Click on the title in this index to go directly to the discussion below.
From:Sonali
[This opening question has been lost.]
From: Lisa LaSalle
Sonali, As I understand how this online conference works, I am not the only professor on the panel, but I'll begin to answer your question. First off, I am so sorry that your stuttering began after a slap from a school teacher. It could be that you were predisposed to stutter, and/or this unfortunate event plus an understandable fear of speaking that resulted from it triggered the onset of your stuttering at age 10. You are not alone in saying that you stutter more when you are "nervous," and that you get stuck on words that begin with certain sounds. These reports are common across many people who stutter. It would be helpful to know what aspects of therapy that you got 8 years ago that seemed to help your stuttering. Knowing this would help you to answer your question if there is anything you can do at home to help your stuttering. I came up with the following sites when I googled on stuttering and India, so it might help you to: (a) decide which description is closest to the therapy you got previously, and (b) whether there is a different approach that you might be able to benefit from. As I scan these sites, I notice that the fourth one is a self-help group for people who stutter. I think support groups can be very beneficial experiences, simply to find out what has helped others who stutter, and for the camaraderie involved. The Speech Foundation - http://www.speechfoundation.com Intensive short courses and self-help audio-cassette programs for treatment of stammering/stuttering, in Pune, India. Developed by Ajit Harisinghani, MS(USA),CCC-Sp.(USA). StammeringIndia.com - http://stammeringindia.com Online source of information about stammering and its treatment with psycho-speech therapy. Presented by speech pathologist Dyal Chhabra of Chandigarh, India. SpeechTherapyIndia.org - http://www.speechtherapyindia.org/ Stuttering treatment, by combination of speech, group, and maintenance therapies, in New Delhi. Adlakha's Self-Help Group for the Treatment of Stammering/Stuttering - http://www.geocities.com/swarsudharsociety/ Meeting to overcome stammering/stuttering by way of speech therapy, psychotherapy, and group-maintenance therapy. One more thing. Under the ISAD announcements, Indra Shrisreth states that "I want to inform you that in occasion of "International Stuttering Awareness Day", Nepal Stutters' Association is going to conduct two days workshop for strengthening the NSA in Nepal. The workshop will be held with the theme "Planning of NSA activities for 2006 to 2008" in October 19 & 20 at Marshyandi Hotel, Thamel, Kathmandu. This program is going to held with collaboration of The Association of Stutterers in Denmark. Mr. Hermann and Mr. Torben from Denmark is participating this program. The main objective of this workshop is to prepare the plan for increasing the activities of NSA and opening the branch offices outside the Capital." Hope this helps. Best of luck to you, Lisa R. LaSalle, Ph.D., CCC-SLP Professor Communication Sciences & Disorders Dept. University of Wisconsin-Eau Claire
From: John Tetnowski
Sonali, Since I do not know your entire history, I cannot make specific recommendations. The one thing that I hope was considered in your evaluation was outside of clinic speaking evaluations. A considerable number of individuals that stutter do not do so when in controlled testing situations. Naturalistic" assessment is critical to authentic evaluations. I hope that observations outside of clinic and/or video-taped observations from home/work/school were part of your assessment. Let me know if there is anything we can do to help.
From: Peter Ramig
You are bringing up a point that applies to most people who stutter. That is, why are we more naturally fluent in some situations and more dysfluent in others? This is a very frustrating fact of stuttering that pertains to many who stutter. I feel it is safe to say that many researchers of stuttering feel the cause of this disorder is related to a neurologically based predisposition to stutter that a child is probably born with. That said, there is little doubt that the by-product of experiencing something that makes us feel different brings into the picture the emotional and psychological aspects that can significantly fuel the problem. More specifically, when one experiences frequent feelings of embarrassment, frustration, and even shame, as a result of stuttering, the body responds by tensing. This is more likely to happen when we anticipate the possibility of stuttering on sounds and words that have been problematic to us in previously speaking situations, as well as certain situations and persons that been associated with difficulty previously. When stuttering is anticipated, the fear responses to looking different, feeling embarrassed and shamed, kick in, tensing our already highly complex speech motor system and possibly interfering with our cognitive system. These reactions created by our feelings of inadequacy can certainly fuel existing stuttering. In contrast, when we have been more successful previously in certain situations, with certain sounds, words, people, we then enter into that experience with less apprehension and more of a positive expectation that we can do it as opposed to thinking or knowing that we can't. This difference in expectation, as a result of experience, is less likely to create the powerful and debilitating fear response. This scenario can certainly impact how much stuttering we experience in one situation versus another. Keep in mind that my aforementioned simple explanation is my perception that comes from MY experience as a stutterer and a clinician who works with persons who stutter. For the sake of this forum, my explanation is also meant to be a simple exposition to an incredibly complex problem and less-than-understood disorder.
From: Glen Tellis
Sonali, Apart from the information provided by Lisa LaSalle, you can also contact Dr. Maya Sanghi at Nair Hospital in Bombay. She works with many clients who stutter and should be able to provide you with additional information.
From: Prakhar
Hi Everyone, I'm 24 year old, male, from India. Besides being active on many stuttering related groups/lists; I have also been reading some books and many stuttering related articles. As such, I have developed some insight into my stuttering. But, one answer that still eludes me is :- Some background - we all know what contextual fluency or non-fluency is. Some people are apparently fluent indoors, with some people, pets etc but cease to be fluent when talking to authority figures, tense speaking moments etc. I also fit perfectly in that mold. But, there's a twist to my non-fluency and that is - I can be fluent, as well as non-fluent, in the same context! Illustrating further - I always had a hard time attending to roll calls back in school days. I just couldn't say "present." Interestingly, I could say "present" on some rare days 100% fluently while blocking severely on it , other times. Whether I was going to block or not , depended upon my feeling fluent or non-fluent. I didn't know, where did that "feeling" of being fluent or non-fluent come from; particularly if you keep in mind that it was a routine activity(the same teacher, the same time, the same classmates, the same room, the same furniture, same air, same thoughts in my mind i.e. figuring different ways of saying "present"...etc). In short, the situation replicated itself every morning and sometimes I could be as fluent as anyone, while blocking fiercely on other occasions. Now, as you may have gathered, my question is simple: How can non-fluency or fluency be explained even when the contexts are identical? And, I wasn't under any sort of fluency enhancing therapy during my school days. No techniques, no drugs, no devices , just nothing except my normal self. Further, where did this feeling of being fluent or non-fluent stem from? It must have a driving cause. What could that be? Or there was something more going on, which I couldn't attend to? I must add that I'm more interested in knowing the answers to my questions so that, if possible, I can generate that fluent feeling at will. That's my only intention( to "feel" fluent when I want to be, and even perhaps feel non-fluent when I want to be; instead of sometimes forced to feel fluent or non-fluent without my say or choice). So, if you don't have answers to my each and every question, but point me some way through which I start feeling the way I want to; it would be more than I could have asked for!
From: Brian Humphrey
Hello Prakhar, You raise some interesting questions. I am not a person who stutters, so I cannot offer personal experiences and feelings related to fluency and stuttering, but I will do my best to offer some initial ideas. Being fluent or non-fluent in the same context is often noted. There may be considerable variability in fluency for a given person who stutters. Phil Schneider offered his thoughts about �Riding the Fluency Instability Roller Coaster in the 2004 ISAD online conference: http://www.mnsu.edu/comdis/isad7/papers/schneider7.html . You may be interested in his paper. Some clinicians may define the desired outcome for a particular client as improved fluency control. That is different from setting our outcome as "fluency", or a "feeling of fluency." Would you say that your feeling of fluency is equivalent to a feeling of control? People who stutter have reported experiencing a feeling of loss of control associated with dysfluency. You may be interested in Louise Heite's paper, La Petit Mort: Dissociation and the Subjective Experience of Stuttering, in the 2001 ISAD Online Conference: www.mnsu.edu/comdis/isad4/papers/heite4.html . You asked, where did this feeling of being fluent or non-fluent stem from? It must have a driving cause. What could that be? Determining a cause, or a set of causes, for a feeling of fluency is likely to be a complicated problem. It may be that a driving cause, or a set of causes, for a feeling of fluency or a feeling of dysfluency could arise from several sources, as varied as the proposed etiological factors underlying stuttering. Affective, behavioral, and cognitive factors could contribute to such feelings. No matter what the causes may be for feelings of fluency or dysfluency, people who stutter often develop their own combination of control strategies during the treatment process. It seems reasonable that increasing someone�s experience of fluency control may increase his/her feelings of fluency control. Others may be able to tell us if research has been done to address that exact question. I can only say that several people I have worked with have indicated that they would agree; and some have told me that they learned to do things like using the telephone even though the old negative feelings still may arise. We need to know more.
