Brazil is a country with more than 150,000,000 inhabitants, distributed over an area of 8,511,965 km and is divided in 27 states. The state of São Paulo, in the southeast portion of Brazil, is the area with the higher population density. Considering all of our country, we have about 15,000 speech pathologists and more than half of these professionals are concentrated in São Paulo. In our country, assistance to individuals with communication disorders ( of primary and secondary manifestation ) is given by the Public Health System; by the Universities' Speech Clinics or by specialists who have their own speech therapy practice. With few exceptions, no treatment is offered at elementary schools. Given this brief view of Brazil, it can be seen that the necessary attention to problem has not been given. The country is developing and one day we will solve these structural difficulties and will then be able to improve the quality of life of our population.

In regard to stuttering, the situation is even more difficult. We do not have any entity, governmental or private, that will give directions or will help the individual with fluency disorders. The speech-language therapists who specialize in stuttering still are very few. Most of our professionals do not work with stuttering, either because they lack the knowledge of how to do it or because they do not believe in the success of the treatment. Overall, we are not giving our young students the complete and up to date knowledge about this disorder.

In Brazil, prejudice related to stuttering still exists, shown by society ( does not employ a stutterer; does not allow a stutterer to enter a graduation class of Speech-Language and Hearing Pathology and etc. ) and by the professionals themselves. Hopefully this situation will slowly change. Even as an isolated initiative, it has already been formed in São Paulo ( in the end of 1997 ) a Fluency and Fluency Disorders Committee; formed basically by professionals linked to universities. This initiative is already receiving support from the Brazilian Speech-Language and Hearing Scientific Society and in the future other states, the population and maybe even governmental organizations will join.

The University of São Paulo is one of the largest universities of Latin America ( more than 5,000 professors; 40,000 graduation students; 25,000 post-graduation student; libraries; museums; hospitals etc. ). Our department ( at the Medical School ) has 15 Ph.D professors, 30 assistants; 120 graduation students; 60 post-graduation students and 13 research labs. Our Fluency Lab. is formed by myself; 4 assistents; 3 master-degree students; 3 research beginners and 3 students that are part of the university training facility. The aim of this lab. is the research, teaching and assistance to the population. In teaching terms, we offer theory and practice to all graduation students ( one semester of theory classes and practice on this subject ); training for specialists ( 720 hours per year ); training for master degree professionals and doctors. As for the assistance given to the population, in the year of 1996 we had 2080 appointments and in 1997, 2680. This means that about 100 children/teenagers/adults with fluency disorders are being seen annually at our clinic. This kind of service, at our university, is completely free of charge. In terms of research, we have concluded:

Research submitted in English:

Andrade, C.R.F.de - The Natural History of Stuttering: a speech-language study about the genetic underlying component. The Brazilian Journal of Dysmorphology and Speech-Hearing Disorders. ( submitted )

The study here shown refers to the characterization, in terms of pedigree analysis, of 12 subjects that were part of a risk group for stuttering in a longitudinal study about the natural history of this disorder. The aim of the original research, which took part 24 subjects, is to access the attributes that constitute the multiple causes responsible for the onset of the disorder and also to find out how these factors inter-relate. The general objective of the research is to follow the evolution of acquisition, development, and the pathological factors for stuttering - in the areas of speech, language, oral myofunctional system and neurovegetative/feeding functions - in children, born normal, with genetic background for stuttering ( close or distant ) and in children with no family history for this disorder ( as a control group ) during 60 months. The results obtained in the study here shown indicate that the variables existence of family history for stuttering ( close or distant relatives ) and sex do not seem to constitute, by themselves, factors of risk for the development of the assessed functions.

Andrade, C.R.F.de - The Natural History of Stuttering from 0 to 12 Months of Age. Journal of Speech, Language and Hearing Research. ( submitted )

The research about the Natural History of Stuttering aims to find the attributes that constitute the multiple causes responsible for the manifestation of the disorder and also aims to discover the way in which these attributes inter-relate. The main objective of this research is to follow the evolution of acquisition, development and pathological characters for stuttering - taking in consideration speech, language, oral myofunctional system and neurovegetative/feeding functions - in children born with no neonatal inter-occurrence, with the genetic background for stuttering ( close or distant ) and in children without the genetic trace for this disorder ( control group ) during 60 months. The study here shown refers to the period that goes from 0 to 12 months. The subjects of this research were 24 babies, 12 in each group, male and female. Six assessments were done ( at birth; at 1; 3; 6; 9 and 12 months ). In relation to the studied items, the comparative results showed, until this moment, no difference between the groups.

