راهکارهای درمانی خاص در درمان لکنت زبان کلینیک تخصصی لکنت کرج شهرک اوج – بوعلی ۲۰
increased severity comes increased punishment in the form of negative listener reaction. Why then is the second¬ary activity, which can develop into the most noticeable part of the disorder, sustained? There are perhaps two answers, although they are somewhat intertwined.
First, to many people who stutter secondary escape behaviours are quite simply seen as necessary. Although circumlocution, head jerking or knee tapping may not be ideal tools to help fluency, they serve a purpose. If a potential block is avoided by word avoidance, or silent block terminated by a moment of head thrusting, that may be considered by the speaker to be a worthwhile trade. To that extent, these features are reinforcing and self- perpetuating. They may also be modified or exaggerated if they are no longer working. In the same way that, after a period of time, the effect of a pre¬scribed drug may wear off and a higher dose is required to achieve the same effect, so too accessory behaviours may increase over time to become ever more obvious and intrusive features alongside the stutter. Even if the speaker is aware of the abnormality of these self-induced features, it may by now be difficult to extinguish them without specialist help.
The second reason lies in the unreliability of the escape behaviours men¬tioned above. Operant conditioning laws state that those behaviours which are reinforced intermittently are the hardest ones to extinguish. So, just as the jaw jerk may not prove effective at terminating a block every time, so the behaviour exists in the person’s belief that it will help next time. Many people who stutter realize the secondary behaviour may fail to terminate each moment of stuttering, but the association between the stuttering moment and the secondary response becomes automatically linked over time. As such, this might be seen as habituated behaviour, although this term barely seems to do justice to the association.
Stuttering as an operant disorder – current status
The reality is that while many texts towards the end of the twentieth century have continued to report on psychological perspectives on the development of stuttering, thinking in the late 1970s