From: Rachel Meyer
Greetings Professors, As an SLP student currently enrolled in a Stuttering/Voice class, I have been provided the opportunity to do 2 stuttering simulations if I so choose. The first week of class I familiarized myself with the general parameters and suggestions about simulations by reading Dr. Schwartz's article about his students' experiences with this activity. I planned on doing the simulations. However, I am currently enrolled in a Disabilities and Society class, and a few weeks ago we covered information regarding how the majority of persons with disabilities view disability simulations. In colloquial terms, "It's not pretty." I read several articles written by persons with disabilities making their case against simulations. The logic behind their protestation made sense. Suddenly I found myself re-thinking my plans to do the simulation project. After wrestling with both sides of the issue, I have decided to go ahead with the simulations. My questions are for any/all of the professors. First, do your students perform stuttering simulations? If so, has anyone reported difficulty doing the simulations because of his/her knowledge of how many persons with disabilities feel about them? If your students do not do simulations, does it have anything to do with this controversy? Last, are there any tips you can give to a student who is doing a simulation but wants to remain sensitive and respectful to the opinions of persons with disabilities?
From: Barbara Amster
Dear Rachel I understand your concern. I do have graduate students in my fluency and stuttering course pseudo-stutter in public situations and we discuss the activity both before and afterwards. The students do it in pairs so that each student has the opportunity to pseudo-stutter and to observe the experience. I think that the way the activity is approached is important and the students realize that we are not mocking people who stutter, rather it helps a student to understand what someone who stutters confronts on a daily basis and provides the students empathy for the day-to-day experience of stuttering. Many of these students have told me the activity is very difficult to do but the result is invaluable in understanding what their clients� experience. I hope that you will give it a try.
From: Dale Williams
I too have students pseudo-stutter in pairs. Later in the semester, they also talk to people using speech patterns characteristic of stuttering modification and fluency shaping. I do this not to torture them (that's more of a bonus) and not even so much to give them the experience of feeling like a PWS. Rather, I consider it clinical training. That is, if they're going to ask clients to perform such tasks as open or voluntary stuttering, preparatory sets, and/or shaped speech outside the clinic room, they should be willing to lead the way. I tell them to think of these assignments as the first of many times over the course of their careers that they will pseudo-stutter with new listeners.
From: Howie Schwartz
As the person requesting the simulation I thought I might provide a comment. When I ask my graduate class to enter into five different situations and stutter, they often complete these activities individually and as a group. Later on during the semester, these same students have the opportunity to share their experiences when I ask a number of adult clients to come to my class and interact with the students. These interactions have always been positive experiences for both the students and clients. The clients reported that they appreciate the fact that the students have faced some of the difficulties faced by many persons who stutter. It is through this common experience that a dialogue begins between the two groups. The students have a better appreciation for how the general public is aware or not aware of persons who stutter and I believe that this experience helps the students to become a more empathetic clinicians. A second part of the task for my graduate students is to share information with the public regarding stuttering and confront individuals who were rude or disrespectful regarding the person's speech. I believe this task helps students to be more assertive and enables the public to learn more about stuttering. Rachel's question relates to an undergraduate project for extra credit. While this project is less detailed than that described above, I believe there are more positives than negatives to this task.
From: Charlie Osborne
I too ask my students to engage in simulated stuttering (in three different public situations, one by phone, two in person). They are then required to write about the experience and their reactions to it. Most students feel they develop insight into what it might be like to deal with a stuttering problem. Interestingly enough, this year, about 1/2 of my class reported planning on doing pseudostuttering in a situation and then not following through due to the perceived social consequences, then anguishing over the next possible opportunity. One concern reported by students is that they not be perceived as "making fun" of stuttering or of someone who does stutter or of being found out to be faking it. They have practiced pseudostuttering prior to actually attempting it in public. Most feel that this experience gives them a degree of empathy they would not have had without the experience.
From: Walt Manning
It appears that many instructors make use of the pseudostuttering experience and I'm happy to add my name to the list. As others have said, I ask students to do it in many forms and to construct a journal describing the situations, their level of anxiety and the listener reactions. On occasion they may need to debrief the listener, especially if the person is a PWS in order to explain what they are doing. One basic reason I ask (force) my students to do it is because there will come a time when they will need to model various desensitization and modification techniques beyond the clinic setting for their clients. It can be especially helpful for parents to do in order for them to understand what courage their stuttering children have as they go about their daily activities.
From: Dick Mallard
Pseudostuttering is probably the one activity that the parents in our program say benefit them the most. Experiencing stuttering from the child's perspective does more to help parents develop realistic expectations than anything I could say. I also have my students participate in pseudostuttering. The discussion of their experiences and feelings before, during, and after the assignment is one of the best classes of the semester.
From: Lynne Shields
PARAGRAPRachel, Others have already shared the many good reasons to have students participate in pseudostuttering experiences. I, too, have my graduate students complete such an experience in my fluency disorders course. Let me share with you one way in which it has paid off directly for one of my students. This semester, she is working with an eight-year-old girl who stutters in our on-campus clinic. This little girl was very uncomfortable with her stuttering, and initially would not attempt to describe her stuttering or show the student what her stuttering looks like. The students asked this girl if it would be O.K. for her (the clinician) to imitate stuttering, so that the girl could tell her what she saw when stuttering happened. The girl agreed, and most recently, the two of them have been having lots of fun practicing stuttering in all sorts of crazy ways (loud, soft, squeaky, fast, slow, looking in the mirror, etc.), and have stuttering contests to see who can stutter the most. As a result, this child is becoming much less sensitive about her own stuttering, and can talk more openly about it. So, there really are direct clinical benefits to the exercise, in addition to those that have been mentioned by others here. Regards and best wishes as you complete your simulations.
From: Charlie O
It's nice to have the child focus on someone else's talking. So often all of the focus is on the child's speech. It sure is easier for a child, or anyone for that matter, to focus on someone else's talking behaviors, at least initially. Being able to simulate different stuttering behaviors is an effective clinical tool!
From: Jochen Krueger/Germany
I have a daughter (3 y,2 m) who has been stuttering for 3 month. I am not sure about the definition but she repeats for example ba-ba-ba-ba-ba-ball or baaaall, some times in one out of three words esp. if she comes home from nursery school. It seems she does not even notice it and talks a lot with her friends and us. She startet speaking at an eary age (e.g. used I and you at the age of 20 months in a correct manner) and has a large treasury of words. At the moment it stabilizes somewhat but there is always some disfluency. Only once when she was sick (temperature above 40 dgr.C/104 F)she spoke normal. Do I have to start intervention with her? Or should I? Does it make sense anyway?(as proposed in Kalinowski J in Int J Lang Commun Disord. 2005 Jul-Sep;40(3):349-58) What are her chances given that she is somewhat lefthanded (Brosch in Int J Pediatr Otorhinolaryngol. 1999 Jan 25;47(1):71-6)and has good speaking abilities?
From: Brian Humphrey
Hello, and welcome to the conference. A thorough fluency evaluation would be very helpful in deciding if your child needs treatment. Usually an evaluation is required before treatment is offered. If there are significant fluency concerns, it is generally considered safer to seek early intervention than to wait. Perhaps you have discovered Ann Packman's paper, "When a young child starts to stutter: To treat or not to treat?" in the 2003 ISAD Online Conference. Her paper discusses a number of your concerns. You may find it at:https://ahn.mnsu.edu/departments/center-for-communication-sciences-and-disorders/services/stuttering/professional-education/convention-materials/archive-of-online-conferences/isad2003/when-a-young-child-starts-to-stutter-to-treat-or-not-to-treat/
From: Lynne Shields
Jochen, I agree with Brian's comment that seeking an evaluation for your daughter is the best way to at this point. Since your daughter has only recently begun being disfluent, and due to her young age and the fact that she is female, changes are good that she will recover on her own. But, your concerns are very understandable, and I think it would be helpful to have a professional see your daughter and follow her for a period of time to see how her fluency develops over time. I think that learning all that you can about the development of fluency in young children can be very helpful as well. I am glad to see you reading these conference papers, as well.
From: Anna Hearne (nee Huber)
Hi Jochen I agree with Brian and Lynne's comments regarding an assessment from a speech thearapist, however I just wanted to add a comment about treatment. The Lidcombe Program is an effective treatment for preschool stuttering which was developed in Australia but is now gaining recognition in Germany. Recently we have conducted workshops and therapists from all over Germany have been trained to do the treatment. A colleague of mine is also conducting research at the University of Frankfurt am Main looking at the effectiveness of the treatment with German children. You can find out more about this program on the website of the Australian Stuttering Research Centre http://www3.fhs.usyd.edu.au/asrcwww/treatment/lidcombe.htm
From: Brian Humphrey
Jochen, Anna Hearne's suggestion to learn about the Lidcombe Program on the web site for the Australian Stuttering Research Centre is a helpful one. The article by Ann Packman that I suggested to you also discusses the Lidcombe program. Dr. Packman is the Senior Research Officer for the Australian Stuttering Research Centre.
From: Sarah
If a PWS is seeing a speech pathologist and requests information on medication that can help with stuttering, who would be the professional that the speech pathologist could refer the patient to so they could prescribe the medication?
From: Judy Kuster
Sarah, any medical doctor can prescribe meds, including the individual's doctor that s/he sees for other things. If I were referring a client, I would look for a doctor who understands stuttering and the role speech therapy plays. I would try to find a doctor like Nathan Lavid, who has written an excellent article about some of the meds used with people who stutter. You might be interested in taking a look at his paper from this year's conference.
From: Anita Blom
The iceberg theory seems to be on its way out. Can you tell me why and what we can use instead?
