Stuttering Secondaries - Strive to Empower, Not Fix
People, stutterers and non-stutterers alike, are very curious about “secondaries”. What are they, and should we be more focused on reducing those than the stutter itself? How do they develop?
For my own story - I have had secondaries and continue to. I used to assume all my secondaries were due to avoidance or trying to “push through” the stutter, but as I learn more about ADHD and autism, I now see that that only accounted for some of them. Before I share much about my own journey with them, though, I wanted to create a guide on what stuttering secondaries are (different people may have different opinions), and if I think we should be working to eliminate them in people who stutter (PWS).
What are stuttering secondaries?
Secondaries are defined as things a person who stutter does in relation to the stutter that isn’t part of the core stuttering.
“Core stuttering” is speech prolongations, repetitions, and blocks.
Many PWS develop other shared traits in relation to their stuttering that fall outside of this - we call these “secondaries”. This could be, but is not limited to, head bobbing, looking away, hand tapping, using whisper voices, and touching their lips when speaking. Some people also consider any type of avoidance behavior to be a secondary: such as word swapping or pretending not to know an answer.
Why do people who stutter develop secondaries?
The reason a person who stutters has secondaries may vary from person to person. Some of these reasons are:
1. Struggling to “push through” a stutter. If a person who stutters is stuck and feels a pressure (internal or external) to hurry up, they may unconsciously perform an action like tapping their hand against their leg. If the stutter happens to end while performing this action, a secondary may develop. Each time they feel stuck, they may resort to doing this. However, since this does not actually “help”, they may continue this behavior as they continue to stutter. They may develop additional secondaries on top of each other.
It is important to note that this is rarely a conscious act. Someone who stutters may not even realize that their head bobbing is in connection with the stutter. It often feels out of their control.
2. Avoidance or fear of rejection. Some who stutter struggle to look at their listener in the eyes, in fear of the pity or annoyance they worry they will see. As such, they may look away when stuttering, or shut their eyes. They may also suddenly stop speaking, or change the word.
3. Stimming + emotional regulation. As stuttering is a neurodivergence of speech, there is a high comorbidity of autism, ADHD, and other neurological conditions that are associated with “stimming”. Even if not diagnosed, it is important to keep this in mind as we learn more about neurological conditions. Secondaries may be self-soothing to a person who stutters. This is further notable if someone is feeling stress while stuttering - the stimming may serve to help regulate their stress levels.
Should secondaries be addressed or ‘treated’ in speech therapy? Should speech therapists work on elimination of secondaries?
The first question to ask is: is the secondary is causing immediate harm? If someone is holding their breath to the point of pain, or if they are biting their tongue consistently, this may be reason to address the secondary directly and work to minimize or eliminate it until it is no longer causing harm. This is unusual but it is impossible, and should be worked with immediately.
If the stutterer is not in direct harm, then the answer is: it depends. Some have been taught that secondaries need to be eliminated to ensure “clean stuttering” - or, stuttering that is only the core stuttering behaviors. However, this overlooks the possibility that the behavior is currently serving the person who stutters.
It is essential that we allow for differences in communication. People who say “Stuttering is OK, but secondaries are not, as they are the real distractors of conversations!” are creating a new ‘right’ and ‘wrong’ way to communicate.
Instead of assuming that secondaries are inherently bad, we should work with individuals to understand their needs and preferences. If self-acceptance is the focus of speech therapy, some of the secondaries may resolve on their own. If the secondary persists, what to do with it should be client-led. The secondary may no longer bring the relief it once did, but the person feels ‘stuck’ doing it and would like to stop. Or it's possible that the secondary still serves a purpose for the speaker, even after accepting their stutter.
How does the secondary influence communication? What benefit does the stutterer get from the secondary?
It is important for the speaker to know that it is OK to communicate in the way they do, but that they can have options to help reduce behavior they find personally unhelpful. The focus should be on the communicator feeling safe and comfortable to communicate in the way they need (as long as it isn't actively harming anyone.)
Stuttering therapy can be learning what choices a person has when communicating. You can teach someone how to make eye contact if they need or want to - and tips on how to appear to make eye contact without truly doing it, but you also teach them that it is OK to decide they'd rather not.
Conclusion
In summary, the goal of stuttering work should not be to eliminate secondaries or strive for fluency, but rather to empower individuals to communicate in the way that works best for them.