention to the speech produc-
does not permanently
eliminate
the problem.
In these
instances, the amount of attention devoted to speech production probably decreases as the stutterer begins to devote more and more attention to planning and executing avoidance and escape behaviors that have been developed to cope with the negative aversive stuttering.
What begins, then, in the incipient
stimuli
associated with
stutterer as an apportion-
ment of attention to improve an inefficient speech production mechanism ends up in the mature stutterer as an apportionment as much on the various the processes surprising
of attention focused
learned escape and avoidance behaviors as on
of speech production.
In light of these points,
it is not
that the most successful therapies, through various means, have
eliminated
the attention
stutterers
direct
towards
the planning
and
execution of escape and avoidance behaviors, thus allowing stutterers focus the majority
of their attention on coordinating
to
the speech produc-
tion processes. In conclusion,
the experiments
reported in this paper have com-
pared the ability of stutterers and nonstutterers nonspeech tasks during speech. Stutterers than nonstutterers speech. This
on an attention-demanding
finding
to simultaneously
task which accompanied
was taken as evidence that stutterers
attention to speech than nonstutterers.
perform
were found to perform poorer devote more
It was speculated that the relation-
ship between attention and stuttering appears to be contradictory at times because of developmental
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