From: Walt Manning
I don't believe that viewing stuttering as an Iceberg (Sheehan, 1970)is a theory, simply a description of stuttering as a complex and multi-layered phenomenon. Articles in Letting GO (NSA) have also portrayed the experience of stuttering as an onion, again with many layers. I suspect that most people in the field, in particular clinicians and clinical researchers, believe such analogies to be a reasonable way to view stuttering. They key point, of course, is that what you see (and hear) is only a portion (sometimes a relatively small portion) of the overall experience FROM THE SPEAKER'S PERSPECTIVE. It's often critical that the factors under the surface are considered during assessment and also as indicators of progress during therapeutic or nontherapeutic change.
From: John Kagie (PWS from the Netherlands)
Greetings professors, Here in the Netherlands the general accepted concept is that there is primary and secondary stuttering. (The primary symptoms are caused by a neurological defect in the brains. Secondary symptoms are learned by the PWS in the course of time, they are a result of all of his attempts not to stutter.) For an average PWS it is estimated that some 90% of his problem is a result of secondary symptoms and only 10% primary. Is that concept acceptable for most of you or do you have reservations towards it? When we follow this concept it looks logical to focus therapy first on the secondary symptoms. Those are learned behaviour, so it can be unlearned. Unlearning is hard because the symptoms are a result of habit and mixed with emotions such as shame and fear. Only when the secondary symptoms are (nearly) disappeared therapy should focus on primary symptoms. Of course the neurological cause can not be cured, but its effect can be compensated with speech techniques. Quite another question is about Individualpsychologie as developed by Adler and Dreikurs. They see stuttering as a neurotic disturbance and therefore they think therapy should be psychologically oriented. Instinctively I do not like this view, but I have to admit it might be true to some degree of for some PWS. I am very interested to hear the views from all of you.
From: Walt Manning
John- An interesting question and I don't know what my colleagues think about this. I'm not sure what I think and this is one way to find out. I think in an etiological/developmental sense the ideas of core (neurological/physiological) factors and learned responses are intuitively appealing. From a clinical perspective I don't know that it makes much difference. I don't think it matters at all with adolescents and adults and maybe not much with school age children. I work with adolescents and adults and I certainly don't distinguish between core and learned behaviors. It depends on the speaker, but we most often simultaneously focus on both behavioral techniques as well as a variety of cognitive changes. Your second question concerning stuttering as a neurotic disturbance is in opposition to all the research which indicates that PWS are quite typical, except when they speak. I hope your question generates some discussion.
From: Charlie O
John: As Dr. Manning stated, there is an appeal with looking at the stuttering problem from a primary/secondary perspective as you've described. However, in management the concepts are not considered in a linear fashion. The affective, behavioral, and cognitive aspects are addressed during the course of management and these elements are intertwined in most sessions. When considering the younger child, the preschool or early school-age child, focus on the primary and secondary features you mention is done in a more holistic way. The process is usually simpler compared to when working with the older school-age child. The younger child has had fewer learning experiences and more importantly is just beginning to develop the ability to reflect on talking as a process. His/her coping strategies reflect this. The preschool child's learned coping responses can span from opting to answer questions with an "I don't know" or shying away from situations where he/she figures talking will be required — the beginning behaviors associated with anticipating stuttering. Intervening at the time when a child is just beginning to be able to reflect on talking allows the clinician to lay the groundwork for effective communication skills without the hassle of having to deal with the more complex learned responses to the stuttering problem.
From: John Kagie
Charlie: Thank you for your response. I understand affective, behavioural and cognitive aspects are intertwined during sessions. I would think all of those aspects are concerned with the secondary symptoms, so it is more of less logically they are intertwined, but that is no reason not to differentiate between primary and secondary symptoms. That you treat children in a more holistic way is understandable. Children have developed less secondary symptoms because of the time, so there is also less need to focus specifically on the secondaries. Early intervention seems indeed a good idea. Please, could you also read and answer the questions in my previous post to Dr. Manning.
From: John Kagie
Walt: Thank you for your response. You do not find the concept useful from a clinical perspective and I would like to understand better why that is. If the concept is correct, the therapist has to use psychological techniques to treat the secondary symptoms and speech techniques to compensate for the effect of the neurological cause. Would not differentiating between the two categories of symptoms not mean a risk of using the wrong tool for the wrong job? I put the same question on STUTT-L some days ago and received mixed reactions. Some support the concept, some find it outdated. Some people argued against the learning theory with reasonable arguments. How valid would you say this learning theory is nowadays? Please understand I am not propagating this concept. I am just looking for a generally accepted concept as a basis for a stuttering association to stimulate the development of effective therapies. Writing this I realise that this may sound very ambitious. :) Which concept would you suggest?
From: Rick
Hello! What are some appropriate subgroups (official names?) for stuttering? I mean, besides mild, moderate, severe stuttering or classifications by age. Stuttering is a really general/broad term... Bob Quesal said: it is very likely that there are "subgroups" of stutterers. In other words, while the behaviors of stuttering may be similar, the underlying causes for the disfluency may be different in different individuals.
From: Tom Weidig (thestutteringbrain.blogspot.com)
You are thinking along the right lines in my opinion. Stuttering is really a misleading term as it refers to the symptoms and the disorder at the same time. This ambiguity often leads to some confusion during discussions. In my blog, I refer to PDS (persistent developmental stuttering) as the disorder and stuttering as the dysfluent speech and other related symptoms. Subtyping is very interesting, crucial for truly understanding the nature of stuttering but very tricky. What I have read so far, the following classification features might be useful: developmental as opposed to acquired (by stroke or neurological illness), family history vs none, persistent as opposed to transitional (early childhood dysfluency), neurological incidence in early childhood (blow to the head, ADHD symptoms, etc.) vs normal development, female vs male.
From: Rick
Hi, thank you for your response. PDS: persistent developmental stuttering seems to be an established term that people should use more often. what about covert stuttering or psychogenic stuttering? Is there really covert stuttering or psychogenic stuttering? And how do you classify someone as a recovered stutterer. Bill Walton calls himself a recovered stutterer and he is probably right. Assuming that we can classify someone as a recovered stutterer and we don't need to argue why people need to recover from stuttering? Recovery from stuttering seems to be a political correct term.
From: Rick
Hello! Isn't psychogenic stuttering: disfluencies after a psychological trauma that is totally different from what we call stuttering. Psychogenic stuttering implies that the cause is psychological and it can be treated with psycho-therapy. If someone has psychogenic stuttering, should he/she (no matter what age) be getting therapy from a psychologist or a SLP? Both is not an option (too expensive). A separate question. Someone once said that psychologist have the tools to treat stuttering but don't have the knowledge, and SLPs have the knowledge but don't have the tools. Is this correct or incorrect?
From: Judy Butler
Hello, Today I heard myself say that stuttering was all about reactions to the laryngeal block. I was talking with the mom of a 3rd grader. This mother knows much about stuttering and challenges me with thoughtful questions. Today, her son explained that lately he gets stuck on /h/ words. He demonstrated what I interpreted to be a block in which he exhaled air but made no sound. This is how we got into the conversation of blocks vs repetitions, prolongations, secondaries and emotional reactions. Back to my question. Where did I get this idea that all physical and emotional components originate in a person's reaction to the laryngeal block and attempts to speak when the vocal cords refuse? Should I be saying that the other behaviors occur in conjunction with - not as a result of - the block? Can you give me a few references on this issue that I can access and that this mom could read?
From: Darlene Lengel
I have had this come up with two of my students through the years. They stutter only when speaking to one authority figure (a grandmother for one and stepfather for the other) and nobody else. What can one do for this situation?
From: Brian Humphrey
Hello, Darlene, If someone were to inform me that a client of mine was stuttering with only one authority figure outside of the clinic, before deciding what to do I would want to define the problem as clearly as possible. Time and effort spent in understanding a problem helps me to develop effective solutions. It often helps me to involve clients and/or families in problem-solving; it helps them to understand their own situations better, and it is an opportunity for them to practice some self-help skills. Here are some of the kinds of questions that could arise: What is the evidence that the person who stutters (pws) is only dysfluent when communicating with one particular person? Is that really the case? Who told me and how reliable is the information? Have I observed this directly? How does the pws see the problem? How does the problem communication partner see the problem? Do their perspectives agree with mine? Are interactions with a problem communication partner somehow different from interactions with other communication partners? What are the communication demands? What are the fluency and reactions of the pws really like in the problem situation? Is there a way to observe the problem -- a clinic visit by the problem communication partner, a field visit by the clinician, or a recording, or perhaps observing a telephone conversation? Is the pws ready to provide information by making observations or ratings about an outside situation? After defining the problem well, my next step would be to generate some alternative solutions to chose from, and then decide what to do.
From: Lynne Shields
I would add one other question to the very comprehensive list provided by Brian. Is he or she obtaining fluency in most situations by using word substitutions or circumlocutions? We have a client here at our clinic who is quite fluent in almost all speaking situations. On closer questioning, however, it became clear that she is quite adept at substituting words. She chooses her words very carefully when speaking, and thus maintains nearly 100% fluency, but at a very high price in terms of lack of spontaneity and great fear that a stuttered word will slip out.
