Click on the title in this index to go directly to the discussion below.
From: jkiekhoefer
Hello, I remember seeing a card (business cards size) while I was in graduate school. The card talked about how the person was a stutter and that they needed some time to collect their thoughts. It also gave some tips for talking with people who stutter. I was currently looking for this resource for a client of mine. Does anyone know where I could find it?
From: Charlie Healey
I have never heard of a card that has tips for the person who stutters but you might be thinking about a brochure published by the Stuttering Foundation on "Tips for Speaking With Someone Who Stutters." This is meant more for the listener than the person who stutters. Hope this helps.
From: Ken St. Louis
As Charlie mentioned, there is a brochure that lists tips for people listening to a person who stutters. I'm not aware of where one might get a card that would be carried by a person who stutters and given to listeners, but you could probably make one with a program for do-it-yourself business cards. Many years ago, we had an All-American place kicker on the football team at West Virginia, Paul Woodside, who went on to play in the NFL. He was an amazing athlete, and he also stuttered. I remember that he had a card that was more caustic than what you had in mind, but it read something like, "I stutter. If you don't have time to listen to me, then I probably don't want to talk to you." He used to hand them to people on campus, and I have one somewhere. Ken
From: John Tetnowski
I could see the benefit of such a card. Some people need to "advertise" their stuttering as part of a desensitization program. I think the best way to "advertise" is to tell people that you stutter and how you would like for them to react. But using a card as a preliminary step may indeed be helpful for some as a beginning step in desensitization.
From: Temitope Osundiran {Stuttering Association of Nigeria}
Hello, I work with the Stuttering Association Of Nigeria and I attended one of the ISA recent conference in Croatia. Could anyone explain to me why exactly the causes of stuttering in adults and kids in most African countries are not yet known compared to the foreign development countries?
From: Lynne Shields
Dear Temitope, Perhaps I am not understanding your question, but if you are asking why no one knows the cause of stuttering in Africa as opposed to elsewhere, then I have to say that I do not think anyone has yet identified the cause of stuttering anywhere in the world. There are many ideas about why people stutter, but no one really knows what the answer is to your good question. There are many possible reasons why someone stutters, the cause of stuttering for one person may not be exactly the same causes in another person. Regards, Lynne
From: David Shapiro
Hello Temitope, You are asking a good question. However tempting it may be to think that we do know the cause or causes of stuttering, in fact we do not. Indeed research in many allied disciplines is ongoing and is addressing that very question. Nevertheless, one of my own interests is to investigate the assumptions and practices of nontraditional, or indigenous, healers. What fascinates me, both with traditional and nontraditional approaches, is the link between the assumptions held about stuttering and its causes and the related methods of intervention. You might find the following links of interest: http://www.mnsu.edu/comdis/isad5/papers/moussa.html (Moussa Dao), http://www.mnsu.edu/comdis/isad/papers/kathard.html (Harsha Kathard), http://www.mnsu.edu/comdis/isad9/papers/emerging9/africa9.html (ISAD 2006 Online Conference). I would be very interested if you might provide me with additional papers that address the assumptions and practices related to stuttering in Nigeria and other African nations.
From: Pamela in Florida
I'm a 37 year old female that has stuttered most of my life. With each passing year the worse it becomes. I recently downloaded some free software similar to the Speecheasy software from Rick Arenas who also wrote a submission for the online conference and is offering the link for the free software. My question is, is there anywhere that will give us the Speecheasy free - even if it's a used model so we can also benefit from it's development. It has been the only mobile device that has given me 100% fluency. It's amazing the stress taken off of a person when they can communicate without any fear. Any are appreciated.
From: Greg S
Hi Pamela. The SpeechEasy uses delayed auditory feedback (DAF) and frequency altered feedback (FAF). And as you probably know, the use of DAF and FAF have been used (via prosthetic implementation) to reduce stuttering frequency for quite some time. What makes the SpeechEasy unique is that it�s the first company to use DAF and FAF in a convenient and (functionally) invisible form factor. And this type of research and development does not come for free. So if your heart is set specifically on the SpeechEasy device, the best option may be to contact Janus and inquire if your state supports any type of discount or subsidy. To the best of my knowledge, Florida does not offer such a program. Another option would be to try to work with your Health Insurance Plan--however, this is rarely successful. With all this said, there are any number of more affordable DAF/FAF options, such as that by Rick Arenas, the FluencyPal, or Artefact Soft. These latter programs could be used with BlueTooth headsets, providing you with the same benefits of DAF/FAF, but at a fraction of the cost of a SpeechEasy. CasaFutura also provides a great alternative, but is also perceived to be expensive by many people.
From: Klaas Bakker; Missouri State University; Springfield, MO
Pamela, Greg just gave you a nice description of some options that could work for you.Yet, I am worried about a few aspects in your case. (1) The technology you are considering is not a cure, but may help you speak more fluently (but only if...) you have it turned on; if it works for you, you are pretty much dependent on using it permanently; (2) not all individuals who stutter respond the same way to DAF/FAF. If you pursue this as a "prosthesis" to help you through difficult moments, or as a way of life, it is probably better to find out how you respond to DAF/FAF, and thus if it is worth to pursue it in the first place. By downloading the trial of the (www.artefactSoft.com) DAF/FAF Assistant- software you could try it out on your own computer. Best solution would be to do this together with a speech language pathologist and determine how your needs can be best met. You don't hear yourself speak very well while listening to DAF/FAF. Hope this helps.
From: Greg S
Hi Klaas. Yes--it sounds like we're reiterating each other a bit, as my response stated: "With all this said, there are any number of more affordable DAF/FAF options, such as that by Rick Arenas, the FluencyPal, or Artefact Soft." The program written by Rick Arenas (featured in this year's ISAD) is every bit as good as Artefact Soft, and is 100% free.
From: Klaas Bakker
Yes Greg you are right about stressing these exciting new options. I frankly had not come across the Arenas program yet but now realize it is a great opportunity both for PWS and their clinicians to experiment what DAF/FAF can do with their speech. Most importantly, if the portable version is going to be available this creates a very economic alternative. Some questions need to be answered still and perhaps Rick Arenas can help us with that. I don't know for example if his software shifts a limited frequency range (leading to more thorough change of the speech input), or if it shifts most frequencies (which is a heavy task for computers and certainly hand helds). I don't know the frequency range it works on to begin with. And, I don't know if this actually matters. This all will need to be researched. I guess my main issue is that I would like to be able to objectively compare the specifications.
From: Dale Williams
Pamela--are you a college student? I'm asking because university financial aid/scholarship/stewardship offices can sometimes find donors to supply resources requested by students.
From: John Tetnowski
Going along with Daale's , there are places that can help offset the cost. For example, I know of a few cases where Vocational Rehab. has paid for a device like the SpeechEasy. Also, service groups like SERTOMA also fund needs like this. However, I must agree with Greg and Klaas and say that a fluency device may be part of the "cure". I think it can serve as an adjunct to therapies, and can work situationally. The device by itself is probably not the best idea....just an adjunct to a more complete program.
From: Rick
Hello, I know several people who stutter (PWS) who talk fast. The perception seems to be that stutterers would have a slower rate of speech because of stuttering. However, that doesn't seem to be the case most of the time. Wouldn't you say that PWS have an uneven rate of speech. ex. talk fast until they stutter (have a block and etc). Do you think some PWS have a faster rate of speech because subconsciously they talk fast because they have a history of past stuttering and they are afraid they are going to stutter? Any research studies on speech rate of PWS? Do most PWS talk fast or talk slow and how does stuttering severity affect speech rate. I know that some SLPs work on slowing the speech rate of PWS. And that advice is great: "slow down." But doing it is more difficult considering the alternative is stuttering. I know one PWS who din't want to slow down (he went in for stuttering treatment).
From: Joe Klein
Hi Rick. Great question. I'm at home, and can't think of any citations, but I know their have been studies looking at the overall speech rate (time of speech with disfluencies included) and articulation rate (time of speech with no disfluencies), and that many PWS have a slow speech rate (because of the time stuttering takes) and a fast articulation rate (because they are talking so quickly). I think there are two reasons for this: One, an inherited "fast" rate of speech, as those muscles involved in speech just go a little faster than average, may be a reason why some people stutter (enough to put them over the stuttering "edge," so to speak). Two, and this is probably true for many PWS, is that it is a learned behavior, as PWS try to rush through the unpleasant speaking situation as fast as possible. Stuttering is a nasty disorder, as so many of the natural coping mechanisms for children (hey, something's stuck? I'll just push as hard as I can...) work to worsen and complicate the problem. Going more slowly is a HUGE advantage for people who stutter. Whether they choose to slow down by elongating their words or taking nice, natural pauses in their speech (or both) doesn't matter too much. Whatever feels most comfortable for the person... but, wow does it help some people speak much more fluently.
From: Gary J. Rentschler
You make a good observation about speaking rate sometimes appearing irratic. Speaking when your a anxious is reflected in a faster speaking rate for almost everyone. Add some stuttering blocks into that mix and the PWS can sound almost unintelligible.... racing from one stutter to the next as though they can't wait to stutter again. The logic in this is that if the PWS spoke at a slower rate, stuttering less, they would actually get their message out faster! However this is a situation of emotion, not logic. I think this line comes from the book "Gunga Din"... (the best I can do is paraphrase it).."If you can keep your head while those around you are losing their's, you are then man my son." I think there is a parallel to stuttering. If you can manage a slow, relaxed speaking rate in the face of your anxiety, you will also manage stuttering much better.
From: Klaas Bakker
I think you have a great observation about speech rate being variable in PWS, and being rushed close moments of stuttering. Obviously such rushing (if confirmed through empirical research) could either be cause for, or consequence of stuttering. I am not aware of any specific research findings about this, but am personally interested in the phenomenon. Most research quoting speech of PWS being slow is based on averaging WPM or SPM of entire speech samples, and thus is insensitive to the subtle rate variations you are referring to. At the same time it is not very easy to measure rate variability, or to find a way to objectively determine if speech can be disproportionately fast around stuttering, at least in some PWS. I share your interest, but cannot confirm from research known to me this is a fact.
