Written by Matthew O’Malley
The way in which speech control fluctuates and stuttering severity increases and decreases is a puzzling part of the stuttering condition. The person who stutters is often at a loss as to what has caused their speech control to significantly drop off; or on the flip side, what has caused their speech fluency to increase. To the person who stutters as well as scholars and researchers in the field, this phenomenon of fluctuating levels of speech control is just that; a phenomenon. It is not well understood. There aren’t many answers as to what is behind these fluctuations in speech control.
To me, these fluctuations are a window into the nature of the condition. We must look at them as objectively as possible.
In trying to understand anything (in this case, stuttering), we are only equipped with the information that is observable to us (sometimes we design tools that increase what is observable to us). The surface behaviors that are observable in stuttering do not directly yield much information about the underlying mechanisms that result in these observable behaviors (stuttering). As a result, discerning what is going on “under the hood” is not an easy task. Because the processes which are affecting the outcome (which is the stuttering behavior) are unobservable, it is often hard to identify and understand them. Making this task more difficult is the fact that these unobservable processes are interacting with one another. It is no wonder these processes have not been well understood. However, after lots of observation, contemplation, and study, I believe I have begun to illuminate some of the underlying processes that are affecting fluctuations in speech control.
While fluctuations in speech control are a window into the nature of the condition; that is not all they are. They are also a significant part of the life experience of a person who stutters. For myself and many people who stutter who have shared their experiences with me, fluctuations in control have significant impact on daily life. These fluctuations are not subtle, often times. Some people can fluctuate from having a mild stutter to a severe one. Others can go from mild to moderate in severity and everything in between. I personally experience quite a significant difference in my communicative ability when I am having a more fluent period as opposed to a more disfluent period. When I am more fluent, my life is a lot easier and vice versa. So, not only are fluctuations in speech control an informative glimpse into the nature of stuttering, they can also be a source of malcontent and frustration for the person who stutters.
Side-thought: One treatment aim should be to maximize the amount of fluent periods one has and minimize the amount of disfluent periods.
So, what is so puzzling about these fluctuations? Well, everything. Most human ability is relatively stagnant. One day I can ride a bike. The next day I can ride that bike with approximately the same skill level. For someone who doesn’t stutter; one day they can talk and the next day they can talk with approximately the same level of ability. For the person who stutters however, one day they can have a relatively fluent conversation with a friend and the next day that same conversation might contain a lot more struggle and disfluency. Even more puzzling is the fact that they may have three months in a row where their conversation is relatively fluent and they wake up one day after that three months and all of a sudden conversation is a struggle; without any obvious cause. It seems random and is thus frustrating. One is left looking for answers but often does not find any that suffice.
These fluctuations can even lead to self-blame and self-criticism. The person who stutters can spend a lot of their time trying to figure out what they did or what they changed that caused the fluctuation in their speech control. Usually, they seek answers to no avail and end up at a loss as to how to gain the ability to control or even affect these fluctuations. One can begin asking themselves questions like, “What am I doing wrong?” or “What did I do to cause my speech control to diminish?”
Well, let’s try to answer some of these questions.
In explaining some of the mystery behind fluctuation I have come to the conclusion that there are two different types of speech fluctuation. Each type has its own characteristics as well as its own etiology/cause.
The first type of fluctuation is what I have come to term a contextual fluctuation. A contextual fluctuation is a fluctuation in speech control that can change from moment to moment and situation to situation. A possible example of a contextual fluctuation would be if you went and talked to your best friend and your speech was relatively fluent; immediately after that you went and talked to your boss and your speech was significantly less fluent. With a contextual fluctuation the level of control you have over your speech can change dramatically from one moment to the next mainly based on environmental stimuli.
The second type of fluctuation is what I have come to term a periodic fluctuation. A periodic fluctuation is a fluctuation in speech control that lasts for days, weeks, or months. An example of a periodic fluctuation would be where you feel relatively fluent in your speaking for a few weeks. Then, all of a sudden you begin to notice a drop off in your speech control. For a few weeks after you notice the drop off, your speech control is significantly diminished. With a periodic fluctuation, the level of speech control you have across most of the spectrum of your speaking situations is affected. During a period of higher fluency (a periodic fluctuation where your speech control is high), you may be able to talk to your best friend relatively fluently. However, during a period of lower fluency (a periodic fluctuation where your speech control is low) you may talk to the same best friend and experience significantly more struggle in speaking.
To further clarify, a contextual fluctuation varies from situation to situation within a day, hour, minute, and even moment. These fluctuations happen based on who you are talking to, how many people, and many other environmental factors.
A periodic fluctuation usually lasts anywhere from a day, to a week, to months. A periodic fluctuation is when a person who stutters is having a “bad speech day”, or a “bad speech week” or a “bad speech month”.