From: Roslyn @ U of T
In your clinical practice have you observed a correlation between stuttering and a clinical anxiety disorder diagnosis, or is the anxiety disorder acquired because of the stuttering (if there even is a high coexistence)?
From: Rick
A related question. John Harrison doesn't believe in inherited stuttering or stuttering genetics, but he said that pws are more sensitive. Not just more sensitive to stuttering, but just more "sensitive" than the average person. Any research or observational evidence to prove or disprove the claim? Of course, one can also argue the chicken or the egg dilemma (which came first). Sensitivity can be inherited, but if we can train all children to have high self-esteem and don't give a darn about what others think or say...
From: Barbara Amster
I would also like to add that some preliminary research suggests that that some PWS may be more sensitive to making mistakes. This concern about making mistakes could lead to distress over perceived speech errors. We speculate that in efforts to gain control of their speech, these PWS may expend increased levels of energy, resulting in tension, effort, and struggle, the types of behaviors thought to make stuttering persist. Evelyn Klein and I will be talking about this at the ASHA Convention in San Diego.
From: Gary J Rentschler
I find it hard to argue with science (of course John Harrison may be even more formidable) :-) In my opinion, people's sensitivity varies, PWS or not. Disfluent speech of PWS becomes a sensitive issue and it is easy to feel that you're speech is the primary reason that you are imperfect and can become a focal point of one's attempts to be viewed as normal. Several PWS feel their speech must be perfectly fluent to be "normal". As one learns to accept their stuttering, they learn that the stuttering is usually NOT the reason some people may not like you; but it can be the reason that is expressed. I haven't bought into the predisposed sensitivity argument all that much. There are plenty of children who might be considered "hypersensitive" that don't stutter.
From: Mario from Belgium
In Belgium we are working on a site (www.stotterforum.be) and want to put objective information on it. I would like to know how other people (including professors) view what "objective information" could or should be put online with the goal in helping guide a person who stutters towards good therapy for stuttering.
From: Glen Tellis
Dear Mario, A few years ago, my co-authors and I wrote an article (reference provided below) about the Internet and stuttering. Because there is so much information about stuttering on the Internet - accurate and inaccurate, we decided to provide consumers with resources that they could access. For example, people could go to the Stuttering Home Page (the site for this conference) and access a link that could lead them to accurate and inaccurate information. In the article we expressed our concerns about certain websites and recommended certain ones as well. All three reviewers of the article agreed with our suggestions. You may want to read the article before updating your website. Here is the reference: Tellis, G. M., Gabel, R., Smith, D.A., Tellis, C.M. (2002). Information about stuttering on the Internet: A resource for school speech-language pathologists. Contemporary Issues in Communication Science and Disorders, 29, 165-172.
From: Brianne Linaman
I was wondering if anyone had ideas or resources to help increase a child's internal locus of control.
From: Lynne Shields
Brianne, This is a wonderful question. I think that a child can develop a feeling of internal control by gaining strategies for managing the situations that seem to them to be out of their control. For example, if a child is feeling helpless because she is being teased, she needs some tools to use to handle the situation. First, she can begin to look at who is at fault when teasing occurs--that it is the one who teases or bullies, not her. What belongs to her is the bad feelings; what belongs to the bully is the shame. With younger kids, I usually phrase this something like, "So I'm wondering, who is the bad guy in this story you just told me?" Secondly, if she can develop what I call a snappy comeback (or better yet, several) for such situations, she is no longer helpless. She is in control of the situation when she responds, "that's pretty mean to tease me. I really don't want to play with you" and walk away, or, "I think you need a new hobby." The child can be engaged in a fun way in coming up with responses to teasing that fit her personality and the situation. An engaged child is one who is taking control. The same kind of work, engaging the child in developing their own strategies, or choosing from among strategies or tools suggested by their SLP, can help to give the child a sense that they can take control of their speech, their communication, and their interactions.
From: ben
From: Dale Williams
Hi Ben. Stuttering modification is a treatment approach based in large measure on desensitization and easy stuttering. It involves goals such as decreasing avoidance behaviors and speaking in situations outside your normal comfort zone. The idea is that, because stuttering is not curable, it is best managed in a way that lifts the shame, embarrassment, and other barriers to effective communication. That is, if clients are going to speak, they are going to stutter; and since they are going to stutter, they may as well become desensitized to it and assume some control over HOW they stutter. There�s a lot more to it than that, but hopefully this gives you an idea.
From: Peter Ramig
Dr. Williams gave an appropriate overall definition of stuttering. I would add that stuttering modification helps stutterers respond to their stuttering in a manner that is completely opposite of what their brain tells them to do when expecting or experiencing a stutter. Generally speaking, the brain senses danger, embarrassment, shame, etc., and as a result, the body reacts with increased muscular tension, a normal reaction to the experience of something unpleasant. However, with a great deal of practice and knowledge of where and how one is responding to the threat of stuttering, one can learn to stutter with much less interference to the natural flow of speech. In modification treatment the client is taught to confront the stuttering and the feelings related to it, as well as ways to stutter with much less effort. In turn, learning to stutter with less effort decreases interference with the normal speech production system, specifically the on-going need for proper air and voicing.
From: Alan Badmington
I recently attended a workshop in London where (in addition to the main agenda) the organizers assembled a panel of six persons who have made considerable strides in relation to their stuttering. The three hours session commenced with each panel member providing brief details of his/her personal history. The remaining time was taken up with questions and answers from the floor. Are such events of value? Should the speech-language profession encourage greater dialogue with those for whom stuttering is no longer an issue? Would it be of assistance to establish any possible commonalities? Your views would be greatly appreciated.
From: Judy Kuster
Alan, I also believe we have a lot to learn from people for whom stuttering is no longer an issue, and in fact there is interest on this side of the pond as well. NIH had been doing a study, testing people who recovered from stuttering as adults. A few years ago, one of my own students who recovered from stuttering in her early 20's, participated in that study. You might also be interested in listening to several panels (every decade since the 1950's) of people who stutter, several talking about their paths toward recovery from the "handicap" of stuttering. Check https://judykuster.net/stut/voices/voicesindex.html
From: Walt Manning
Hello Alan- As I understand your comments the London workshop was about how speakers successfully managed their stuttering over the years. Of course every story of success is quite different but we have found some common themes that help to explain eventual success. (See Plexico, L., Manning, W., & DiLollo, A. (2005). A phenomenological understanding of successful stuttering management, Journal of Fluency Disorders, 30 (1) 1-22. I believe there are common themes or principles of change that operate across a variety of therapeutic approaches and are also present outside the formal therapeutic view of change. I suspect that change that is assisted by a truly competent and experienced clinician (another topic to be sure!) would be more efficient and effective but the same basic principles of successful management (of stuttering and other things) likely hold in any case.
From: Alan Badmington (to Walt)
Hi Walt, Thank you for your prompt and informative response. Incidentally, the London panel was chaired by John Harrison, and included two SLTs, an NLP master practitioner, myself, and one other person.
From: Bobbie
How does mild-moderate stuttering affect an elementary school aged student's reading ability - specifically, reading comprehension? When the child who stutters is reading silently in his head, does the fluency disorder slow him down? When state testing is administered, should a student who stutters be given more time?
From: Judy Kuster
I cannot answer your specific questions, but Pete Smith did address "Stuttering and Concomitant Reading Problems" in an article for the 2000 ISAD online conference that you might find of interest.
The link is here./
From: Ira Zimmerman
To what extent are persons who stutter in denial? So many stutterers seem to turn the other cheek to the public ridicule of PWS and how that can affect their career or social life.
From: Lynne Shields
Ira, I don't think that people who stutter are any more in denial than the rest of us. Clients whom I have worked with of all ages seem quite aware of the repercussions that stuttering has on their lives now, and may have in the future.
From: Tim - United States
Is there anything that family members can do to stop stuttering before it becomes to disruptive in families where there appears to be a genetic predisposition to stuttering? For example, what should they do when they first notice that their child is beginning to stutter?
From: Lynne Shields
Tim, I do not think that my advice would vary depending on whether or not there is a predisposition toward stuttering within a family. I don't think we really know at this point whether or not there is a way to prevent stuttering entirely. A few pointers relative to how to interact with new talkers certainly may be helpful, whether or not they act in a preventative manner. I encourage parents to pay attention to their child's message rather than the delivery of the message, so that the focus is on successful communication rather than perfect pronunciation or perfect fluency. Keeping the pressure off regarding communication skills is always appropriate, whether or not the child is demonstrating any disfluencies. And, if parents become concerned about their child's fluency, seeking professional help is advisable.
From: Mac Farmer
After several years, I experienced recurrence of blocking speech, especially on the telephone. This happened at the time of my retirement from work. It is particularly discouraging when I speak with my grandchildren. Why the return of stuttering after being fluent for several years.
From: Walt Manning
Hello Mac - You pose a difficult question to answer and I can't believe I'm trying to respond with so little information to go on. What you describe is not unusual or surprising, especially with major changes occurring in your life. However, without meeting with you and talking to you, understanding your story, nature of your stuttering, previous therapy, degree of avoidance behavior, etc. it's not possible to explain your increase in stuttering. You mentioned that you were blocking and I'm not sure if you mean blocking of airflow and voicing or whether you are using the term blocking for stuttering. Can you provide a little more information (either on this site or offline) and I'll try to respond with some possibilities.