From: Michael Susca
Hello Rick, At the risk of getting into "trouble" with my colleagues, I'm not so sure a fast speech rate is a necessary requirement for stuttering. For sure, many PWSs improve speech fluency when speaking rate is reduced. But many already have an overall reduced speaking rate and they still stutter. Speaking rate also does not exist in isolation: emotions, propositionality of the message, prosodic factors, linguistic complexity and many other factors are linked to rate....and any one (or more) of those factors may affect the fluency/stuttering regardless of rate. For example, maybe you have known some PWSs who, when very angry, talk faster than typical but with fluency. Other PWSs, when angry, might talk faster but lock up into a stutter. I think a change in speaking rate may also be a by-product of therapy as well as those other factors mentioned. And regarding your query about research: I'll bet most research studies on speaking rate of PWS vs. non-PWS are based on average findings of groups.....and if you know anything about comparing group means, you'll often find overlap of members from one group into another group. Let me just end with a clinical observation: I recently had one client speak so fast she was unintelligible....I couldn't understand her regardless of her stuttering.....We initially focused on speaking rate reduction so she could be understood before we attended to the stuttering to enhance fluency. Hope my response wasn't too convoluted.
From: Laura M.
I would like to know if stuttering is more prevalent in bilinguals than monolinguals? Also, what is the common stuttering pattern seen in bilinguals-are there more types of dysfluencies or are they just more severe?
From: Glen Tellis
There is very little information about stuttering and bilingualism. One excellent review conducted by J Van Borsel, E Maes, S Foulon - Journal of Fluency Disorders, 2001 - indicates that some data suggest that stuttering is more prevelant among bilinguals. The review also indicates that there are some divergent findings reported in studies of bilinguals who stutter.
From: Lisette M. Betancourt
Hi, Laura. I'm a bilingual Speech-Language Pathologist and a Fluency Specialist and unfortunately, there is a small amount of scientific information involving bilinguals. Points to consider when reading the information: what languages are being studied and how is bilingualism defined. Dr. Jennifer Watson (Texas Christian University) and her students have conducted work with monolingual Spanish preschoolers in PR. In the population of preschoolers that I serve at Miami Children's Hospital (Spanish/English households), we have not seen more stuttering. Those observed with patterns of atypical disfluencies include: prologations, sound repetitions, laryngeal blocks, etc. Please note that this information is not objective as the population served is defined by a concern with communication development.
From: Ed Feuer
What specifically are the current issues in stuttering about which ASHA members (including the professors here) disagree and debate when they get together at their professional conventions? I refer to issues regarding treatment and research. Since stuttering is by no means "solved", one would reasonably expect that there are such disputes among the professionals.
From: Ken St. Louis
Hi Ed, That's a tough question, "What do we disagree about?" It's a good question though, because it identifies issues that are currently in debate. Let me mention a few areas of disagreement that I have observed in the past few years, as well as some areas of agreement. A. With the recent revival of "operant" approaches to stuttering as a result of the the documented use and success of the Lidcombe Program for preschoolers who stutter, there is an issue of the extent to which we (1) should accept any stuttering in the speech of children and (2) should be concerned about desensitization to stuttering in this group. Other, perhaps more traditional, approaches to stuttering for very young stutterers often use a combination of parent counseling and fluency shaping or stuttering modification. These, of course, would accept some forms of stuttering or speech that is not perfectly normal. B. A similar issue has to do with evidence-based practice. If a particular approach is supported by the lion's share of experimental evidence, does if follow that other approaches for which there is less published evidence should not be used? Many years ago, I coauthored a chapter on stuttering therapy, and we concluded that the EVIDENCE suggested that fluency shaping approaches were more effective than other approaches. One reason for that, however, was that some of the more traditional approaches, e.g., the Van Riper stuttering modification approach, was popular when studies looking at efficacy were not being carried out with the same rigor that were characteristic of some of the fluency shaping studies. Now, I'm not at all sure that I would make the same conclusion. C. The issue of whether or not to carry out desensitization activities with stutterer seems to be less of an issue than in the past decade or two. Now, regardless of the approach to therapy, many clinicians seem to have concluded that desensitization is important. One reason for this seems to be that negative and unhelpful emotions did not seem to disappear with quickly achieved fluency and often came back to interfere with long-term gains. D. How to measure stuttering has been--and continues to be--a challenge for clinicians and researchers. We typically agree that we need more than frequency measures (i.e., %SS or SS/M), but there is not uniformity of opinion as to what other measures should or must be included. So there's a start. Hope it answers a bit of your question. Ken
From: Ed Feuer
Thank you for responding, Ken. The comparative delay in response to my question by your colleagues might have created the impression that there are no current issues dividing SLPs and that their professional gatherings pertaining to stuttering are one big love-in where they sit around singing Kumbayah. But while the issues you cite are in themselves interesting, I respectfully suggest other, more pressing problems which ought to be the subject of some very heated discussions at your conventions. Such as: the continuing travesty of clinic-room fraud; token therapy; short-term quickie fixes; distractor devices and some SLPs peddling these devices; the false hope of the pink pill; flawed research methodology in which subjects are not differentiated according to severity, age, gender, overt, covert, before or after intensive treatment; school boards paying SLPs unqualified to treat kids who stutter; and other SLPs not blowing the whistle in such situations; ASHA not enforcing standards; and the absence of genuine multidisciplinary interaction. I submit that the failure (or refusal) to effectively address these issues has harmed the profession and has failed people who stutter.
From: Orlin Baev
I would love to become a fluent and influential orator. But - I have stuttering - so, how to proceed and how long it will take me to become orator?
From: Gary J. Rentschler
Many people who stutter feel that stuttering and being an effective communicator are at totally different ends of the spectrum. Speaking fluently is only a small, and nonessential, part of communicating effectively. Fluency is a like the clothes that you wear. Does wearing a suit and tie make you a better painter? ...a better plumber? ... a better lecturer? I think not. One of the BEST (most inspiring, motivational, and enjoyable) speeches I've ever heard was given by a gentleman who had cerebral palsy. His speech was a little slurred and you needed to listen a little more carefully to understand him. However, his message was DYNAMITE! ...he was also very humorous and I'd love to hear him speak again. So, don't let your stuttering get in the way. You may need to learn a way to incorporate it into your message. If you can show your audience that you have adjusted to being a person who stutters, they will forget about your disfluencies and focus on your message. The short answer to your question is that a good orator has a strong, sincere, persuasive message.... whether he or she stutters or not. Best of luck.
From: Walt Manning
I fully agree with Gary about the importance of become a better communicator. Like Gary, I've heard many people who stutter (especially if they do it easily and smoothly) who are exceptional communicators. With good therapy (and lots of practice) you can get to the point where the content of your message rises above the way you are speaking. Dave Daly, who I believe is member of this panel, describes how wanting to become a famous orator inhibited his progress in that direction. I'll let him tell the whole story if he wants but essentially . . . once he decided to be himself and to focus on becoming a better speaker in spite of stuttering he make progress. He is now , by the way, an exceptional presenter. Fluency is only part of the process for you have to do your homework and come up with interesting, thoughtful and perhaps even inspirational ideas. Your also remind me of a person I was working with who asked me "What happens if I become fluent and find out that I have nothing to say."
From: James
I heard about the McGuire programme for stutterers. Recovered stammerers helping people who stammer. http://www.mcguire-freedomsroad.com/ I was wondering if it is a good program for the treatment of stuttering? What have you heard and what is your opinion? Should I go for it or not? What should I expect?
From: Judy Kuster
There are many who have attended the McGuire program. Since you have found and posted their URL, you can read about it on their website and make your own decision about whether it fits for you. One thing I like about the program is the continuing support they provide for those who have participated. Personally I am not a person who believes "one size fits all." I don't think the McGuire program thinks that either. The British Stammering Association has information about the program, including a couple articles by SLTs from the UK. Perhaps they will be helpful in making your decision. http://www.stammering.org/adther_costal.html
From: Judy
Would one or more of you please address the process of change? I am not referring to hierarchies or desensitization. I would like to know about models of change. I've read a little about the Stages of Change model. Are there other models of change that I am not learning about by was of ASHA? What readings or authors do you recommend on this topic. I would like professional references and also popular paper-back book references for the layperson. I ask this because changing speech may need to consider this.
From: Andy Floyd
Just a quick reference - My wife, Jennifer Floyd, recently had published her master's thesis (edited of course for the journal) -"Stages of change and stuttering: A preliminary view." It can be found in: Journal of Fluency Disorders Volume 32, Issue 2, 2007, Pages 95-120
From: Judy
Andy, I read that article and that is what prompts my question. The notion that therapy activities need to respect specific stages of change is very interesting to me. Please tell her I loved the article!
From: Judy Kuster
There is an excellent article on the very first ISAD online conference (1998), written by Louise Heite and entitled Stages of Coping A Stutterer's Journey from Denial to Integration. The URL is http://www.mnsu.edu/comdis/isad/papers/stages/heite.html This year's online conference has an article by Ellen-Marie Silverman entitled Creating Conditions for Change which you might also find of interest.
From: Judy
Thank you Judy. I love everything that Louise writes and I enjoyed that article also. I still need to read Ellen-Marie's article.
From: Michael Susca
Hello Judy. I am not sure which stages of change model you are familiar with so at the risk of being redundant, there is an excellent book regarding making (and keeping!) change called "Changing for Good" by three Ph.Ds: James O. Prochaska, John C. Norcross, and Carlo C. DiClemente. Check it out if you haven't already. I hope that helps.
From: Judy
Thank you. It is only 1 cent as a used book on Amazon.com! I don't know any stages of change models. I do find the personal stories of PWS to be helpful and there are lots of those around.
From: Walt Manning
Hi Judy, I was pleased to see your question (as well as the good responses) about your query concerning the process of therapeutic change. I think it is an area that will see increased research in the coming years. Patrick Finn and colleagues have considered self-directed change and identified some useful principles that likely to informs the process of (formal) therapeutic change. Change doesn't appear to be linear or step-wise and although the work of Prochaska, DiClemente, Norcross and colleagues provide some useful concepts there is literature suggesting that change is dynamic, multifaceted, and cyclical. Here are a couple of additional references to add to the those you've been receiving- We have a chapter in Ed Conture and Dick Curlee's book which addresses several aspects of change where we discuss rules and principles of change, the issue of long-term success and relapse. [Manning, W. H., & Dilollo, A. (2007). Management of Stuttering for Adolescents and Adults: Traditional Approaches, In E. Conture & R.F. Curlee, Stuttering and Related Disorders of Fluency. (3rd Edition, pp. 231-253) New York: Thieme]. Another article you may consider (if you haven�t already looked at it) which speaks to the process of successful change (or management) is Plexico, L., Manning, W., & DiLollo, A. (2005). A phenomenological understanding of successful stuttering management, Journal of Fluency Disorders, 30 (1) 1-22.