Now what makes fluctuations in speech control quite confusing is the fact that these two types of fluctuation (contextual and periodic) are interacting with each other at any given moment. Let me explain with an example.
Let’s say an individual has a mild-moderate stutter when they are going through a period of higher level fluency (they are having a periodic fluctuation where they are more fluent). However when they go through a periodic fluctuation where they become more disfluent, their stutter severity increases to a moderate-severe level.
Now, let’s outline some characteristics of this same person’s contextual fluctuation. Let’s say that this person usually speaks more fluently with their best friend than they do their father. So to clarify, they stutter less with their best friend and stutter more with their father usually. This is a contextual fluctuation.
So let’s say this person one week goes and has a great conversation with their friend and their speech was great. A day after that they go and talk to their father and they have some disfluencies and moderately stutter but it was manageable and they communicated what they wanted to and were relatively satisfied with the interaction.
Then a week later, they see the same friend and they notice they are stuttering a lot more and struggling to communicate as they would like to with their friend. They walk away puzzled saying, “Just last week I spoke quite well in this exact same situation! Welp, can’t be environment!” Then the next day they go and talk with their father and they find it very difficult to get words out at all. Again, they’re mystified because just last week they felt they had a decent conversation with their father. Yeah, they stuttered a little but they could deal with that level of dysfluency.
So what happened in the above scenario? Well, the two types of fluctuation in stuttering were interacting. The individual I used in the example (a person who stutters) is subject to periodic fluctuations that alter his stuttering severity. During a more fluent periodic fluctuation the individual’s stuttering would be classified as mild-moderate. However, during a less fluent periodic fluctuation the individual’s stuttering would be classified as moderate-severe.
So, what happened in the above scenario was in the first situation, the individual was experiencing a periodic fluctuation in which they were more fluent. When they spoke with the friend, contextual fluctuation also came into play. Because they are usually more fluent with their best friend (they are more fluent in this environmental context) AND they were experiencing a periodic fluctuation in speech control where they had higher levels of fluency, their speech was very good. During that same period of periodic fluctuation in which their speech was more fluent they had a conversation with their father with whom they usually stutter with more than their best friend. Again, the periodic fluctuation interacted with the contextual fluctuation in this scenario. Because their father causes more stuttering for this individual than their friend, however, they were experiencing a periodic fluctuation of increased fluency, they only stuttered moderately. So, they were experiencing increased fluency periodically, however they were in a context (speaking with their father) that triggered increased stuttering. As a result they stuttered moderately (periodic increased fluency, interacting with difficult context led to moderate stuttering).
Now, in the scenario I laid out that followed that, where the same individual struggled and stuttered talking to the friend and could barely get words out with their father; this is also the result of the interaction between contextual and periodic fluctuation. During the second list of interactions, the individual in the example was now going through a periodic fluctuation in which their speech control had significantly dropped off. When they spoke with their best friend, their stuttering increased to a moderate level because their periodic fluctuation had increased stuttering, yet their contextual fluctuation with their friend usually did not increase stuttering. This resulted in moderate stuttering and they struggled more than in the previous situation (periodic fluctuation of increased stuttering combined with a context that does not induce increased stuttering led to moderate stuttering). When the individual in the example could barely get words out with their father, it again was a result of the interaction between contextual fluctuation and periodic fluctuation. Because the individual in the example was going through a periodic fluctuation where their speech control was diminished and they were in an environment (speaking with their father) that increased stuttering based on contextual fluctuation, their stuttering became severe and they struggled to get words out. Their periodic fluctuation increased stuttering and their contextual fluctuation increased stuttering resulting in the two interacting to create more pronounced stuttering (severe).
The above scenario shines a light on the interplay between contextual fluctuation and periodic fluctuation. However, for the sake of completeness, I have to touch on a couple other factors involved in stuttering fluctuation. Firstly, let me state that contextual fluctuation and periodic fluctuation paint a relatively complete picture of stuttering fluctuation. However, I must point out that contextual fluctuation is affected by a lot of elements. In the above explanation I focused mainly on who the person who stutters is talking to. While the individual(s) the person who stutters is talking to is a large part of what factors into contextual fluctuation, it is far from all encompassing. Many things in the environment contribute to contextual fluctuation; they are too numerous to list. However some examples of environmental factors that could affect contextual fluctuation would be whether you are standing or sitting when you are speaking; whether the person you are talking to is standing or sitting; the speed at which you feel pressured to talk at; how loud you think you are supposed to talk; how important you feel it is that you speak well; whether you feel like people around you are listening to your conversation; whether the person you are talking to is looking you in the eye; whether you are looking them in the eye; etc. etc. etc.