From: [no name]
Are there studies or anecdotal evidence of stuttering increasing or decreasing during adolescence?
From: Brian Humphrey
Very general questions are often easy to ask but difficult to answer. The literal answer to this question is: Yes, stuttering can increase or decrease during adolescence. That's not a very helpful answer, but perhaps the answers to some related questions may be more helpful: Can we predict what will happen for a given individual? Not really. Variability across situations and over time are hallmarks of stuttering. However, for an individual who continues to stutter into adolescence, stuttering is more likely to become a lifelong issue; and feelings and attitudes about speaking and stuttering may become more significant components of the individual's stuttering problem. Can treatment help an adolescent who stutters gain fluency control and/or communicate more effectively? Yes - provided the individual in question is ready for treatment. Adolescence is a time of change, and for some individuals, stuttering problems may be less of a priority during adolescence than before or after adolescence. Support groups can also be helpful for adolescents who stutter. "Friends", a national association of young people who stutter, organizes an annual convention and publishes a newsletter called "Reaching Out". Information about "Friends" and "Reaching Out may be found at: www.friendswhostutter.org
From: Karen from University of Stuttering
I was wondering if in your practice if there you have noticed a high correlation of people who stutter who also have ADHD/ADD. If so, is there any research that may support this?
From: Barbara Amster
Karen You may be interested in looking at the following article: Healey, C. E., & Reid, R. (2003) ADHD and stuttering: A tutorial. Journal of Fluency Disorders, 28,2. For an overview of the topic.
From: Judy Kuster
Dr. Amster's response guides you to an excellent article. Healey and Reid provided
some preliminary information on the 2000 ISAD online conference as well.
From: Monika Gerlachova - cz
We have a 6 year old daughter, who has been stuttering since the age of two. This problems seems to lie in the family: also her grandfather and her uncle are stuttering. 1. What therapy would you recommend for pre-scholars? We are afraid, that our 3 year old boy could start to stutter, too. 2. Have you heard of cases, where more than one child in the family are stuttering?
From: Lynne Shields
Dear Monika, There are a number of good ways to approach stuttering in young children. If you have not yet taken your daughter for an evaluation of her speech, I encourage you to do so. Contact speech therapists in your area and interview them. Ask them how much experience they have in working with children who stutter, and what types of treatments they would consider To answer your second question, yes, I have seen cases where more than one child in a family stutters, particularly when there seems to be a predisposition for stuttering such as in your family. However, just because one child stutters, this does not mean that a second child is going to develop stuttering. Each child must be treated as an individual. You are doing a very positive thing for your daughter by informing yourself about stuttering.
From: kb
Just a question for you because we have been watching a lot of your videos in my fluency class. If this is not something you focus on, I'd appreciate info from anyone. I am wondering about people who stutter who have hearing loss. It seems like what helps a lot of people become fluent is to use DAF or a masking noise. So then if someone has hearing loss and doesn't have that necessary auditory feedback, do they stutter less, at all, or what?
From: Peter Ramig
This would depend upon the degree of hearing loss. The DAf would probably still be effective, as it may have been for this person to begin with, if the loss is not significant. If the person can hear the interference created by DAF, I believe it would still be impactful for the client. P.S. I hope you like the Stuttering Foundation videos! :)
From: Ira Zimmerman
I understand that the SpeechEasy Device is based on fooling the Stutterer's brain that the stutterer is not speaking alone. It produces a choral affect. Does the brain ever wise up and realizes that the stutterer is alone and fully responsible for what is being said? If it is only temporary, that young man who got a Speech Easy device as a wish on the NBC-TV Program, "Three Wishes", is in for a great disappointment sometime in the future.
From: Judy Kuster
Ira, you asked "does the brain ever wise up" and the SpeechEasy device become ineffective. Larry Molt and his associates from Auburn University are conducting an independent study to determine the long-term efficacy of the SpeechEasy. They are evaluating data collected from 45 people who stutter. Measurements will be conducted at one month, three month, six month and one-year intervals. This long-term study will hopefully determine at least the one-year effectiveness of the SpeechEasy, and hopefully will provide insight not only if the device is effective, but for whom it might be effective.
From: Judy Kuster
Date: 24 Oct 2005
The live, threaded discussion part of the 2005 ISAD online conference is now closed. The responses made here during the conference will remain online. Thank you for stopping by. Judy Kuster
From: Ed Feuer
[This first question has been lost]
From: Tom Weidig
Dear Ed, It is difficult to reply to your comment, as you are generalizing and not referring to a specific example. My experience is different. Many research groups collect individual data from their experimental subjects in order to see whether some aspects like age, severity, or gender correlate with some observations. Sometimes the researchers only study subgroups. From the back of my mind, I can think a study by the group around Ingham which studied how female "stuttering" brains differ from male ones. From my own research, we collected many different aspects of patients of a fluency shaping therapy, and tried to find out which patients are most successful. However, we did not find anything, except severity, so the more you stutter before therapy the less likely you are fluent afterwards. Or I can think of research by Yairi and Ambrose (I think) where they found that kids with family history recover less often. So researchers try to make distinctions, but it is hard to see any clear subtypes. Having said this, I believe that much research into stuttering is indeed flawed (but for different reasons), and many people conducting research lack the necessary scientific training and statistical know-how. Due to the complexity of stuttering, there are no clear answers to many issues, and people get away with a lot of sloppy thinking, unlike in computer programming where a minus left out crashes the system!
From: Ed Feuer
Tom, I thank you for your reply but I would urge you to examine the peer reviewed journals for the past 10-15-20 years to see that what I describe is sadly not the exception. I also submit that subjects differentiated by such criteria as degree of severity, gender, age, overt, covert, before intensive therapy, after intensive therapy cannot simply be relegated to some rare "subgroup" or "subtype" category. These are the very real differences among people who stutter. Failure to recognize these differences constitutes bad research. One size does not fit all -- despite the sweeping generalizations of such flawed research about "stutterers".
From: John Tetnowski
Ed, As you have stated, there are some flaws in the studies that make it to press. I would also agree with you that just as one method does not fit all subjects, one method of inquiry does not fit all research questions. As I have argued, qualitative research methods can handle some of the issues that you have addressed. Recent papers by wonderful researchers like Susca and Healey, DiLollo and Manning, Margaret Leahey, and others have all addressed individual versus group results. The qualitative papers are not a better method......they are just an alternative method. Gifted researchers can fit the right technique to the right research. I see it happening more and more often these days. For a review, see my paper in JFD from 2001.
From: Ed Feuer
John, Thank you for your reply but I'm sorry other accredited SLPs didn't see fit to respond because the issue is legitimate and serious. I submit that scientifically valid research into stuttering demands the use of differentiated subjects. Ultimately, there is no substitute. While recruiting differentiated subjects is difficult in small university towns, such is not the case in large metropolitan centres if researchers put forth the effort. In the world of publish or perish . . . anything, it is so much easier to use generic "stutterers" and then claim the results fit all "stutterers" -- especially if peer reviewers in the academic journals co-operate as they have. I submit that we who stutter have been ill-served by such "research".
From: Rick
Hello! I was wondering if someone was interested in doing research on stuttering in the 21st century, what should he/she do? Should he pursue a PhD in SLP/Comm. Disorder with an emphasis on stuttering/fluency disorder? If that is the case, who are the leading stuttering experts in the US or outside the US? Or should the person consider studying genetics, neurology, or psychology (psychotherapy can help pws) and then do research on stuttering?
From: William Rosenthal
Hello Rick, I think it is not easy to answer your question, because it is likely that fruitful research is possible in each of the areas or disciplines that you list. If this is something that you, personally, are considering, my recommendation is that you first follow your own interests. That is most likely the way for you to prepare and eventually to do good research on stuttering, and to have a satisfying career. Having said that, it is certainly the case that very interesting work is going on in the area of genetics, and that direction may hold the greatest hope for cracking the code. As far as your question about who are the �leading� researchers in stuttering, after excluding me, you can start by looking at the list on this site.
From: Tom Weidig (thestutteringbrain.blogspot.com)
I guess there are two types of researchers. Researcher A has a background in speech and language, and think "what research should I do in my area". Researcher B has a more general background in science (neuroscience, neurology, genetics, psychology, statistics), is part of a larger research group and thinks more along the line "I have a brain scanner, which disorder should I look at" or "I have genetics know-how, which disorder should I look at". I would not specialize too early, and try to get a solid science background as an undergraduate But a final year thesis into stuttering would help. And then you need to find a researcher that does research into stuttering, that accepts you. Two things are crucial: 1) show enthusiasm for and some knowledge of the PhD subject 2) be pro-active, show intellectual rigour, and ability to learn. Even though I don't work as a researcher, telling you which researcher is best is too dangerous! :-) I would say go for someone who is youngish (between 30 and 45), look at his paper output over the last 5 years and is an all-rounder and thinks multi-disciplinary.
