Stuttering is a complex communication disorder characterized by involuntary disruptions in the flow of speech. These disruptions, often referred to as core behaviors, include repetitions of sounds or syllables, prolongations of sounds, and blocks where the airflow or voice stops completely. While these core behaviors form the overt experience of stuttering, many individuals who stutter also develop learned reactions called secondary behaviors. These secondary actions are attempts to cope with, minimize, or forcibly terminate the moment of disfluency. Secondary behaviors are not an inherent part of the disorder itself but rather a behavioral response to the anticipation or experience of speech difficulty.
Defining Primary Versus Secondary Behaviors
The distinction between primary and secondary behaviors rests on whether the action is an involuntary disruption of speech (primary behaviors) or a learned physical or verbal reaction to that disruption (secondary behaviors). Primary behaviors, or core disfluencies, represent the actual breakdown in the speech production system and are the foundational symptoms of stuttering itself. Secondary behaviors are accessory characteristics that develop over time as the speaker tries to manage the core disfluency.
These learned behaviors initially appear random but quickly become habitual and integrated into the individual’s overall stuttering pattern. A person may use a physical movement, and if the word immediately follows that movement, the brain falsely attributes the movement as the cause of the release from the stutter. This perceived effectiveness reinforces the behavior, turning an accidental movement into an automatic response used whenever a moment of stuttering is anticipated or experienced. Secondary behaviors are broadly categorized based on their timing and intent: those used to escape a stutter currently happening, and those used to avoid a stutter before it begins.
Escape Behaviors
Escape behaviors are actions a person takes during a moment of stuttering with the explicit goal of terminating the block or repetition and forcing the word out. They are reactive strategies, often reflecting a high degree of physical struggle and tension associated with the attempt to gain control over the speech mechanism. These behaviors can involve movements of the face, head, or limbs, and are sometimes referred to as struggle behaviors because of the effort involved.
Physical Escape Behaviors
Common physical escape behaviors include rapid eye blinking, tensing the muscles around the mouth and jaw, resulting in facial grimacing, or noticeable movements of the head, such as a sharp head jerk. Other examples include extraneous body movements like clenching a fist or tapping a foot. These physical actions are used to essentially “push” through the moment of speech disfluency.
Verbal Escape Behaviors
Escape behaviors can also manifest verbally, typically through the insertion of sounds or words during a moment of stuttering to break the block. An individual might interject a filler sound like “uh” or “um” immediately upon feeling stuck on a word, attempting to restart or push past the core disfluency. Other verbal strategies include sudden changes in vocal characteristics, such as an unexpected increase in pitch or loudness.
Avoidance Behaviors
Avoidance behaviors are proactive strategies a speaker employs before an anticipated moment of stuttering, with the primary aim of preventing the disfluency from occurring at all. These behaviors arise from the fear and anxiety associated with the prospect of stuttering on a particular sound, word, or in a specific speaking situation. Avoidance strategies can be subtle linguistic maneuvers or complete withdrawal from communication.
Linguistic Avoidance
One of the most common linguistic avoidance strategies is word substitution, where the speaker quickly replaces a feared word with a synonym or a phrase they believe will be easier to say fluently. A related tactic is circumlocution, which involves talking around the intended word or idea by using many extra words to convey the message, hoping to bypass the feared sound entirely. These techniques allow the speaker to mask the stuttering, but often at the expense of clear and direct communication.
Starters
Another distinct type of avoidance is the use of “starters,” which are introductory words or phrases used to create a false sense of fluency before the difficult word is attempted. Examples include phrases like “You know,” “Well,” or “Let me see,” which provide a running start to the sentence.
Situational Avoidance
More overt forms of avoidance include situational avoidance, such as declining to speak in class, refusing to make phone calls, or remaining silent in social settings to entirely eliminate the risk of stuttering. While these behaviors may provide temporary relief from fear, they severely limit the individual’s participation in life and communication.
The Role of Secondary Behaviors in Treatment
Secondary behaviors are often a significant focus in speech therapy because they reflect the speaker’s struggle and perpetuate a negative cycle of fear and physical tension. Although these actions begin as a means to achieve fluency, they ultimately increase the overall physical effort and visibility of the communication difficulty. Treatment aims to address the underlying discomfort and fear that drives the need for these behaviors, rather than just eliminating the physical movements themselves.
A speech-language pathologist works with the individual to first identify and gain awareness of their specific escape and avoidance patterns. Therapy often incorporates desensitization techniques to reduce the anxiety associated with stuttering, helping the person become more comfortable with the moment of disfluency. By reducing the internal pressure to avoid or force out words, the need for the habitual secondary behaviors naturally diminishes.
Therapy often involves techniques from stuttering modification approaches, such as voluntary stuttering or “open stuttering,” which encourages the speaker to stutter without using any secondary behaviors. This practice helps to reduce the physical tension and struggle, transforming the moment of stuttering into a less effortful event. The goal is to reduce the overall burden of stuttering by minimizing the learned behaviors and allowing the person to communicate more freely.