What do People Want – Fluency or Freedom?

This article is a summary and review of the following:
Article: What Do People Who Stutter Want — Fluency or Freedom?
From the Journal of Speech and Hearing Research, Vol. 52, April 2009
Author: H. S. Venkatagiri, 2130 Pearson Hall, Iowa State University, Ames, IA 50011.
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This article documents the method and results of a survey of people who stutter to investigate their preference for difference possible treatment options. One option presented is the Freedom Option, where the goal is to modify the stuttering and reduce the struggle to avoid stuttering by freeing the subject from concern for fluent speech. Contrarily, the more common approach that most PWS are exposed to is the Fluency Option, which aims to reduce or eliminate stuttering.

Implications for treatment

There have been earlier studies attempting to investigate treatment outcome desired by PWS in similar terms. Researchers such as Barry Guitar have shown that pre-treatment attitude is “the best predictor of treatment outcome.” This has implications for treatment on an individual basis, and the role of the subject in designing his or her own therapy.
In 2008 Venkatagiri launched a large scale survey to estimate what proportion of PWS prefer one or the other option – freedom or fluency. This would include a study on the factors that have a bearing on this choice.

Method

A web-based survey was advertised on the NSA site and with speech pathologists and support group co-ordinators across the United States. The result was 216 useable voluntary responses to the questionnaire from self-chosen PWS.
The first question asked the participant’s preference for “talking fluently” OR “talking freely”. The following questions were more comprehensive, to examine if the answer given to the first question were consistent with responses to more nuanced inquiries. Factors addressed were: gender, age, family history of stuttering, amount of speech therapy received, severity of stuttering, age of onset of stuttering, nationality and pre-treatment attitude.

Gender and other factors

It can be expected that most PWS choose fluency over freedom to stutter, but the margin is relatively small according to the survey – 46% of respondents chose the freedom option, and 54% opted for fluency, when asked outright in the survey’s first question. 152 males and 64 females responded, but a larger percentage of females than males chose freedom over fluency. Also, respondents that had a family history of stuttering were more likely to choose the freedom option, as were older PWS, whereas those who had never received therapy were more likely to choose the Fluency option.

Results

The survey revealed four groups of PWS: Those who preferred either freedom or fluency and were certain about their choice and showed little signs of ambivalence in their answers, and those who chose either freedom or fluency but were not consistent in the subsequent answers. 61% of respondents showed consistency in their responses, and the remainder showed inconsistency.

Among the freedom-choosing group, there was a 34% discordance for subsequent answer. For those who chose the fluency option, 43% were not consistent in their subsequent answers. (A full breakdown of the responses and consistency in each category and for each question is available in the article.) The results show that even those who desire fluency are conflicted in their expectations, slightly moreso than those who choose the freedom option.

Implications

Certainly it is easier to plan therapy for those who most consistently choose the fluency option. Conflicting expectations and desires on the part of the patient presents a problem from a therapeutic standpoint: the two approaches cannot be pursued together. Obviously any effective therapy must have clearly defined goals and expectations, one cannot aim to “not stutter” and to “stutter freely” at the same time. For those who do not wish to aim for purely fluent speech, but rather learn to control their stuttering to a point where it can be called “managed” stuttering, the treatment options are scant. In fact, no therapy currently is offered by any speech pathologist in North America. Therefore, it is even hard to imagine what such therapy would even look like.

Like a lot of research, this experiment does not reveal anything incredibly groundbreaking, but rather confirms what many suspected. Its value is that it provides empirical data on which to build further research, and continuous re-evaluation of how speech therapy is given. PWS do want more choice and control over the type of treatment they receive, and pre-treatment analysis of what is desired by the subject is perhaps even more crucial than once thought.