In addition to the numerous factors that go into contextual fluctuation, there is also an element of chance involved in stuttering frequency. My explanation will be a bit simplified for the sake of brevity. To begin, let’s say when you are going through a periodic fluctuation of increased speech fluency you stutter on about 5% of words. However, when you are going through a periodic fluctuation of decreased fluency you stutter on 25% of words. The laws of probability would still allow you to occasionally stutter a lot in a given situation when you are going through a periodic fluctuation of increased fluency. On the flip side, the laws of probability would also allow you to occasionally speak relatively fluently in a given situation when you are going through a periodic fluctuation of decreased fluency. I could lay out all the math but I won’t. This answers the rebuttal of, “Well, I was going through a period of decreased fluency and I was in a difficult context, but I spoke well. Explain that.” Well, that doesn’t happen often but it does occasionally. Math answers that; as well as the complexity of environmental factors that affect contextual fluctuation.
To simply and briefly summarize all of the above I am going to list this formula:
(Contextual Fluctuation) interacting with (Periodic Fluctuation) interacting with (Chance) = Stuttering Frequency/Severity
To further address the above information, I stated at the beginning of this explanation that I believe contextual fluctuation and periodic fluctuation have separate etiologies/causes (as a result, they will require different treatment regimens). I am veering a bit from my earlier theory where I believed that the attempt to control an automatic ability (Read here, though summarized below) was the core of the stuttering condition. What I now believe is my prior theory is not one that is all encompassing to explain the totality of the stuttering condition but it explains only contextual fluctuation; still a very big piece of the puzzle. In line with that, I believe that the ideas behind treatment that I have previously laid out can be used effectively to improve contextual fluctuation; i.e. minimize the amount of increased stuttering based on environmental context. I believe this part of the stuttering condition is treatable and can be effective today/now. If one can significantly improve contextual stuttering, this can have impact on quality of life for someone who wants to reduce their stuttering. Lastly, on contextual stuttering, I want to state that I currently believe that contextual fluctuation is a learned part of the stuttering condition. It is developed as a result of living with stuttering, and in essence, is the result of trying to not stutter at varying degrees of effort.
The attempt to control an automatic ability is laid out in depth in earlier posts (Here: The Role of Time & Control and Automatic Abilities). I believe contextual fluctuation is caused by the attempt to control an automatic ability which is supported by this research that correlates stuttering severity to the amount of preparatory motor control performed by the individual who stutters(it may also be a compensatory strategy) (Vanhoutte, Santens, Cosyns, Van Mirelo, Batens, Corthals, Letter & Van Borsel, 2015). However, I know I never click on supplemental reading links myself so I’ll try to lay it out (my earlier post) as best I can quickly here:
Speaking is supposed to be an automatic ability like walking or riding a bike. Speech is meant to require little (if any) conscious attention to the physical/motor movements required to produce it. The only way to speak normally at an adult level is to speak on “automatic mode”. The movements and precision required for adult speech is far too complex for the conscious mind to perform properly. Contextual stuttering happens largely because the person who stutters is trying to consciously control their speech in an attempt to not stutter. As I said, this is explained in much more detail in the post I linked. I believe this is the cause of contextual stuttering.
So I believe I have identified what are the two types of fluctuation in regards to stuttering; periodic and contextual. I understand fairly deeply what is going on to cause contextual stuttering. This leaves me only with questions regarding periodic fluctuation in stuttering. Because of the clarity identifying the two types of fluctuation in stuttering has provided me, I now know what I know about stuttering and I know what I don’t know. This is encouraging. This is half the battle. I also believe I know what is causing one type of fluctuation in stuttering; contextual fluctuation; which I believe is caused by the attempt to consciously control an automatic ability (speaking) at varying degrees based on context. In essence, much of the mystery of stuttering is illuminated if my theories are correct; which I currently believe they are, but of course is subject to change. I do believe strongly my views at minimum hold some truth about the stuttering condition.
In addition to understanding the above, if we can figure out the underlying mechanisms responsible for periodic fluctuation in stuttering we will be making significantly more headway on fully understanding this condition and treating it effectively. Understanding and treating periodic fluctuation may be the most significant piece of the stuttering puzzle. This is where my thoughts and efforts will be for the foreseeable future. I have some ideas brewing on this front and will share them soon.
Vanhoutte, S., Santens, P., Cosyns, M., Van Mierlo, P., Batens, K., Corthals, P., Letter, M.D., & Van Borsel, J. “Increased Motor Preparation Activity during Fluent Single Word Production in DS: A Correlate for Stuttering Frequency and Severity.” Neuropsychologia 75 (2015): 1-10.