From: Stan Fisher, Boston
Does data exist on the frequency of covert as opposed to overt stuttering? As a covert stutterer, I wonder how common is my way of dealing with disfluency.
From: Klaas Bakker
I have been avoiding answering your question for a little while but am very intrigued by it as well. First, addressing your question head on, I am not aware of controlled studies producing incidence and prevalence numbers for covert stuttering, nor ones that make comparisons using such numbers between individuals who demonstrate covert or overt stuttering. There seems to be a built in problem in attempting to quantify covert stuttering, as it asks for measures that are "covert" as well. I think it is an important fact that people who have a covert stuttering problem exist, suffer consequences of the problem, and obviously need help for it. Stuttering modification obviously is not the way, nor is reducing stuttering frequency using behavioral methodologies. What IS the problem in this case is your subjective experience to be a covert stutterer and the way if affects you in your daily life. This could be made measurable through some form of questionnaire which might be given to individuals who stutter overtly as well. To the extent that covert stuttering may be the result of successful avoidance, some measures cover aspects of your problem in that they address degree of avoidance. Other survey measures may determine the relative presence of speech related concerns. These are just some thoughts about the issues but certainly not a complete nor satisfying answer to your question. I think it would be interesting to produce incidence and prevalence estimates for this unique condition, but also to determine that we are dealing with the same problem across individuals who say they have it.
From: Bailey Levis
Hi Stan, I don't know of any research that has looked at the frequency of covert vs overt stuttering, but there are many covert stutterers out there. If you haven't already, check out the yahoo group for covert stutterers. It's a great forum for discussing and getting support for the challenges that we face. http://health.groups.yahoo.com/group/Covert-S/
From: Tom Weidig (thestutteringbrain.blogspot.com)
Dear Klaas, you wrote that "Stuttering modification obviously is not the way, nor is reducing stuttering frequency using behavioral methodologies." My experience (not as a therapist but as an observer) has been a different one. First, I have witnessed two cases at two different therapies (Star Fish and Kassel Stuttering Therapy) where the clients were perfectly fluent before therapy to an outside observer but seemed to suffer and avoid a lot. Both were very happy with the outcome of the therapy ("it changed their lives"), but for the outside observer they were a bit less fluent in the sense that they were using techniques like gentle onset or slow speech!!! Second, the people at the Kasseler Stuttering Therapy are doing fluency shaping with bio-feedback, and it is often said that fluency shaping is for medium to severe overt stutterers. So they did a therapy evaluation (large sample and long-term) and found that people, who stuttered very little/covert, benefited as much as overt stutterers. So paradoxically one could argue that the speech technique (or voluntary stuttering e.g.) gives them safety and control, which then triggers other processes including reducing or dealing with anxiety, expectation to stutter, and pyschological issues. Just some food for thoughts...
From: Klaas Bakker
Tom, you are very insightful. There is more to stuttering than stuttering itself! However, in my answer I was merely referring to the implied need of the stuttering modification and behavior therapy type interventions to make changes in overt behaviors, which shouldn't be there in the case of clients with covert stuttering. It wouldn't seem a meaningful goal to target the stuttering which isn't there in a physical observable sense. I do believe (but where area the data?) that there may be a great deal of (successful?) avoidance that accounts for the absence of stuttering in those who still consider themselves as stutters. Avoidance may well have overt aspects that can be addressed either in stuttering modification of behavior therapy. Also, stuttering modification is not strictly only looking at the overt speech related dysfluencies but does look beyond. These are just some refinements in the statements I made. I do believe that the most effective way to treat cover stuttering is to target what is obviously there, the covert concerns, feelings and attitudes that continue to be a problem for the client. Research addressing covert stuttering, I think, should address these variables head on for discovering more about this unique problem and how often it occurs.
From: Patti Bohlman
I have a concern about the drug studies that are being done in hopes of finding a medication that would help people who stutter. Most of these are psychotropic drugs. I have tried to ask researchers about people who stutter who also have panic disorders, anxiety, depression, ocd, etc. They seem to have no interest. Let's just look at stuttering. However these disorders interact with the stuttering. Some medications make it worse, some better. When it makes the stuttering better, I believe it is because it works on the mental health component that interacts with stuttering. For example. Many stutterers with anxiety disorders report that klonopin helps decrease the stuttering and also the amount of effort that is put into the stuttering (the stuttering is less of a struggle). Wellbutrin is known by many PWS to make their stuttering horrible. Since PWS are just as likely as the general population to have mental health issues, what can be done to advise PWS about medications that may help or make their stuttering worse. Where is the research on this? Or is it even possible? As an slp, how can I reliably guide clients to medications (when needed for a mental health disorder) that will have a chance of increasing fluency and not making it worse?
From: Nathan Lavid, M.D.
Hello Patti, These are interesting topics you address. The drug studies I presented were conducted on patients who did not suffer from mental illness, as this was part of the exclusion criteria for the studies. The effects of the medications on stuttering were not due to alleviation of co-morbid psychiatric conditions. Psychotropic medications do have an effect on stuttering, and the examples you provide are common. Klonopin can alleviate the anticipatory anxiety associated with stuttering and in an indirect manner increase fluency. Wellbutrin increases dopamine and can worsen fluency. In a situation where you are providing care for a patient who suffers from mental illness, a referral to a psychiatrist would be appropriate. Most psychiatrists are familiar with the medication side effects that effect speech, and he or she should be able to offer treatment recommendations that would not interfere with your work.
From: Patti Bohlman
It may be that the psychiatrists that you know, know this information. However, here in Milwaukee, it is not true. I do know of one that does know some things about it. But I know psychitrists that put stutterers on Wellbutrin with no thinking of their speech-this is documented in reports of stutterers talking to each other in person or e-mail listservs. No research. This is a real interest of mine.
From: Nathan Lavid, M.D.
Hello Patti, I'm glad to read of your interest, though sorry to read of these experiences. Its impossible to evaluate medication recommendations from hearsay, especially when it pertains to mental illness as the stigma of mental illness has an effect on candid public discussion. Wellbutrin is commonly used for depression and at times as a second-line agent for AD/HD and a depressive episode of bipolar disorder. Possibly, the use Wellbutrin was deemed to be effective for the patients mood disorder and supersede the risks on fluency. Or, like you mention, the physician did not know of the stuttering or the effects of the medication on speech. If the later, a simple solution would be to write or call the prescribing physician and inform him or her of the side effects. Some medical practices only allow a short time for visits, and time constraints may effect physician-patient communication. In my practice, I dictate an initial letter to the referring clinician and make follow-up phone calls if needed. Also, I'd be pleased to answer any questions you might have after this conference is over.
From: Beth in Oklahoma
Is there recent research that supports brain physiology changes following stuttering therapy? If so, do these changes maintain over time?
From: Tom Weidig (thestutteringbrain.blogspot.com)
There are two studies I know of. 1) J Fluency Disord. 2003 Winter;28(4):357-79; quiz 379-80. A positron emission tomography study of short- and long-term treatment effects on functional brain activation in adults who stutter. by De Nil LF, Kroll RM, Lafaille SJ, Houle S. 2) J Fluency Disord. 2005;30(1):23-39. Cortical plasticity associated with stuttering therapy. by Neumann K, Preibisch C, Euler HA, von Gudenberg AW, Lanfermann H, Gall V, Giraud AL. Neumann K, Euler HA, von Gudenberg AW, Giraud AL, Lanfermann H, Gall V, Preibisch C. (see also The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison. J Fluency Disord. 2003 Winter;28(4):381-409; quiz 409-410. Generally speaking, the studies found a change in activation after a fluency shaping therapy. But I think we need to be careful when it comes to the details and not jump to conclusions. We need more research. (To read the abstracts, go to PubMedline: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi and enter keywords)
From: Anita Blom
The iceberg theory seems to be on its way out. Can you tell me why and what we can use instead?
From: William Rosenthal
Anita, The "iceberg" theory is not exactly testable using traditional research methodology. The concept is, I think, more of a metaphor than a theory. Anyway, I think that most researchers and clinicians believe that there is much more to stuttering than meets the eye. That is, the phenomenology of stuttering has an underlayment of neurological, genetic, social and psychological elements that ARE the subjects of research. Therefore, I do not think the concept is actually dead, just somewhat transformed in view of understanding that is more recent.
From: Robert Shields
I've been reading about stuttering and genetics. It says that in all likelihood stuttering is more apt to be found in a person who has a family history of stuttering. This seems logical, but I have a couple of questions. Who is the most likely carrier of the gene? The material I read stated that boys are more apt to develop stuttering than girls, but a girl is highly prone if it runs in the family. When is the gene recessive, and when is it apt to show? Does it skip generations?
From: Tom Weidig (thestutteringbrain.blogspot.com)
Hi, I am not a geneticist, but the consensus seems to be that there is no single stuttering gene. It is very likely that different combinations of genes make people venerable to developing persistent development stuttering. For example, genetics research has been conducted on two families: one in Pakistan, and one in Cameroon. Most members of the two families are stuttering. The studies reveal strong signals on several chromosomes (packages of genes) but they were different for each family. Also, research from other disorders like deafness (I think) found more than 80 different genes correlated to deafness. Thus, I just wanted to say that the picture is complicated. Dr Drayna, who has written a genetics article for this conference, will be able to answer your more detailed questions.