Andrade, C.R.F.de - Children Who Stutter - A Comparative Study Between Prevalence. Journal of Fluency Disorders. ( submitted )

To determine the prevalence of fluency disorders in a segment of the population and compare the data obtained to the prevalence of communication disorders that have idiopathic background, for the same studied group. Material and Method: After evaluating and establishing a diagnose, groups were classified according to their main disorder. In sequence the prevalence was calculated for fluency disorders and others, per age group. Results: The prevalence for communication disorders with idiopathic background was of 5.19 and the prevalence for fluency disorders was of 0.33. Discussion: The numbers obtained can be compared to international findings. Due to the limitations of this study, researches in this field must be continued.

Research submitted in Spanish:

Andrade, C.R.F. de - DiagnÓstico Precoz de la Tartamudez ( Early Assessment of Stuttering ). Revista de la AsociaciÓn Argentina de Logopedia, FoniatrÍa y AudiologÍa . ( submitted )

The aim of this article is the presentation of a screening protocol for the identification of the risk level, in children with fluency disorders, to develop the chronic form of stuttering.

Andrade, C.R.F. de - Programs TerapÉuticos en Fonoaudiologia: Experiencia com los Disturbios de la Fluencia ( Therapeutic Programs: Experience With Fluency Disorders in Children ). Revista de la AsociaciÓn Argentina de Logopedia, Foniatria y AudiologÍa. ( submitted )

In a brief retrospection, speech-language traditional treatments are based on two paradigms, the doctor ( diagnose / treatment ) and the psychologist ( therapeutic modality ) to establish the level of recovery. This situation, through time ( because we are dealing with disorders that do not have a direct cause - effect relation and therefore do not cure with drugs, they are treated with therapy ), had as a consequence an important lack of information about how efficient the assessment procedures and treatments, as well as the interaction between both are. In South America this means, in less than 50 years of Speech-Language and Hearing Pathology, we do not have enough quantitative and qualitative data about our performance, precise in methodological terms, that can be shown to the users of the Speech-Language and Hearing Pathology services ( public or private ) and to health administrators ( who decide where, how and how much money can be spent ). This situation is not exclusive of our continent.

Research submitted in Portuguese

JOURNALS

Andrade, C.R.F. de - PrevalÈncia das Desordens IdiopÁticas da Fala e da Linguagem em CrianÇas de Um a Onze Anos de Idade ( Speech-Language Idiopathic Disorders Prevalence ). Revista de SaÚde PÚblica / Journal of Public Health. São Paulo. 1997, 31 (5): 495-501.

Andrade, C.R.F. de - Gagueiras Infantis: atualizaÇão sobre a determinaÇão de fatores de risco e de condutas (Stuttering in Children: Update About Risk and Procedure ). Pediatria ( São Paulo ). São Paulo. 1997, 19 (2): 152-158.

Andrade, C.R.F.de; Rosal, C. - Programa FonoaudiolÓgico de Tiagem nas Gagueiras Infantis ( Stuttering Screening for Children ). Revista da Sociedade Brasileira de Fonoaudiologia. São Paulo. 1998 ( submitted )

Andrade, C.R.F.... de; ZACKIEWIECZ, D. - Programa FonoaudiolÓgico de AvaliaÇão das Gagueiras Infantis ( Stuttering Assessment for Children ). Revista da Sociedade Brasileira de Fonoaudiologia. São Paulo. 1998. ( submitted )

BOOKS

Andrade, C.R.F...de - Fonoaudiologia Preventiva - Teoria e VocabulÁrio TÉcnico-CientÍfico ( Speech-Language Prevention: Theory and Scientific Vocabulary ). Ed. Lovisel 165 pages. 1996.

Andrade, C.R.F...de - DiagnÓstico e IntervenÇão Precoce nas Gagueiras Infantis ( Assessment and Early Intervention in Stuttering ). Ed. PrÓ-Fono, 1999. ( in press )


Research currently in progress: