Understanding Stammering: The theoretical module

Secondary Symptoms:

The symptoms of stammering vary greatly from individual to individual. To help us understand these symptoms it is useful to distinguish between the primary symptoms—which constitute the central core of the disorder and which are beyond our control, and the secondary symptoms—which constitute our learned responses or reactions to the primary symptoms. In the beginning, secondary symptoms provide some short-term benefits, and because of this they develop into habitual responses. However, in the long run, they generally cause more problems than they solve. In the following videos and slideshow we provide a detailed description of how this comes about. As you work through these videos and slideshow, use the information provided to help you to identify your own secondary symptoms and to identify what roles they currently play.

The primary and secondary symptoms of stammering (part 1 & part 2)

In the slideshow below, we discuss the nature of secondary symptoms in greater detail. We also provide some practical guidance to help you indentify which of your secondary symptoms are most likely to be contributing to the long-term persistence of your stammering and how to go about modifying them.


Because every stammerer’s secondary symptoms are different, because they keep changing over time, and because many secondary symptoms of stammering are very subtle and sometimes indistinguishable from some of the strategies used by non-stammerers (at times when they are experiencing word-finding or formulation difficulties) it is simply not possible for therapists or other clinicians to identify all of your secondary symptoms for you. So ultimately this is a task that you need to undertake yourself.

Remember, not all secondary symptoms are harmful. So focus on identifying the ones that are likely to be sustaining your stammering in the long-term, as these are the ones you really need to modify in order to affect a lasting reduction in the severity of your stammering.

“Avoidance” is often (correctly) cited as being one of the most damaging secondary behaviours. However, be cautious when practicing non-avoidance. Expand your comfort zones gradually. Don’t force yourself into situations where listeners are likely to respond negatively to you or where you are likely to be traumatized. Be reasonable, and remember that some avoidance is necessary in order to protect you from trauma.

Covert (interiorized) stammering

Many people, especially people whose primary symptoms are relatively mild, try not only to avoid moments of stammering but also to hide the fact that they stammer from other people. People who do so are described as having “covert stammering”. As the slideshow below explains, this can lead to serious psychological problems. If you try to hide your stammering, you should find this slide-show useful.

Stammering and Post-traumatic Stress

If you stammer severely, and if it takes an excessively long time to get your words out, it is likely that you will frequently experience negative reactions from the people you try to speak to. It is also likely that you will frequently run out of time and fail to get your messages across. Such experiences can be traumatic, and may lead to the development of post-traumatic stress as a complication of stammering. The slide-show below discusses this possibility and also discusses how sometimes therapy can unwittingly add to the problem.

A more detailed description of the possible connection between trauma and stammering and its implications is available in the following article, published by the British Stammering Association…

Stammering and post-traumatic stress – some food for thought

Further reading

Psycholinguistic Insights into Dialogue: This chapter (from the book “The Perfect Stutter”) discusses research into how people normally communicate through dialogue and its implications for people who stammer. Particularly relevant is the finding that listeners understand the speaker better when they try to predict what he or she is trying to say, and that speech that contains a certain amount of dysfluency is better understood than speech that is completely fluent!

The Paradox of Non-avoidance: This essay attempts to explain some of the more subtle aspects of avoidance, and describes (from a historical perspective) how the concept of “non-avoidance” has come to constitute such a major part of modern approaches to stammering therapy.

The uses and abuses of disfluency: An essay on the identification of “avoidance disfluencies” in people who stutter: This essay discusses the subtle differences between normal disfluencies, and disfluencies that arise as a result of avoiding anticipated stammering.

Understanding Stammering: The theoretical module