From: Bailey Levis
Hi Robert, I am a grad student working in Dr. Drayna's lab. First I just want to say that the studies we are doing on Pakistan and Cameroon are still underway. It is true that genes on different chromosomes appear to be involved, and like deafness, there is probably not just one gene involved. As far as the male to female ratio, in children it's about 1:1. The difference is that girls seem to recover more often than boys. About 80% of children who stutter do spontaneously recover. Why more girls than boys? I don't know. As for stuttering being a recessive or dominant trait, it's not so simple as that. To quote Dr. Drayna, "...most stuttering isn't inherited in a noticeable pattern..." This is one of the reasons that stuttering is considered a complex genetic trait, and it is one of the challenges we face in identifying a gene involved in stuttering.
From: Darlene Lengel
Are there any past or current research projects that attempt to find a link between cluttering and stuttering? They seem to be two distinct disorders to me, but I do not have any research to back up my opinion.
From: Klaas Bakker
Darlene, Your question cannot be answered very quickly or completely through this forum but I'll try to get an answer started. One of the possible complications is that persons who clutter may stutter to varying degrees as well. Cluttering is mostly recognized as an affliction of speech fluency that in most cases is centered around the tendency to have a rapid or irregular rate of speech delivery. As a result, articulation suffers and quite possibly many other aspects of communication. So, rate forces a clutterer to make more mistakes than usual. Speech rate does not always have to be fast in an absolute sense but could be fast enough to compromise one's speech production integrity. In the case of stuttering difficulty is in the fluent progression from one sound to another, or between sounds while usually the part of the message to be spoken is completely formulated internally before an utterance begins. It is experienced as an involuntary inability to proceed with speech sound production. While not thoroughly researched, fairly good descriptions of the differences between cluttering and stuttering are available. I would, among others, refer to a chapter by Alf Preus(Norway) published in the following book (1986): F. L. Myers & K. O. St. Louis (Eds.). Cluttering: A Clinical Perspective. Kibworth, Great Britain: Far Communications.
From: Robert Shields, WWU
I've been reading on the inactivity of the left hemisphere in the brain of PWS. I also just got done reading the article by Larry Molt on the history of stuttering devices. A very good article. Are there any way that the left hemisphere can be stimulated back into doing its job of language processing and speech production?
From: Tom Weidig (thestutteringbrain.blogspot.com)
Hi, brain studies do not really show inactivity in the left brain but in general only lower activation levels in some regions than for people who do not have PDS (persistent developmental stuttering). There is now more evidence that there is a structural weakness (or defect) in the left brain region based on research by Sommer et al., Jaehnke et al., Foundas et al. and Watkings et al. It is natural to think that this weakness arose due to genetics or neurological incidence in early childhood, forcing the brain to compensate. Thus, "stimulation" would very likely not eliminate the weakness or defect, if it exists. The best hope would be to "stimulate" your brain to learn the best compensatory system possible, e.g. neighbouring regions taking over. But the picture is still diffuse, e.g. how do neurotransmitters come in. Currently, there is much research going on, and I am convinced that five years down the line the fog we will be wiser.
From: Alan Badmington
I recently attended a workshop in London where (in addition to the main agenda) the organizers assembled a panel of six persons who have made considerable strides in relation to their stuttering. The three hours session commenced with each panel member providing brief details of his/her personal history. The remaining time was taken up with questions and answers from the floor. Are such events of value? Should researchers involve themselves in greater dialogue with those for whom stuttering is no longer an issue? Would it be of assistance to establish any possible commonalities?
From: Hans-Georg Bosshardt
Your question has a very intersting implication which is certainly true in one sense but which is at least incomplete in another sense. In their daily life stuttering persons experience the highlights and frustrations of their speech and self presentation, and they are confronted with a more or less supporting and sometimes cruel environment. In this sense stuttering persons are experts about their own stuttering and its impact on their own life. Stuttering persons are also experts in evaluating the consequences of therapies on their own life. This is the reason why in the history of the development of therapy techniques stuttering persons have made very important contributions to the development of new therapy techniques, to the refinement of existing ones, etc. However, I have serious doubts whether this expertise also covers a knowledge about the causes of stuttering and about new, until now unexplored useful therapy techniques. Imagine that we make an inquiry about the special tactics which help stuttering persons to improve their speech or verbal forms of self-presentation. It could be very interesting to see whether at least some of these manoeuvers differ from the commonly used slowing down, breath management, mental concentration, thought and emotion control. However, the risk is very high that we end up with a long list of rather nonsensical suggestions - the history of therapy techniques is full of examples and I am rather skeptical whether it is helpful to prolong this list. The major reason for me to be skeptical is that neither disfluent nor fluent speaker do have good intuitions about the cognitive, emotional, and motor processes involved in speaking. Having said this, I must admit that in individual stuttering therapies I always systematically explore the individual resources and to find out how they can be used or integrated in therapy. In summary, I am somewhat ambivalent against your suggestion. Stutterers have some privileged knowledge and experiences which makes it absolutely indispensable to carefully listen and understand what they have to say about their own speech, therapy, and therapy effects. This is particularly true if they tell, for example, about the ineffectiveness of therapy techniques in certain situations. However, if it comes to other issues as for example about the effectiveness of a therapy technique, not for oneself, but for a group of people, about cognitive, motor and neurological processes involved in speech and fluency, then it is better not to rely on anybodies' personal intuitions - irrespective of whether she/he stutters or not.
From: Andres Loorand, Estonian Association of People Who Stutter
Most of stutterers are almost fluent if they speak with loud voice being alone. Also I can forget my stuttering and speak expeditiously and absolutely fluently when I am alone in room or in car etc - I know that in fact nobody can hear me, although I imagine that I talk to other people. When I really talk to other people (even friends), I start to stutter quite strongly. WHY I can't in this case to speak fluently like being alone? WHY I can't transfer exercising situation to real life? How could I talk to other people as fluently as alone? Actually I have some answers (psychological tension, etc) but I'm not satisfied with these answers. Still I do not realize very well, why I can't talk to other people in the same fluent way like alone. Maybe this point (speaking with other people in the same way as speaking alone) could be bigger part of stuttering therapy for adults.
From: Tom Weidig (thestutteringbrain.blogspot.com)
This is one of the most intriguing aspects of persistent developmental stuttering. It is the main challenge for people who believe that psychological issues are only consequences or re-enforcers of symptoms. Many things about PDS are still uncertain, but I think there is/are explanations. 1) We need to realize that such effects not only happen in PDS. For example, a friend of mine is a doctor, and he told me that many Parkinson patients have very little shaking before the doctors enter the room, and heavily start shaking during the visit! Or nearly deaf people also have good and bad days and good and bad situations where their hearing deteriorates or becomes better. But no-one would suggest that the variability of their condition is proof of a psychological origin of their condition. 2) Situations with increased stuttering are typically situations where the brain has more work to do. When you are alone, your brain has far less work. But when you are around people (or think that you are around people), your brain has so much more workload: applying a social filter, coordinating the appropriate body language, increased stress, increased tension, responding to other people's ideas, future scenario analysis of your planned message and so on. If you think of stuttering as an unstable speech system, it is clear that more work means less stability. Like a road with road repairs is free of traffic jam on a Sunday, but not a Monday morning at 8. 3) Point two only explains why in some situations we should stutter more ON AVERAGE. But it does not say why sometimes we can be very fluent, even in situations of more workload. So I now distinguish between variability of stuttering, and fluency-inducing effect. Often, we mix the two: we put "less stuttering" equal to "more fluency". The two might well not be the same!! 4) According to a theory developed by Per Alm, Uni Lund, broadly speaking, there might be TWO pathways in the brain that regulate speech: an automatic one, and an active-control one. When you focus on your message, your brain runs the speaking for you (you speak without thinking about how to speak), and when you are focused on how you want to speak, you take control of your speech system. Once you have accepted this theory and you assume that PDS is instability of the automatic mode, everything makes more sense. If a person with PDS uses his active-control mode (like speaking with a foreign accent, imitating someone, speaking loudly, speaking in chorus, speaking in rhythm and so on), s/he becomes more fluent, because the unstable automatic mode is not used or only partially used. This would in my view explain the phenomena. OK, the details might turn out to be different, but at the very least I (or rather Per Alm) have shown that it is POSSIBLE to explain the effect WITHOUR mysterious and vague reference to psychological factors. Here is a citation from Per: "The theoretical work focused [on] the basal ganglia, leading to a model based on the dual premotor systems hypothesis (G. Goldberg, 1985, 1991), which defines two parallel premotor systems: the medial (basal ganglia + SMA), and the lateral (lateral premotor cortex + cerebellum). Stuttering is suggested to be caused by a disturbance of the medial system, in most cases in the basal ganglia. The core dysfunction is proposed to be impaired "go-signals" from the medial system, supposed to trigger the next motor segment in speech. Under some conditions speech control is shifted from the medial to the lateral system, thereby bypassing the dysfunction and resulting in fluent speech. The lateral system is suggested to be active when speech is combined with sensory input, like chorus speech or metronome. Also the effect of altered auditory feedback in reducing stuttering is proposed to be based on this mechanism. The lateral system is able control speech timing without sensory input, but this demands increased attention to some particular aspect of speech, as occurs in imitation of dialects, exaggerated rhythm, reduced speech rate, or role play. Also singing is suggested to be based on the lateral system." (Source: Per Alm, PhD thesis 2005, Lund University in Sweden)
From: john kagie
Tom: That is a very interesting point of view and it must be true for a subgroup of PWS. I have some observations that suggest another explanation and I would like to hear your view. Some PWS are more fluent when they focus on the message and do not formulate in advance. It could be explained that in that way they avoid the anticipatory stress of difficult words showing up at the horizon. In some other posts, I asked about the primary/ secondary concept. Could it be that for people with mainly primary symptoms avoiding the automatic mode gives an improvement, where on the other hand for people with mainly secondary symptoms focusing on the message, so using that automatic mode results in an improvement? A research done by Dr. Frank Wijnen (University Utrecht, Netherlands) would support this view. He looked into the relation between the speech monitor function and stuttering, and concluded that PWS have developed a too critical monitor function. They interpret normal non-fluencies as the beginning of a stutter, stop, start again, stop etc. Distracting the attention from the speech to the message would diminish the influence of the monitor, and the result would be more fluency. Just an idea. 😄
From: Tom Weidig (thestutteringbrain.blogspot.com)
Hi John! I am still tired from the dancing in Goettingen, and I am still in contact with the student therapists.. ;-) OK lets get serious. My explanation just shows that it is (at least theoretically) possible to explain the effects without reference to psychological factors and learned behaviour. But in reality they must be added on top and are part of the game like the anticipatory stress of difficult words. So only thinking about the message might well help those who experience great stress. It might be that PWS have developed a too critical monitor function, but couldn't this also be because the brain had to adapt to a sloppy speech system. And how does this relate to the latest brain imaging results?
