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When speaking situations cannot be avoided, people who stutter adopt other strategies, including word avoidance and circumlocution. This phenomenon is known as anticipation or expectancy and is considered the basis of avoidance behaviors. If trouble in the form of stuttering is expected in a situation, the stuttering person tries to avoid it. In conversational speech, people who stutter constantly think about the inevitability of saying certain difficult words. Tension mounts when such words are spotted. While reading aloud, people who stutter rapidly scan ahead to see if there are any difficult words. Most adults who stutter can predict a certain amount of their stuttering before they occur. Such reductions reinforce the avoidance reactions and thus perpetuate them. These feelings are automatically reduced when a person avoids a word or a situation that causes them. These feelings of apprehension and anxiety are the causes of avoidance behaviors. The emotional responses may get stronger as the person who stutters gets older, especially when stuttering severity increases. Practically all people who stutter report the experience of painful emotions associated with stuttering. However, avoidance of speaking situations, when combined with other evidence, strongly supports the diagnosis of stuttering. Therefore, stuttering comes first, and the avoidance responses come next. The individuals would not have learned to avoid certain situations if they did not stutter in those situations. Like with the associated motor behaviors, avoidance of words and speaking situations is not essential to the diagnosis of stuttering. To create a painful awareness in the child, the response need not be critical or negative. Generally, speaking, people who stutter tend to avoid strangers, formal audiences, counters where services or products are bought, telephones, restaurants, and self-introdutions or other introductions. People who stutter carefully avoid many speaking situations. Relieved, people who stutter then eagerly confirm it. They beat around the bush until the listener says the word they have been avoiding. Circumlocution is another strategy that people who stutter use. Repeated stutterings on certain words or in certain words or in certain speaking situations eventually lead to the avoidance of those words and speaking situations. Each person who stutters may find some words more difficult than others to say. Friends' teasing, strangers' occasional glances of surprise, or a sign of impatience can compound the situation for the child. Some parents might criticize the child for being dysfluent and may urge the child to work harder to maintain fluency. The child who stutters is likely to confront impatient or outright rude responses from others. However, they rarely do, but the effort of these and other adult reactions is an intensified unpleasant feeling that the child associated with his or her own speech problem. Other adults may politely look away from the child who is stuttering. In an effort to help a child who is struggling to say something, some adults anticipate the child's word and say them. Polite, kind, and well-intentioned responses also can make the child aware of his or her difficulty or make the existing awareness more keen and painful.
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