From: A.(Drew). G. Stewart. (Auckland. New Zealand.)
Good Morning.(0615 hrs N.Z.Time.) I trust you slept well. My query is my 2-3 month lay off from Toast-masters. I practice "Exposure Therapy", after hearing about it in 2005, with a lot of success; I might add. There are areas of my life where my speech does need improvement; but what baffled me was my return to public speaking. I was apprehensive & dreading getting up in front of an audience & speaking again. I was the Toastmaster for my return meeting & was expecting a performance of a number of severe blocks etc well under par of what I'm capable of. Instead, what happened is Toastmasters weaved its "Magic" for me one(1) more time & the opposite happened. I was 100% fluent throughout except for a couple of blocks at the end of my assignment. I was even called upon to give am impromptu speech in the Table Topics. Again with 100% success rate as far as my speech(stutter) was concerned. What the hell is going on??? I thought I knew all about myself & my stutter. Obviously, I do not!!! (I'm 58 at the end of the month) May I also point out that where others fear to tread, I have no real difficulty at all. eg: Phone, R.T. etc. May I thank you in anticipation of your learned explanation(s).
From: Rick
I read that some PWS have benefited from joining Toastmasters. How can joining Toastmasters help with stuttering (Toastmasters is not speech therapy)?
From: Andy Floyd
I am no expert on Toastmasters, but I do know it's a public speaking organization. It's members come to meetings where they present to each other. So, for someone who stutters, it's a great place to either practice any techniques they're learning, just talk and stutter openly, and just become a better public speaker.
From: Keith Boss British Stammering Association
Hi Rick, I have seen toastmasters talked about in several stuttering forums. I did not really see it would benefit me. However in recent months I have been spending a lot of time on the Internet doing work for the International Stuttering Association as well as the British Stammering Association. Friends told me to get out, meet and talk to non stutterers. So last Monday 8th October I went as a guest to our local TM meeting. It was great fun; I assessed I would learn a lot; I applied for membership. As a guest I was offered a chance to speak at the table talk session, I accepted, and did a 2 minute speech on a subject drawn from a dish. At the next meeting on October 22nd I have to count the ums/ers in all speakers. The following meeting in Novenber I do my 7 minute Ice breaker speech. Speeches are commented on constructively. Leadership and organizational roles are available to help develop your abilities. For a stutterer you remove more comfort zones and become more at ease with your speaking. You begin to think less about the mechanism of speaking and more about content / presentation / body language. I think it will help me in many ways.
From: Gary J. Rentschler
Drew: Perhaps you are rediscovering that stuttering is variable, unpredictable, and sometimes pleasantly surprising (by its absence)! I was in Tmasters for a couple years and I gained a lot of confidence in public speaking, particularly extemporaneously. Many PWS come to recognize that there is a difference between stuttering fears and the public speaking fears that the rest of the world has! Once the stuttering fears wear down, many are surprised to find underneath it the normal, everyday fears related to speaking. My advice to you would be to celebrate your success!!....but keep an eye open for the return of the "evil monster" (stuttering)lurking just around the corner! I've accepted that my stuttering will never go away; but my fluency is my responsibility and I have to earn it all of the time. Best of Luck to you and congratulations at reaching this new level. P.S. -- I visited Auckland a couple years ago and fell head over heels for your wonderful city.. I can't wait to come back!
From: Charlton Knowles
Currently, I am involved in a situation at work, were my integrity, self worth and competency was/is being questioned by my business partners and the board of directors. I have supplied documentation that vindicated me of any and all possible wrong doing. This situation gave me an opportunity to look deeply into myself and to ask myself "what am I worth to myself?" initially as probably most stutterers do (and perhaps others too) took the defensive stance, when all the facts in front of me suggested this position was false. I have since took the offensive stance and emphatically told my partners and the directors, perhaps it is time for me to go, to resign as managing director/company general manager. They all went numb. For years I defended my decisions, but now I said no more, if you don't like it, ask for my resignation. All during the past month my speech including the stuttered speech has been so relaxed. My attitude was/is I don't care. I am quite able to survive. The level of anxiety has decreased profoundly, for the simple reason that I can do other jobs and survive. What a liberating feeling to just "let go." If stuttering is a "role" disorder as sheehan states, then the gains may be real. I am not trying to not stutter or be fluent, I just talk. Dear professors, what's your take on this? Will the bubble burst?
From: Lynne Shields
Dear Charlton, From what you write, it seems that you have had a major attitude change about your speech, and that, at the same time, your stuttering has become much less tense. If your stuttering is easier because you are letting yourself stutter freely rather than try to push through words, then you are doing what some call 'stuttering easily'. That is often a goal of formal speech therapy for stuttering. You seem to be concerned about whether this is a temporary condition, right? How long ago you made the decision to "just let go", and how long you have been able to stutter with less tension? If it is the case that you have stopped using struggle behaviors or tension when attempting to get through stuttered words, then your greater ease of speaking comes from that change--you have stopped doing what made speaking physically more difficult for you. What I have described is not a bubble--it is a real change in behavior leading to a real change in communication skill. You may still experience the typical and natural ups and downs in fluency that many who stutter experience, but this would still constitute a real gain. I am interested to hear more about what you changed when you say that you are not trying to not stutter or be fluent. What physical behaviors have you altered? I believe that it is important for you to know exactly what you have done to make the change in speaking, so that you can maintain it. By way of analogy, people who are good athletes aren't good simply because they have natural talent. They are good athletes because they analyze the physical moves then need for their sport and work to improve those so that they can perform well consistently. And, they practice, tweak the skills, and practice some more. Best wishes, Lynne
From: Gary J. Rentschler
Sometimes for PWS, emotions about stuttering (fears and anxiety) and emotions about "real life" seem integrated -- one and the same. Many PWS who gain fluency are surprised that they are still nervous to give a speech?! Under the stuttering anxiety is the same speaking anxiety that everyone else experiences. It was just bound together before. It sounds like you've stripped away some work ('real world') anxiety by recognizing this job doesn't define you or is not the only option available to you -- that's very liberating. As the real world anxiety decreases, I'm not surprised that your stuttering decreases too, as I see stuttering as resulting for the combination of stuttering fears and real world fears. As for the bubble bursting... only time will tell. Its my life philosophy to expect it to burst... if it does I'm prepared; if it doesn't, that's pretty easy to live with. Hope that helps.
From: Charlton Knowles
Dear Gary, Very well put and clear to understand. Thanks
From: Mario
Hi, I'm Mario from Belgium and am 42, stutter since my childhood. I have joined the past years many groups for pws, and have noticed that there is no equality, they fight for who has the right therapy, mock each other, on groups they give their opinion about therapies in a negative way, some therapists are being placed in a negative light, ... Why is there so many hate amongst pws ??? Is it frustration, or brainwashing by a program ? I'm really depressed if i read some messages on pws groups and forums. Why can't we all work together in unity, and accept each other with our own speech and therapy method. SLP with SLP, SLP with pws, pws with pws ... Together we might reach the outside world to learn them about stuttering, that everyone is unique. Like my favourite artist wrote : "Imagine a land of love, Where people have time to care, Where everybody's equal, And we all tell the truth, ..." (Extract from Song Of Scatland from Scatman John) Am I so idealistic that SLP and pws can work together in unity ? And how can that be reached ?
From: Judy Kuster
I'm a person who tries very hard to stay out of what one might call the "Stuttering Wars," (some day in the very distant future, when all the "warriors" are dead and gone, somebody could write a very interesting book). Disagreement and challenges can lead to new discoveries, but attacks and threats accomplish little, in my opinion. Besides John "Scatman" Larkin, another person who worked hard to bring us all together was Marty Jezer. I miss them, and their wisdom. I really appreciate your post, and your wisdom, Mario.
From: Ed Feuer
Judy, You're right. "Disagreement and challenges can lead to new discoveries" but they can also be ignored (see my "What are the issues? posting of Oct. 4). Twenty-one professors, count 'em, and the silence is deafening -- as in deafness, another communication disorder.
From: Greg S
Hi Mario--I think one of the issues is that so much of stuttering (research and therapy) is based on Dogma, rather than true science. And one doesn't get personal about true science, as the goal is simply to reveal reality. Dogma--however, is something entirely different. It's a personal belief (w/ or w/o any shred of evidence), and so people have a sense of greater personal ownership. (Don't disagree with my ideas, because you're disagreeing with me!) (Almost akin to going up to someone and saying, "Your favorite band stinks.") *** *** *** And Ed--I think your conclusion may not be entirely correct. I intentionally didn't respond to your earlier question because it really didn't ask anything specific. I'll answer specific questions with specific answers, but I don't have the time or emotional energy to provide some kind of diatribe at your whim. So that deafening silence may represent busy people intentionally not responding to an unanswerable question or poorly communicated concept, rather than some type of conspiracy to halt progress.
From: Ed Feuer
Greg, you promise specific answers to specific questions. OK. Do you acknowledge that the following exist; do you regard them as problems; and if so do you agree that the profession's failure (or refusal) to effectively address these issues has harmed the profession and has failed people who stutter: 1) the continuing travesty of clinic-room fraud; 2) token therapy; 3) short-term quickie fixes; 4) the promotion and sale of distractor devices and some SLPs peddling these devices; 5) the false hope of the pink pill; 6) flawed research methodology in which subjects are not differentiated according to severity, age, gender, overt, covert, before or after intensive treatment; 7) SLPs lacking qualifications to treat stuttering claiming they can treat stuttering 8) school boards paying SLPs unqualified to treat kids who stutter and other SLPs not blowing the whistle; 9) ASHA not enforcing standards; 10) the absence of genuine multidisciplinary interaction. Answers from any of the professors would be welcome -- and instructive.
