Tuesday, May 17, 2011

Defending Covert Stuttering, Part 1

It appears that one of the dogmas of most speech therapy approaches is to extinguish covert stuttering. Covert stuttering may involve behaviors such as substituting or omitting words, as well as circumlocution; yawns, coughs, or throat clearing may be used as well. In addition, avoidance behaviors may be present, such as choosing not to speak or entirely avoiding a situation that may involve speaking. In short, covert stuttering is regarded as an attempt to conceal stuttering.

Covert stuttering may be quite effective for individuals with relatively minor disfluency. Such individuals may appear to be perfectly fluent to most listeners. On the other hand, severe stutterers may not have the option to be covert.

According to most speech therapists, covert stuttering is a manifestation of embarrassment on the part of the stutterer. A goal of therapy is to desensitize the individual to his disability and to turn him into an overt stutterer.

On the stuttertalk website, two covert stutterers discuss their lives as coverts and are apologetic for their past behavior. See:


While I agree that one should strive to conquer the “embarrassment demon,” and effectively get control over one’s amygdala (see the posts on “An Anxious Mind Affects Stuttering”), I contend that it is not necessary to transform oneself into an overt stutterer. In many cases, giving oneself permission the stutter may result in a decrease of fluency. There is a modicum of mind control over one’s speech and ceding this control may actually increase stuttering.

Some speech therapy approaches involve voluntary stuttering--instead of ballgame, you say b-b-b-b-ballgame; similarly, prolonging a sibilant is regarded as acceptable. This is a form of substitution but at a syllabic level rather than a word level.

If you have trouble with s-words, for example, satellite, would a therapist be upset if you replaced the s with a ts-sound? What about replacing the “de” in the word decaffeinated with a rolled European r sound to give recaffeinated (instead of placing the tongue at the top of the upper teeth for the d-sound, gently roll the tongue across the roof of the mouth to get the European r)? Both of these substitutions are not that much different than the ballgame example, yet their upside is that you do not come off as a disfluent. So to take substitution to the extreme, is whole word replacement so bad (i.e., replacing teacher with instructor)?

An individual may choose to be covert for reasons other than avoiding embarrassment-- for example, a desire to communicate effectively. A job may require a certain level of fluency. A disfluent lawyer may be relegated to the “backroom,” but a covert stutterer would have the opportunity to practice the more people-oriented aspects of law.

It is simply much more fun to be a covert stutterer rather than an overt one.

Thursday, May 5, 2011

Antipsychotic Drugs and Weight Gain

For those individuals taking atypical antipsychotics (such as zyprexa, abilify, etc.) to improve fluency, weight gain as well as type-2 diabetes may be a problem. According to a single randomized controlled trial, metformin (an anti-diabetic drug) may reduce weight gain, in particular, when it is combined with lifestyle interventions such as dieting and exercise.


Wu RR, Zhao JP, Jin H, et al. Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. JAMA. 2008;299(2):185–93. doi:10.1001/jama.2007.56-b. PMID 18182600.