From: s
are there any studies about spontaneous recovery and later relapse? Are children unlikely to relapse? What is the rate?
From: Ann Packman
A large longitudinal study of children who stutter has been conducted in Illinois by Prof. Yairi and colleagues. As far as I know, there are no reports of relapse to stuttering in the 74% (a conservative estimate) of children who recovered naturally (that is, who recovered without professional intervention).
From: s
What about children who recovered with professional intervention?
From: William Rosenthal
I believe that Bruce Ryan has some data that suggest that most children treated early and successfully do not, for the most part, relapse. Part of the problem here, from a research standpoint, is that even among children successfully treated, a number would have recovered spontaneously. If your question is purely a research question, then there is no definitive answer. If you are personally concerned about a particular child, please let me know. I will be happy to "talk" with you off list about the clinical implications.
From: Tom Weidig (thestutteringbrain.blogspot.com)
It is possible to address this question in research, but it is technically difficult due to the natural recovery rate. For an individual case that you have treated, you cannot distinguish whether the child recovered due to your intervention or would have recovered anyway. So what you need to do is to look at a large sample. Let's assume the natural recovery rate is 80%. If you treat 100 children and 90 children recover, you still don't know whether your treatment helped an extra 10% or whether by chance all 90 children would have recovered naturally anyway. BUT the more recover above the natural rate and the bigger the sample, the lower the probability that you by chance have only children that would have recovered naturally. It is possible to calculate the probability but I spare you the exact statistical details. There is one article out in the British Medical Journal that has done something like this on Liddcombe treatment (but I think they got their statistics a bit wrong): "Randomized controlled trial of the Lidcombe programme of early stuttering intervention" by Jones, Onslow, Packman, Williams, Ormond, Schwarz, Gebski.
From: Tom Weidig (thestutteringbrain.blogspot.com)
Hi, after answering too many questions, I have a question myself! :-) I have realized that I do not really know anything about how children had spoken before becoming dysfluent. I always thought that they only spoke in sounds but once they start with grammatically correct sentence they become dysfluent. But now I have the impression that they are fluent before becoming dysfluent. So are all children fluent before they become dysfluent? Why? If they have structural weaknesses (due to genetics or neurological incident) they should have never been fluent in the first instance?? And a neurotransmitter imbalance would make more sense?
From: Hans-Georg Bosshardt
Hi Tom, I think that there is some information from Ehud Yairis work available to answer your question. About 41% of the parents of stuttering children report that their children suddenly began to stutter within up to three days and another group of 27% reported that their children gradually began to stutter over a period of 3- to 6 weeks. So, there is not always a strict border between fluency and disfluency or stuttering and the average age at stuttering onset is shortly before the third birthday (34 months). At this age the language of most children is already quite elaborate. When stuttering begins at this age, children generally have already spoken without any obvious disfluencies or abnormalities. These facts do not contradict any of the explanations you mention in your question. The reason is that genetic dispositions are not always expressed in phenotype (i.e. in our case lead to stuttering) and are not expressed phenotypically without variation. Similarly, neuroanatomical deficits or neurotransmitter imbalances can manifest themselves in overt behavior (i.e. stuttering) only under certain conditions of language complexity. Imagine that you test a used 8 cylinder car. You will probably not be able to detect a defect in one cylinder if you drive it with 30 km/h. But you have a good chance to detect this motor problem if you drive it 220km/h over a German highway.
From: Sarah Gutbrodt
Hello. What's a reasonable estimation of the prevalence of stuttering in adults? I've read numbers ranging from 0.1 (T.D. Kehoe) to 1 percent. There are also people who say the prevalence of stuttering in the whole population - including children - is 1 percent. Can the researchers here reach any agreement on this question?
From: Klaas Bakker
Sarah, Although I don't have the exact numbers on me, the 1% estimate is the better one. In the United States it is slightly less than that but worldwide the number is very close to 1% which is amazing given the other variabilities that exist (e.g., languages spoken). Of course, most results are based on fairly old studies which may have used variable methodologies. To get an exact number would involve a population study to catch all those who stutter who normally do not get to our attention.
From: Courtney University of Tulsa
I know that individuals who stutter experience a lot of anxiety, especially in certain situations. However, has there been much research concerning a correlation between people who stutter and clinically diagnosed anxiety disorders?
From: Ellen-Marie Silverman
Hello. Whether or not, statistically speaking, groups of people with stuttering problems experience more of what are labeled anxiety disorders than groups of people without them, you, if you intend to function as a therapist, need to be aware that individual consumers may experience anxiety associated with their stated need to address their symptoms that, if undetected and unmanaged, can sabotage a scripted plan for change. So, it is well to familiarize yourself with means of detection and ways of helping another manage their anxiety that, otherwise, will interfere in subtle and gross ways with treatment. // As a matter of fact, based on my experience, anxiety is almost always present as a potential interference to change in anyone (whether he or she has a stuttering problem or not) who seeks relief from their own and/or a famly member's communication problem. So learning to identify and skillfully manage anxiety in consumers (and, even, yourself) is well worthwhile.
From: Ann Packman
I agree with all that has been said and Larry Molt's overview is indeed comprehensive. Our group published a recent research report in Journal of Fluency Disorders, "Social anxiety in stuttering: Measuring negative social expectancies" (2004) pp. 201-212. The adults who stuttered scored higher than the nonstuttering group only on the measures of social anxiety. This means that they were no more anxious (as a group) on any of the measures of other types of anxiety. Of course, this was a group study and does not mean that every individual who stutters will be socially anxious. And people who do not stutter can be socially anxious too! We are also nearing the end of a large trial of cognitive behavior therapy for adults who stutter and the results are looking promising.
From: kb
I am just wondering if there is more behind stuttering being more prevalent in males than females than just that males develop language a little later than females?
From: William Rosenthal
Interesting question, but no firm answers as far as I know. The genetic studies show no sex-linked characteristics in stuttering. It is known, however, that there is a whole host of developmental problems that occur more frequently in males than in females. The male/female ratio for stuttering fits roughly within that model.
From: Klaas Bakker
I am sure there is much more behind it. To begin with there may be reasons why there is a slight delay in the linguistic domain for male persons who stutter to begin with (which is of course not true for all individuals who stutter). Gender differences in the organization of parts of the brain, differential effects of gender related hormones, differential genetic transfer patters could all be related to why there are so many more males who stutter compared to females. An important additional aspect is that the gender difference appears to be growing with age as well.
From: Ellen-Marie Silverman
Research I have published with Katherine Van Opens in 1980 showed that elementary classroom teachers in a suburban public school in Wisconsin were more likely to refer a boy for speech therapy who showed symptoms of a stuttering problem than a girl presenting identical symptoms. Yet, the same teachers were no more likely to refer a boy than a girl for speech therapy who presented symptoms of a voice problem, an articulation problem, or a language problem. This suggests that the incidence of girls with stuttering problems reflects under-reporting for the problem in girls due to the perceived differing social-cultural implications of stuttering problems for boys and girls. So, it seems the reported ratio may not accurately reflect the difference in incidence by gender.
From: Judy Kuster
Date: 22 Oct 2005
The live, threaded discussion part of the 2005 ISAD online conference is now closed. The responses made here during the conference will remain online. Thank you for stopping by. Judy Kuster