From: Retz
Ed...I've read this thread as well as the "Divergence from the thread" with great interest. Your spirit comes through loud and clear, and to me, your questions sound so legit, whether I agree or not... As in all professional fields, there are posers, pleasers, truth seekers, people who put professional legacy first, etc...We also have fluency bigots, fluency nazi's, touchy feelies, scoundrels, professionals seeking to get rich quick, etc... And you know what? There are also some good ones out there who do give a ****. But man - oh - man...You do have great spirit! Hang in there!
From: Greg S
Ed--you've come across as angry individual, and this exchange will be archived on the net for the foreseeable future. One may wish to consider this when posting. In that light, I will not take your bait and waste my time to deal with these issues that are apparently unresolved in your mind. It is my hope that you can find peace at some point. There are more or less qualified professionals in every field. Those that I associate with do not continue a travesty of clinic-room fraud, nor do they provide token therapy and short-term quickie fixes. Your complaint about flawed methodology is one that I've not found to be accurate in the peer-reviewed refereed scientific literature. Some of the distraction devices that you speak of actually do have quite a bit of merit; it may be worth your time to read the literature and become an informed in that area. And with all this said, I will (as will all on this board) heartedly admit that ASHA has (in many ways) failed relative to stuttering research, and evidence-based stuttering treatment. And in my youth, I was angry at some aspects of the stuttering and SLP reality as well. But I ultimately found that this anger and frustration was useless and ultimately hurt my quality of life. Giving up that anger and frustration, and consciously choosing to enjoy life, was one of the best personal decisions of my life. Good luck on your journey.
From: Mario
Hi Judy Thanks for your answer. See what I meant, just this little question can put a fire in someone's heart. I guess I will have to live with it, or just ignore it. Some people still live in the past, and might have had a sad experience with an SLP or so. So now some are overgeneralizing it. I hope one day, people can work together side by side to conquer what they fear most. In Belgium something little or that cooperation is growing bit by bit, with respect for each other's therapy and working together with some SLP. I hope this will reach out more and more. I wished you lived in Belgium Judy, we could do lots :) Greets Mario
From: Ed Feuer
Greg, Your response to my questions has indeed been instructive -- as has the silence of your colleagues. And take note, SLP students: clients with aphasia or swallowing disorders won't ask such questions. As for distractor devices, I refer the professors to Charles Van Riper's The Treatment of Stuttering on their bookshelves (or somewhere in storage as may be the case) and read or re-read his chapter on Suggestion, Distraction, and Persuasion Therapies. They will see that such devices, whether they're called the Amazing StutterMaster or whatever, have a long and sordid history. See what Van Riper has to say about the Derazne Correctophone, the Klein Auditory Masker, the "electronic ear," the Freed Stammercheck, Columbat's Muthonom, the Zond, Idehara's "Stuttering-curing Apparatus," Itard's "forks," and the Bates appliances. Talking in a foreign accent or in metronome speech (also distractors) is a lot cheaper and ultimately has the same temporary effect.
From: Virginia S
I have a client who has very set ideas about his stuttering, including that he "always has trouble" with certain sounds, like /k/. In your opinion, do such beliefs need to be altered for fluency to be more consistent (through reduced anxiety), or does fluency need to be more consistent before such beliefs can change? In other words--is it normal for certain sounds to be troublesome, or is it more of a mental idea becoming reality?
From: Greg S
Hi Virginia. This is a great question that's pretty difficult to answer, because (for better or worse) much of stuttering treatment is idiosyncratic from client to client. It has been my experience that there has never been any "successful" (in my eyes) adult stuttering treatment until there's been a certain amount of personal education, acceptance and advocacy relative to stuttering. So if I client has a negative or helpless attitude relative to certain phonemes, this would be something worth addressing. However, we can't change our clients minds; they will continue to believe what they want to believe. At best, we can walk beside them in their therapeutic journey. Different PWS will have different sounds in which they struggle; part of successful stuttering therapy is empowering the client with tools that let them regain control of those sounds. Sounds such as /k/ may be best approached by using a bounce. And use the appropriate vowel sound following the bounced /k/, rather than a central (schwa) vowel. How many times does one bounce? However long it takes! Until the /k/ is produced in a 100% gentle (i.e., secondary free) and 100% controlled fashion. Other approaches, such as a gentle onset, may also work; the bounce is merely my personal preference.
From: Vivian Sisskin
Virginia, I find that specific sound and/or word fears are extremely common among the clients I see. One explanation is that these stem from conditioned learning, for example, a man whose name is Chris (and has trouble saying his name) reports that he always has trouble with /k/ sounds like "computer" or "communication." Another frequent remark I hear is "I can never say /s/ words, like the word 'stuttering'!" These beliefs are realities for the client, as they experience these fears daily. I find that in the context of treatment, it is more important for my clients to understand the process of conditioned learning, and how it might apply to their unique stuttering pattern, than it is to try to change their beliefs. In fact, sound fears don't differ much from situational fears (talking on the phone, ordering in a restaurant, introducing oneself) in terms of how they are successfully reduced. Most often, people are changed by what they DO, not what they believe. Once they begin to face the feared sound (confront the fear) and reduce the avoidance of that sound (say it often) they report less difficulty and eventually the sound becomes neutral as a stuttering predictor for them.
From: Joseph Nsubuga Easy Speak association, Uganda
Why is it that my rate of stuttering increases so much when I am going to do something eg address a gathering, my blood pressure increases and i sweat a lot and at times my handwriting changes BUT it becomes normal towards the end of activity ? Actually this syndrome makes me dodge most events and i normally don't put up my hand for say a comment. Kindly advise me.
From: Gary J. Rentschler
The situation you describe is quite common. The frequency of stuttering is related to fear and anxiety. Fear and anxiety create changes in your body, like increased muscle tension and more rapid breathing rate, in addition to the symptoms you describe. For many people who stutter, just the thought of talking to others or having to say their name elicits the fear/anxiety responses. As a result, they begin to avoid situations in which they would likely need to talk. These avoidances give more strength to the fears, and the cycle becomes more pronounced. Its also common that toward the end of an activity your anxious lessens as your fears and apprehensions diminish. My advice to you is to confront your fears and continue to speak to others every chance you have. Most fear that they will stutter; so if you stutter easily, on purpose a few times at the beginning, you may be able to reduce some of your anxiety -- because what you feared (stuttering) has already happened -- but you were in control of it. A wonderful question. Best of luck -- don't get discouraged -- keep working and learning. Be brave.
From: Barbara Amster
Dear Joseph I completely agree with Gary's great response. I would like to add that many people who stutter find that they can reduce their anxiety by letting other people know that they stutter. This type of self-disclosure also puts your listener at ease and helps them understand what is happening if you are disfluent. Best wishes, Barbara
From: Yemi Akintunde
PARAGRAPH
From: NAME
Is there any possible means you could provide speech therapy training for selected people in different stuttering associations in Africa who wish to be counselling stutterers in most places where such are very rare to find in Africa? A lot of stutterers in Africa are lacking stuttering counselling not to talk of speech therapy activities in different stuttering associations in Africa.
From: Lynne Shields
Dear Yemi, You may wish to look at the article at this conference, "Fulbright Senior Specialist Opportunities in Stuttering". This may be an opportunity that you can investigate as a way to connect people together for some needed training. Regards, Lynne
From: David Shapiro
Hello Yemi, It is so nice to see your post. I have thought of you many times since our meeting in Douala, Cameroon at the 1st African Stuttering Conference, 2005. You are asking a good question. I think some of the best inroads for clinical training and clinical service are being created by the International Stuttering Association's ISP-S (International Speech Project-Stuttering, http://www.stutterisa.org/ISP-S.html Also, the congresses of the International Fluency Association (and the resulting proceedings) often have papers that address instructional and clinical methods that can be adapted for implementation in different countries on the bases of unique multicultural factors. I must add that I have such a respect for your contributions to clinical service, research, and self-help. Keep up the good work!
From: HK
I'm a student clinician with a fluency client. While my client is motivated and hard-working during therapy, he has admitted that he really does not use his targets (slow rate and easy onset) outside of therapy. He claims that he usually "forgets" to use them until he is really struggling with his speech. What can I do to get him to remember to use his targets more regularly outside of therapy?
From: Mario from Belgium
Hi HK I'm a pws and have taken many therapies and met many pws. One of the main reason for me in not using voluntary stuttering was fear in how people would react to that kind of speech. For me it sounded a bit unnaturally, but I knew in therapy sessions it helped me. It helped when my therapist went outside with me and did it herself, so I could see how people reacted to it. And then bit by bit, first the easiest step, using it by a good friend who knows bout my stuttering, i extended my comfort zone (like Alan Badmington use this term very great), and used it at work, and even asked my collegues how they looked at my new "kind" of speech. And they all said I was doing great, and they understood me more then they did when i stuttered very badly (that was 1992, i guess). Good luck HK, and I hope you get some more suggestions and hope my story may be usefull for your client.
From: Lynne Shields
I agree with what Mario shared on this topic. Going outside with your client is helpful in several ways. First, your client has a partner in the work of taking the therapy techniques outside--it's easier than having to do it alone, and the therapist provides support on site. Second, when the therapist also uses the techniques, it gives a model for the client. It also allows the client to see what the techniques 'looks like' outside and to observe the listener reactions as the therapist takes his or her turn. Setting up a hierarchy of activities, from role playing in the clinic with the therapist, bringing in friends to practice during sessions, talking to the clinic secretary, going to the cafeteria on campus or near the clinic, and then going on to other people and locations makes the transition a gradual one. The client can help set up the hierarchy, choosing levels so that he or she feels able to move from one step to the next. Whatever is decided on, having the client be a partner in planning and executing therapy is very important for success. Best wishes, Lynne
From: Barbara Amster
Not using his "targets" all the time may not be a bad thing. Its possible that the type of speech he has to use when he is using his targets does not sound natural to him and he does not feel like himself. Using these tools only when he needs to, may actually be a good goal of therapy. A good discussion of this can be found in Dr. Philip Schneider's DVD "Transcending Stuttering."
From: Dale Williams
HK, how old is the client? I'm asking because with kids it is sometimes possible to increase the reinforcement to help with generalization. With some adults, OTOH, all I've been able to do is give them the tools and let them know it's their choice if and when to use them.
From: HK
The client is in his 50's, and he claims to be "ok" with the fact that he stutters. He says the only reason he's coming to therapy is because he feels like he's not getting jobs he deserves because of his speech. Anyway, like I said earlier, he says he just forgets to use his targets most of the time.
From: Lynne Shields
From your comment, it sounds as if there may not be a great deal of internal motivation to change his speech. If he really isn't too bothered by it, that could explain his tendency to not transfer skills outside of therapy. It may be too distant of a pay off to make changes in order to effect a change in his work status. Perhaps you might spend some time exploring with him what he hopes to gain and how he would like to make that gain. Regards, Lynne
From: Greg S
It's been my experience that this usually falls on the client and the client alone.* (* denotes a caveat) If the tx goals are realistic, and specifically tailored for that specific client; and if the clinician is doing 100% of what is asked of the client; and if the clinician and client go well beyond the clinic room; and if the client is given daily homework and assignments in which to use these techniques... then it's ultimately a client choice to execute speech techniques. But with that said--motoric speech therapies are feel abnormal, and consistently executing abnormal speech feels very abnormal, and is very difficult. Only when stuttering becomes more of a nuisance than the abnormal (feeling) motoric speech targets do stuttering clients really get serious. Or--that's just been my observation in my self and in others...
From: Walt Manning
Expanding on some comments so far, especially those by Lynne and Greg, there are lots of things operating for someone who appears not to be motivated enough to use techniques in everyday life. Beyond high degrees of motivation, it's very important to have a clinician who is willing to do what they ask the speaker to do. The speaker has to have achieved a high degree of desensitization and be able to "stay in" the stuttering moment, especially when speaker in the upper ranges of his or her hierarchy of difficult communication situations. And, as I believe Greg suggested, many of the techniques not only sound and feel weird (in most cases stranger than the stuttered speech that the person has adapted to to some extent) but they are nonintuitive. That is, the new coping responses really have to be over-learned until they begin to become a natural response that makes sense and feels right (like steering in the direction of a skid in a car or moving toward the opponent rather than away from them in martial arts). Most of the therapy techniques are not terribly complicated but the trick is to get people to stick with them and practice them long enough for the person to begin to (a) believe they can do them under difficult situations and (b)incorporate the techniques as part of who they are as people and speakers. So, I suspect it's far more than motivation that this person will have to deal with but taking small, achievable steps in the right directions should help.
From: Brian Humphrey
Transfer to new situations works best with planning. Going outside the clinic with your client is great. Bringing family into the clinic helps too. The parents of a three-year-old I'm working with have designed their own rating scale with their son's help to use in selected situations at home. My little client understands the scale because he helped work it out. I have had success with clinician-and-client-designed rating scales for clients through adulthood. I ask clients to bring their ratings in every week, so I have documentation of what they are doing outside the clinic and how they are rating their performance. I have my clients' parents and the clients practice doing ratings in their clinical sessions and comparing their ratings to mine so that they have an idea of how to rate performance outside the clinic.
From: Vivian Sisskin
Hello HK, It sounds like your client may have achieved some self-acceptance as a PWS and may be looking for comfort in communication rather than fluency per se at this point in his life. He appears to be concerned about how he may be perceived at work and may want to be known as someone who can take on more responsibilities, perhaps some that include good communication skills. It is often the case that it is the struggling that interferes with communication, not the stuttering. The targets you have chosen may not be congruent with his goals, as they are aimed at increased fluency. You might discuss other possible targets, for example, the ability to modify the moment of stuttering both during and in anticipation of disfluency. These strategies will help him move through stuttering moments easily and build confidence in his ability to say what he wants when he wants. It will also allow him to make choices about the way he stutters rather than having to learn a new way of talking. Stuttering modification targets also require some practice. Selecting cues during his daily routine can be reminders, for example, practice at least once before every meal, or practice daily with the first person he sees in the office. Introducing him to support groups (local NSA Chapter) would offer opportunities to practice with others in a less fearful environment. Finally, reporting in to a group of others working on speech targets through an email list is very helpful. Perhaps team up with another student who has a fluency client and create a list. Check with your supervisor about some of these creative options for support between sessions. Good luck!
From: Chanel Monroe (SUBR)
In reading several of the paper in this conference, I have become interested in drama-therapy. One paper spoke about traditional therapy, group activities and drama therapy being combined and showing results in increased verbal and non-verbal communication, greater confidence and the ability to handle stressful situations more easily resulting in greater fluency. Is this type of therapy used often when treating PWS? And what are your thoughts on using this type of therapy?
From: Ken St. Louis
Dear Chanel, Good question. First, I'd suggest you pose it to the authors of the paper, "The use of drama-therapy in the rehabilitation of stuttering patients" by Donatella Tomaiuoli, Francesca Del Gado, Paola Falcone, Calogero Marchese, Eleonora Pasqua, and Maria Grazia Spinetti. Yet you are asking about one of the "professor's" opinion. Here's mine. I read the article and found it very interesting. stuttering clients were treated in traditional ways and then brought into a drama component that lasted several months. Even though a large number of them were fearful or nervous about appearing on stage, most found that they rose to the challenge and did very well. I have never used this sort of therapy, although I have worked with one or two stutterers who were actors. I suspect that these people were different than many of the stutterers the Italian authors describe. They had no difficulty during acting, but their stuttering emerged when the were NOT playing a role. I would have to agree with the authors that the drama training that their clients received would clearly provide important practice in verbal and nonverbal communication, voice projection, body awareness, grace in movements, assertive speaking, and so on. All of these skills could enhance transfer and maintenance. And certainly the emotional "high" that would follow the first successful play would generate a the positive feeling of having met a difficult challenge. Personally, I would be reluctant to put all stutterers through this regimen since many of them might wish to meet other, equally difficult, challenges, such as successfully interviewing for a new job, reading a story to one's child or grandchild, asking someone for a date, and so on. I am also inclined to think that the time involved to learn and present a play might be too much for some clients. (Of course, I recognize that the reason for my caution might be that I have never done much acting.) A clinician might teach all stutterers to ride horses or learn to dance as part of therapy, and such activities could have value. But ultimately, most people come to speech therapy to learn to speak with less stuttering (or no stuttering) in their daily lives. We may well be doing them a favor by helping them learn that those might be goals that are (1) hard to achieve in the long run or (2) could actually make progress difficult (if the aim is to simply be a more successful avoider of stuttering), but the fact remains that clients are the ones who should decide whether or not they wish to go along with the clinicians' agendas. If possible, I try to give clients what they want, but I try to tell them honestly what they will likely gain and give up by working toward those goals. If my suggested goals are quite different from those of my clients, I make that clear to them, recognizing that they may not wish to partake of what I can offer. Hopefully, this makes sense and provides at least a partial answer to your question.
From: Walt Manning
Can't add much to Ken's excellent response but I think his point about approach (v. avoidance) is the key principle here. Any therapy, even anyTHING that helps speakers to do what they think they cannot do tends to flow over into approaching and beginning to accomplish victories in communication and speaking situations. It's one of the reasons assisting people who stutter can be so much fun. Approaching and achieving success with stuttering and fluency often flows over into other aspects of life and vice versa.
From: j.mihelic
I am a SLP student. Please share advice for where to begin when working with PWS. Thanks!
From: Lynne Shields
I am glad that you are interested in working with people who stutter. Reading the papers here on the ISAD conference is a good start toward learning how to do that. I'd also suggest reading other information on The Stuttering Homepage. If there is a course available in fluency disorders at your university, I hope that you are taking advantage of that, as well. Regards, Lynne
From: Mario
Hi Good question. Try to meet some pws in real life or by trying to go to a self-help group in your local area. By getting to know some, you will get an idea that everyone's stuttering can be different, and each is an individual with their past and problems. Some isolate themselves, some don't. Learn from them, ask questions, don't be afraid, we don't bite :))) I wish you good luck with your studies!
From: Glen Tellis
One more thing that I would suggest is to observe fluency therapy; perhaps, treatment conducted by a board recognized fluency specialist. Try and observe several different therapy sessions with different age groups as well. Stuttering manifests itself very differently from one person to another
From: Keith Boss British Stammering Association UK
I am also pleased you are looking into this aspect of SLP work. The others responses offer good advice. I would add that there are several on-line groups worth joining just to 'taste' the different opinions we express when we are at our fluent keyboards or using our 'voice to text software'. There are groups like STUTT-L, http://health.groups.yahoo.com/group/stutteringchat/ and http://health.groups.yahoo.com/group/neurosemanticsofstuttering/ to name but three. There are websites with a wealth of information BSA http://www.stammering.org/ NSA http://www.nsastutter.org/index.php The Stuttering Homepage http://www.mnsu.edu/comdis/kuster/stutter.html to name but three. These three will keep you reading for a 'year of Sundays'. May a make a suggestion for your consideration? If you started to build up skills with helping with the speaking problems of pre-school children, which will mean coaching parents, you will be doing us a very great service as you will be helping, year on year to reduce the number of children stuttering into adulthood.
From: Dr Trudy Stewart
Over 30 years ago Gregory edited a book about controversies in stuttering therapy. I wonder what the professors consider as the most controversial aspects within stuttering therapy in 07!
From: Ken St. Louis
Hi Trudy, This is a good question. I mentioned a few controversies in my first reply to Ed Feuer's query. It's clear that that was is not what he was really asking about. I'd be interested in what YOU think the controversies are.
From: John Paskievich.
I have met several SLPs who admitted to me privately that the therapy that is provided in schools is next to useless and may cause more harm than good because many SLPs know hardly anything about stuttering and are uncomfortable about being asked to treat it, but they do so anyway because to not do so would jeopardize their employment. The therapy provided is usually token, only about an hour once every two weeks or even less. Even then, it raises false expectations in the child and the parents. This is not a good situation.
From: Greg S
Hi John. I think the issue lies relative to what the long term objectives for stuttering treatment. If one is looking for complete elimination of the pathology, then yes--nearly every single adult person w/ persistent developmental stuttering will receive "failed" therapy. And a lot of people never get over this anger and frustration, to their own detriment. However, if one cites the long term objective of stuttering treatment to improve the quality of life--then we can make great strides toward creating effective communicators that can talk to anyone at any time in any environment without shame, guilt or fear. Relative to this LTO, there is evidence that SLP tx can be quite effective. As such, I honestly view all this talk about trying to dig up "controversies" as nothing more than wasted effort to feed someone's righteous anger--which is ultimately counterproductive. Time, and reality, march on--regardless of our anger and angst. *** *** *** So yes, there will be some school based SLPs that are awful. Just like there are some private practice SLPs and even university-based SLPs that are awful. Similarly, there are some dynamite School based SLPs, private practice SLPs and university-based SLPs that are making tangible changes in the lives of many PWS. (Just like any other area of Allied Health.) In summary--it's time for people to start taking control and responsibility for their own happiness; life isn't fair, but those that are happy pick up and move on.
From: John Paskievich
Whoa Greg; My intent was not to "dig up controversies" nor was it to tar all SLPs with the same brush. There are some very knowledgeable and dedicated ones working in the schools and they are the people who brought these issues to my attention.
From: Rick
i think there are many controversies because stuttering is caused by multiple unknown causes with a genetic factor. The influence of Johnson and Sheehan will persist into the future. With school speech therapy, like k-12 public education in the USA today...there are many challenges....What is not in dispute is the proper education of parents. With Children who stutter and school therapy, is it not MORE important to educate the parents (communicate with the parents and proper education)? I can just imagine children in a small room at the school practicing drills in school speech therapy. Some parents still have negative attitudes towards stuttering, which can greatly affect self-esteem of children. The parents are just "not educated" Old beliefs die hard.
From: laura
At the risk of being burned at the stake, I will say that I work in the public schools. I think what is missing from this discussion is how to make the public school SLP prepared for all students on his or her caseload. I believe this is through specialists employed by the district in all areas including fluency. But what I really wanted to say was there are parents that I have never met. They don't come to meetings, reply to telephone calls, or letters. I have had parents tell me they wanted their child in real speech therapy not the speech therapy in the schools. I remember in graduate school the feeling from the professors that school speech therapy was somehow less. As long as the profession freely bashes school speech pathologists parents will think it is less and therefore even when it is better it will be less because no one will listen. Stop thinking about where it is bad and look for where it is good and try to repeat it.
From: Charlie Osborne
Laura, I'm fresh out of matches, so no need to worry! I believe that you make several strong points. Being responsible for every child and the specific delay or disorder he/she walks through the door with is a considerable challenge. Add to that the challenge you mentioned regarding parent contact (or the lack thereof), along with trying to schedule the child, along with the other 60-80 children, along with not having the luxury of working with each child on an individual basis, along with dealing with some teacher's idiosyncrasies (not being able to take the child during "specials," etc., etc., etc,), and along with all of the other challenges I have failed to mention! I worked as an itinerant clinician in the schools for 3 years before I realized that I was unable to function in the way I thought I needed to be an effective clinician (my caseload varied from 70-85 children). During that time, I met other clinicians who shared my angst. However, I also met those who seemed to flourish in that environment as did the children they treated. It was a larger school system and I had the good fortune to become a fluency advisor for the other itinerant clinicians, to provide inservices and to consult with clinicians at their schools (we also provided consults for AAC). In my private practice, I usually had one or both parents coming in, and the fact that they were paying for my services seemed to give me more credibility in their eyes (hence, I must be �real� if I cost so much!). In addition, parents were typically more than willing to be involved and follow through with my suggestions at home. I was able to see each child individually for 60 uninterrupted minutes twice each week. I felt that the success the child experienced was a result of the therapy I provided along with these other factors! Now, I work at a university clinic and still enjoy the advantages of individualized therapy and regular parent contact. My respect for the public school clinician has not diminished. Many that I have met are attending or participating in the numerous continuing education opportunities in an attempt to sharpen their clinical abilities in the area of stuttering. Providing more continuing education opportunities and online supports are steps that I feel are moving us in the right direction. As you mentioned, encouraging school systems to use specialists is an excellent idea. Kudos to you for participating in an event such as this! I hope that no one is in search of more wood, because I am on the stake right next to you!
From: Ed Feuer
John, You've raised a very important point about the shameful situation in the schools. To those professors here who fear washing the SLP profession's dirty laundry in public, I would say that dirty laundry not washed in public is laundry most likely to stay dirty. Attempted public relations apologia for the profession does not fix the very real problems. Meanwhile, one of the most forthright and succinct expositions of stuttering therapy in general and the situation in the schools in particular was given by Prof. Woody Starkweather in his Aug. 5, 1999, posting on the Stutt-L listserv. Woody, who knew of what he spoke, said, "It is a real mess." I doubt that there's been any substantial improvement since that time. Read it and weep. Woody Starkweather wrote: ". . . There are two problems that are still not solved at this point. One, the specialty recognition program is only just getting in place now, and although the stuttering area is far ahead of the others, even we don't have it far enough along for referral to specialists to work really well yet. The second problem is that the generalist has to know enough to make the referral, and with no requirements for stuttering at all in the curriculum, it is not clear that the generalist will have even that minimal knowledge. Specifically, knowing next to nothing about stuttering, they may believe that they do know enough to treat it." Also, a third problem is that in the schools, the SLP's are hired by the Principals to "take care of any and all" speech and language disorders that children may present, of which stuttering is clearly one. But the recently graduated SLP may not have had any training in stuttering or in voice disorders. The SLP applying for such a job is ethically required to say that she is not qualified to work with a part of the school population, which will mean that she doesn't get hired. But the Principal doesn't usually know this. He is looking for an SLP. He has found one who is certified by the ASHA, and that SOUNDS as though they will be qualified to work with speech and language disorders, whatever they are. The applicant under these circumstances is pressured to be unethical, which the association should never promote, but does. The same thing is true for the general public. When a clinician can say that she is a certified SLP the public will believe that she ought to be able to treat whatever comes along, since that is the most obvious interpretation of what the certification and training mean. But it doesn't, so the clinician is tempted to behave unethically, and in fact may not even know that she is not qualified. It is a real mess, in my opinion.
From: Dr Trudy Stewart
I mentioned this book because I remember at the time being very impressed by the informed dialogue which was represented in the text. The contributors discussed, if my aging memory serves me well, issues such as the relationship between attitude change and speech/behaviour change, management of early stammering among other things. All of which was very interesting at the time. In terms of controversies I have a few, Ken (and with a good bottle of white wine and a lively conversationalist could probably come up with more!). Here is a token sample: * spontaneous recovery vs reported cure in early childhood stammering and how to tell the difference! * clinical treatments that use a "fits all" model to manage stammering in both children and adult clients * developing a comprehensive assessment that reflects change (attitude and fluency change) in children * the problems of advocating desensitization and openness with adult clients who stammer when society still has many negative attitudes towards stammering. Feels sometimes like trying to fit square pegs into round holes. THere is my starter Im sure other people have more.....
From: Charlie Osborne
FYI, the upcoming DIV 4 Perspectives in November 2007 addresses issues in assessment and in measuring treatment outcomes. The issue provides excellent information from contributors that include M. Blomgren; C. Bloom, Cooperman, and J. Klein; R. Gabel, D. Daniels, and S. Hughes; K. Logan and M. Haj-Tas; C. Healey; W. Manning; J. Tetnowski; and M. Vanryckeghem. Look for it next month!
From: Judy Kuster
Trudy, Do you have the reference to the Gregory book? I'd like to take a look.
From: Charlie Osborne
I have been staying with this interesting thread and thought I would jump in with the reference you requested Judy. Here it is: Gregory, H. H. (1979). Controversies about stuttering therapy. Baltimore: University Park Press. Hope this helps!
From: Ken St. Louis
Hi Judy, Charlie gave you the 1979 reference. The "controversial issues" that Hugo Gregory (p. 1) identified were: 1. Teaching the stutterer to "stutter more fluently" versus teaching the stutterer to "speak more fluently"; 2. Attitude change: what is it and is it needed? 3. Psychotherapy for stutterers: what is it and is it needed? 4. The appropriate management of stuttering in children; 5. Planning the transfer of changes to the natural environment and dealing with the problem of change; 6. Criteria for assessing the results of stuttering therapy: reports on the results of therapy. We've made some progress on all of them, I think, but some more than others. For what it's worth, I'd say that we don't dichotomize 1 as much as we did; we definitely recognize the value of 2 (Ignoring emotions did not make them go away); not sure about 3, but I doubt that many would believe this anymore; resounding "yes" for 4; almost as a resounding a "yes" for 5; working on 6, as hard as it is. By the way, Trudy, I agree with your view of controversies. Let's get the bottle of wine and see if we can develop some more.
From: Gunars Neiders
Dr. Stewart,........I found on my shelf the 1968 book edited by Hugo H. Gregory called "Learning theory and stuttering therapy" which raised a number of issues in my mind in application of learning theory techniques from psychology, where different points of view were expressed. The current book "Current issues in stuttering research and practice" edited by Ratner and Tetnowski in 2006 reflects the same spirit. As Drs. Ratner and Tetnowski so aptly point out in introduction, "In this chapter, we discuss some challenges that face our disciple,.....If I have not misunderstood your question, this might be a good start.....
From: Gunars Neiders
In Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., et al. (2005). "Randomized controlled trial of the Lidcombe programme of early stuttering intervention." British Medical Journal, 331, 659-661 the authors emphasize as established fact that "Chronic stuttering in adulthood is intractable and has serious disabling effects". Professor Onslow confirmed (in answer to my question in this conference) that he really believes this. My question to you is "Do you agree?"
From: Lynne Shields
Gunars, It's good to see you participating on this conference. I enjoyed meeting you in person at the SID4 meeting this summer. You asked whether I agree with Mark Onslow's statement regarding the intractability of chronic stuttering. Defining "intractable" as 'difficult to treat', I have to say that it all depends on the degree of severity of the chronic stuttering, and also the degree of impact that the stuttering has on the person's life. I do agree that stuttering can be difficult to treat for some people, and that stuttering may interfere with a person's life significantly. I do not believe that it necessarily follows that chronic stuttering cannot be treated, even when the disability is quite severe. And, I do not believe that the fact that someone has a chronic stuttering problem equates with significant disability. There is so much variation in stuttering and in the impact that stuttering has on the lives of those who stutter. I agree that successful early intervention for stuttering is ideal, as this result can prevent the further development of stuttering and the negative impact that stuttering may have on a child's life. Regards, Lynne
From: Walt Manning
I agree with Lynne and I suspect many others who have seen many adults make excellent success both with good therapy and self-directed change. Some individuals who have stuttered severely have better scores on measures of approach regarding stressful speaking situations (e.g., public speaking) than normally fluent adults. Many adults who continue to do some obvious stuttering have become better communicators than normally fluent speakers. Yes, it's generally more difficult to get adults (v. children, especially preschool children) to that point and maybe that's what Onslow really means by his statement. Many adults decide to make many important changes in their early 20s. Later on many speakers have adapted and learned to cope with their stuttering and are much less likely to seek treatment. But even then, there is much progress to be made in fluency as well as quality of life.
From: Charlton Knowles
Dear Walt, how are you, glad to see that you are participating in the conference. If I may comment on the difficulty of treating stuttering in adults and I can only speak from my vast experience with many different types of therapies, I agree with you that chronic stutters, such as myself I think can improve greatly and become effective communicators, however, i am convinced that can only come about by (1) unconditionally accepting your stuttering as a fact of life, (2) make profound attitudinal changes about how you view yourself vis a vis others, (3)empower yourself that you are a dynamic individual and notwithstanding stuttering you are quite relevant. If one views stuttering as a fear/anxiety disorder, fear/anxiety has to be reduced, which will result in better fluency and better ease to control the moment of stuttering. I am at that point now, after years of therapy which has all helped, but until I literally forgot about trying to control stuttering, and wanting to be fluent, I just allow the expectation of stuttering come about and don't panic and slowly move through the sound/syllable/word and the speech is fine. But this only came about when I stopped trying to be totally controlled. I have also gotten rid of other attitudes that kept me handcuffed with anxiety/fear. I am not "perfectly" fluent or void of stuttering, but I really DO NOT CARE.
From: Lourdes
I have been working with a fith grade students with severe silent blocks (covert stutter too) for about 12 months, He went undetected as a severe stutter due to his hiding it for several years, teachers thinking he had cognitive issues for his slow way of responding in class. He is in a substantially separate class, but I'm no sure yet he belongs there. Mind you, he is working on CALMS approaches to address his stuttering. But the interesting thing is that last week I let him borrow the behind the ear device from speech easy which he held with his hand to his ear while he read a book aloud and while he engaged in verbal exchanges with me. What I'm getting at is that he experience 100% fluency in front of my eyes. He was so elated that he asked in a mesmerized manner to explain to him what was happening. He begged me to allow him to keep the device for a longer period. Sadly, I could not let him take it as it is my DEMO from speecheasy, but he agreed to use it the next time he comes to therapy. I can't say how he will respond in the future to the device, but I know he is looking forward to it. In the mean time, I'll continue with my CALMS approach as this is empowering to him as a communicator but I'll also in conjunction use the speech easy DEMO so that he experiences fluent speech.
From: Greg S
I was looking for a question, but never found one! In any event, there are any number of ways to emulate choral speech through every day objects. Talking into a large styrofoam cup, for example, often provides enough reverberated speech feedback to enhance fluency in many people who stutter. Further, the computer software from Rick A (on this year's ISAD) is a great computer-based free alternative.
From: Charlie Healey
I was pleased to read that you are using the CALMS approach to treating the child with severe stuttering and that you said the approach is helping be a better communicator. If you read my Seven Principles of Therapy article, that's one of my points. Using the speech easy is okay as that provides a delayed/altered feedback that is fluency enhancing, There is no reason not to introduce that or other forms of fluency enhancing strategies into therapy as long as the child understands that it isn't magic or something else that is creating the fluency...it's something he is doing differently with his speech mechanism as a by product of the change in auditory feedback for speech. The effects won't last and that's what the child needs to understand. I would recommend you continue with the multidimensional approach by focusing on several factors that contribute to stuttering, i.e., the CALMS factors. Also bear in mind that severe stuttering will be hard to change so if you can improve his awareness and understanding of his stuttering, help him develop a positive attitude about it, help him see that the amount of stuttering and who he talks to will dictate how much he stutters as he tries to manage a very unstable motor system, then you are on the right track. The process will take time.
From: Lourdes
Thanks for your very helpful feedback, Dr. Healy. The following information was most appreciated: "There is no reason not to introduce that or other forms of fluency enhancing strategies into therapy as long as the child understands that it isn't magic or something else that is creating the fluency...it's something he is doing differently with his speech mechanism as a byproduct of the change in auditory feedback for speech"
From: Nancy B.
speecheasy device, this sounds really good. Is this going to be available to everyone, or as said a Styrofoam cup is a great tool too. and may be the cheapest in price.
From: Judy Kuster
Nancy, electronic devices have been around for a long time. There are several studies being conducted right now about the effectiveness of the device you are asking about. They apparently can be beneficial for some stutterers, other stutterers do not like these devices. There is an article on this conference that provides free softward for your computer that gives you an idea of what some of the devices do. Take a look at Add Altered Auditory Feedback to Your Toolbox... For Free by Richard Arenas.
From: Laura
I am a SLP in the public school setting for about 10 years. I am interested in fluency topics and have really enjoyed many of the articles here. What is your favorite resource for SLPs.
From: John Tetnowski
As an academic, I do have the opportunity to read the current literature as it comes out, but I love to read from areas that are outside of the area of SLP. I think that there are great resources out there that most SLPs don't get a chance to look at. Probably the books that I have read recently that have most influenced my role as a clinician/supervisor/teacher are: The Anatomy of Hope (Jerome Groopman) Meaning, Medicine, and the Placebo Effect (Daniel Mooremann) Authentic Happiness (Martin Seligman) I could go on with a few others, but these books emphasize why people "get better". they are not handbooks or sourcebooks. They are books that make you think about how you are treating your clients. In my opinion.......the most valuable resource books!
From: Ken St. Louis
Dear Tricia, This is a good question. What you we recommend for early elementary-aged boys who have easy prolongations on mid-word sounds and who may or may not be aware of them? Perhaps the reason nobody has jumped in to answer it is that the question is not easy to answer. Even so, let me take a stab at it. I first would question whether or not there is a complete lack of tension. Even though you might not be able to see or hear tension, I would tend to look further myself because (1) prolongations are often typical of stuttering that has worsened and (2) I would be suspicious that the boys were not concerned about them. Woody Starkweather observed a number of years ago that stuttering was remarkable in the sense that children as young as two often pretend it does not bother them. I believe I would start out with a fluency shaping approach as follows. First, I would want to find out what the youngster knows about stuttering and what it feels like to be stopped/slowed by the prolongations. I'd consider using a number of available suggestions to try to reduce any strong aversion to talking about stuttering and to reduce any fears, embarrassment, and so on. Like many identification and desensitization approaches, I would want to know all the things the child does when and because he stutters. I would also want to get the perspectives of the parents, siblings, teachers, and friends. After that, I believe I would try a smooth and easy speech modeling approach first, teaching a slower rate, easy vocal onset, and light articulatory contact. I would not expect the child to imitate my models in the exaggerated way I would model them, but I would look for changes. Hopefully, he would either imitate some, reduce his stuttering over the first few weeks, or both. I would also probably begin to model some easy repetitions to show him an easy, repetitive form of stuttering. Why repetition? Because I have found that it is easy to stutter easily and repetitively on all classes of sounds, vowels, continuant consonants, fricatives, stops, etc. It is also easier to model taking a breath if one is running out of breath in a prolongation or block. If there are no changes in a month or so, I would begin to reinforce him for imitating me (to some degree). I would also want him to start demonstrating some easy repetitions, even if they are not real stutters. For example, I might use some pairs of nonsense figures ("aliens") with names like "biiiiip" and "bi-bii-biii-biiiip." Talking about both of these "aliens" would require using easy repetitions. If I still did not get a change in a couple of months, I believe I would consider a more direct approach to teaching the targets, first with single words, and then progressing to longer speech segments. I would consider any of a number of good approaches, such as Guitar's integration of approaches, Cooper and Cooper's FIGS, and others. Ellen Bennett's new book has nice summaries of many of these approaches. So to most of the available textbooks. I hope this helps a little. Good luck. Ken
From: David Shapiro
Hi Tricia, You are asking a good question. And indeed you are right — there always is more to learn. I would be interested to know what you mean when you say the boys are self-aware. Do you mean that they are aware of when/how they stutter? Or do you mean that they are in touch with and/or accepting of their feelings related to the speaking experience? I would need to know more in order to respond more specifically. However, my approach may be a little different. I find that even when clients are aware of when stuttering occurs, rarely are they aware of what they are doing when they are fluent. Typically, the fluency is more frequent than the disfluency. For these reasons, I do not begin by focusing on the disfluency. I focus first on fluency success, creating opportunities for the client to experience speech without stuttering (e.g., via a fluency shaping exercise, such as choral reading or choral speaking). Then, I identify specifically (i.e., first for, and eventually with, the client) what the client is doing within conversation with me when he is fluent. Typically three patterns are observed - even rate, gentle articulation, and natural inflection. By focusing on those three patterns, the client is addressing what he already is doing that results in fluency and how to do even more often what he already is doing correctly. This is different than directing the client in what not to do. In fact, when demonstrating these three patterns, the client cannot stutter. The client learns that fluency is a consequence of what he is doing (and thinking and feeling); disfluency also is a consequence of what he is doing, but differently. With practice, guidance, and regular home assignments, the client comes to understand and thereby control what he is doing in order to be fluent even more often. By creating opportunities such as this, the client experiences an empowerment that is highly motivating. Nothing is as motivating as directly experiencing fluency success. In other words, success begets success. Both the absolute and relative frequency of fluency increases; typically self- reflect increased internal locus of control and the realization of what one can, rather than cannot, do. You might want to review my responses to the people who have reacted to my paper, Being Real, in this conference. In several instances, I explained different aspects of my methods. Also, I elaborated my intervention more thoroughly in the book, Stuttering Intervention: A Collaborative Journey to Fluency Freedom. Feel free to follow up with me outside of the conference if I might provide any clarification. As an SLP and a PWS, thank you for all you are doing to help these two boys. David Shapiro
From: Retz
I am wondering if the professors on this ISAD thread would willingly share their insights and reaction to the following quote... "I've never seen a person who stutters, at any age, get any worse because of therapy."
From: Ken St. Louis
Hi Mike, I've seen a few stutterers who have become worse in therapy. And some of them have quit. For children, who often can't make these choices on their own, sometimes, the parents quit therapy. We cannot treat every case who comes to us, and occasionally, what we try to do has some unexpected negative effects. In my experience, that is most likely to occur when there are other, complicating problems, such as psychiatric problems, significant personal/family crises, etc. But it is not uncommon for people to come to therapy, discover that they are stuttering more (often because they have become more aware of their speech or have tried to eliminate some accessory behaviors). Some of these people apparently preferred not to tolerate some temporary increases in stuttering and presumably returned to the adjustments they had earlier. On a different--but related note--I had at least one severe stuttering client who quit therapy after he finally became decidedly better. This was after doing 100 speaking assignments in one day at the mall (Van Riper's so-called "stuttering bath"). He apparently could not abide the new adjustment that this experience forced on him, i.e., that he could no longer use his stuttering as an excuse to be a victim. Lest anyone think these are common occurrences, in my experience, they are not. Most clients willingly accept the ups and downs that are part of any significant life change.
From: John Paskievich
Mike and Ken; When I began my self therapy my stuttering got a lot worse because I was flushing my stuttering out into the open and was unsure of what techniques worked best for me. My wife and son became very worried about my increased severity. My increased stuttering didn't bother me because I knew and felt in my gut that in my case, I had to stutter more to stutter less.
From: Retz
John- I do understand the idea totally of one having to stutter more to stutter less...absolutely! Thanks for the post! — Ken - Hello to You! Thanks for the response to my post. I guess my experience professionally has been that by the time the clients I most often have the honor of working with -(children who stutter and their parents) - begin working with me, they often share/feel that their previous therapy experiences have contributed to a more severe type of stuttering. For what ever reasons, professionals they had worked with previously often led them to believe - or told them directly - that they were the cause of "failure" in therapy....not the therapy, not the therapist, but the fault of the CWS and the parent. In my experience with adults who stutter that have had therapy, I have found many who choose not to speak - or limit their verbal output greatly - because they are uncomfortable, not only with stuttering, but with their "failure" in using techniques to stop, control or modify their stuttering. In these cases, I wonder about the "therapy" and/or the therapist as well as the pws... I do believe there are some forms of therapy that when engaged in, risk the child who stutters, and the adult who stutters, into developing a more severe stutter. I recently did an evaluation on a 6 year old who stuttered. It was most interesting as the child had had "turtle talk" therapy and Stuttering Mod. techniques administered to her over the course of a year in the school setting. At the IEP meeting at the end of the school year, the school slp suggested a goal of the child using a picture communication system because the child's stuttering had become so severe during the 9 months of therapy....This is what spurred the parents to contact me. Frightening situation... Certainly it cannot always be because of client factors... Consideration factors for "failure" in therapy must also include the type of therapy as well as potentially the therapist. At least that is what I believe. Again...Thanks for your reply. Hope all goes well with you!
From: student
we are studying about the 3-factor model in stuttering, but I don't understand what and how the physiological factors can affect stuttering. thank you for help in clarifying this.
From: Ken St. Louis
Dear student, You mention "the three-factor model" of stuttering. It would be helpful to know what three factors you are referring to. I presume you mean etiological factors, i.e., physiological, psychological, and learning. If so, then let me try to respond. You write, "I don't understand what and how the physiological factors can affect stuttering." I would suggest that you start by getting a recent textbook on stuttering and look at the section on cause/etiology. You'll probably read about the history of each of these factors and some of the data to support each perspective. Then, if the textbook reflects current wisdom, it will probably conclude that most recent evidence suggests that stutterers, as a group, manifest physiological differences from nonstutterers in many areas. For example, a great deal of research suggests that stutterers are not quite normal in terms of central auditory skills and motoric reaction time. There is evidence suggesting that they are different as a group in terms of temperament. Additionally, there is not question that there is a genetic link in about half of those who stutter. In essence, it is not a question of "making sense of" or "understanding" physiological factors; it is a question of empirical research data. We are far beyond the "I feel it in my gut" approach to these matters; we now can and should look at the weight of the evidence. As a student, one of the challenges you face is being able to become a consumer of research. There is no other way to become and stay informed about the nature and treatment of any communication disorder. And a good way to do that at this point is to read current, good textbooks wherein experts have read and summarized the research. Hopefully, you also soon will be doing that for yourself. Good luck. Ken
From: Nancy B.
When a child stutters and is bilingual is it better to talk in one language or is it okay to talk in both?
From: Brian Humphrey
Nancy, so far it looks like children who are bilingual do okay with appropriate stuttering intervention. Way back in the twentieth century, I spent some time collaborating with a trained interpreter on bilingual assessments of Hmong children, including some with fluency concerns, and we managed to conduct appropriate assessments. Later on, I had a bilingual English-Spanish boy on my caseload. whose parents were both bilingual. They chose to have him treated in English. Fluency in Spanish improved too. Before I could put a case study together, he was ready for dismissal. Subsequently I studied four adults who were assessed bilingually, treated in English and monitored in either Spanish or French. All made significant gains in the untreated language, without specific instructions to transfer their training. --- I think it is a great idea to assess bilingual clients in both languages, via a bilingual slp or via an interpreter trained to participate in fluency evaluations. In order to ensure that children improve in both languages, it would be good to provide treatment in both languages if available. BH
From: Klaas Bakker; Missouri State University; Springfield, MO
Nancy, I would like to add that the answer to your question at least in part depends on a child's language skills (and perhaps also phonological skills). If these are strengths, I don't think bilingualism is an issue and the dysfluency can be treated just as dysfluency in other cases. However, if the child shows weaknesses in these areas and struggles with the bilingualism so to speak (it causes higher than average demands on the speaker), this could definitely interact with fluency. I would examine the feasibility of working on fluency in the primary language. Of course, if the language issues are major probably they deserve most of your attention as dysfluency could be a side product of this.
From: Nancy B.
People who stutters do struggle for acceptance. I found that when a person who stutters starts to talk and it is no fluent other people's reactions start to change and they do not what to deal with the person who is stuttering. Why does there have to be this struggle for acceptance?
From: Ken St. Louis
Dear Nancy, You are asking an existential question. Why should anyone have to suffer? I won't attempt to answer that question, but I will comment briefly that there is a great deal of evidence that the public does in fact hold some negative views of people who stutter and inaccurate beliefs about stuttering. For example, virtually nobody who is reasonably informed should respond positively to a questionnaire item that says that stuttering is caused by a virus or by ghosts, demons, or spirits. But still, some do. Most people, many stutterers included, believe that stutterers are shy, nervous, inhibited, and weak. No one knows for sure why, but maybe it is because most people have "stutterer" a few times in their lives, and those times tended to be when they were scared, nervous, under the influence of "stage fright," etc.
From: Vivian Sisskin
Nancy, For years my clients have expressed that acceptance of stuttering is perhaps more difficult than acceptance of other disabilities, for example, a physical disability that the public sees on a daily basis. Stuttering is unique in that it is not always present. Most PWS have "islands of fluency" throughout the day. This variability leads a PWS (person who stutters) to believe that they CAN be fluent, so they try to be. And those who stutter know that the more one tries to be fluent, the more stuttering will occur. My mentor, Joseph Sheehan, wrote about "role conflict" and stuttering. He explained that the act of going through the day as a "fluent speaker" leads to conflict — taking the role of a fluent speaker (trying to be fluent) yet appearing to the public as a PWS, thus enacting the role of a PWS. This conflict makes acceptance very difficult. After all, a visible physical disability is always present to the public. If you want a challenge, perhaps try this experiment: Prepare to enter a speaking situation (a short one, perhaps asking a question in a store or on the telephone) with a strong INTENT to SHOW your stuttering, predicting struggle, and even welcoming it. This reduces the role conflict because you are taking the role of a PWS rather than the role of a fluent person. The roles are congruent, and conflict is minimal. You might be surprised that you may stutter less, and when you do, your feelings of shame and embarrassment are minimal because you have done the thing you wanted to do, stutter! When performed with the INTENT to take the role of a PWS, voluntary stuttering and advertising function in the same way.
From: Walt Manning
Nancy, adding to the responses you've already received, it's clear that stuttering is variable and not well received by most listeners. Those who understand what's going on (including most good clinicians) are going to respond well to easy forms of stuttering and recognize attempts to catch and smooth the more automatic, habitual forms of stuttering. But, alas, most listeners aren't going to have that level of understanding. Rather than striving to please and be accepted by listeners it is probably a better strategy for the adult speaker to do what they need to do to be who they are (as Vivian indicated) and not try to work so hard to hide the fact that they may stutter and to use techniques that they find are useful to them to successfully manage their stuttering. As we become less concerned about wht the listeners might or not think about us we tend to do what is best for us rather than the listener. I'd be interested in your thoughts.
From: sachin
I am 49 and a covert who has learned to self-confess, bounce and practice other techniques. My experience on this theme was- when I began accepting myself along with my stammer and other peculiarities, my listeners too accepted me more. This last was not my goal though: I just wanted to accept myself in totality- that is all I wanted to do. This brought a lot of peace. Communication improved.
From: Sachin from Indian Himalayas
This post is just to add one more facet to the ongoing discussion; I am a covert stutterer who recently came out of the closet. About 4 years ago, I consulted an SLP who explained to me what was happening in my head while talking. Just one session. Thereafter, I read a lot and tried to understand my problem and possible solutions. But no real progress. Then, one day I went to visit a holy man and said to him: When I sit for meditation, I don't see any light here (-pointing to heart); I see only shame and darkness. I have stammered since my childhood but have been hiding it all these years. It took me LOT of courage to say this. I actually stumbled couple of times but somehow completed the thought. He has been observing silence for many years and therefore responds through gestures alone. He smiled gently and made a gesture with his hands- which, to me, meant: Never mind. Just carry on with meditation. On the surface, this was just a routine interaction between a man who had come to the end of his tether (rational mind) and a saintly man who was capable of accepting human beings as they are; But since then, I have been able to talk about my stammer to a variety of people in a variety of contexts. All the sense of shame and guilt seems to have left me for good. This has helped not just my emotional health but also my speech. Religion has been given up as a purely �personal and subjective issue� in academic circles. But should we not accept and acknowledge whatever good it has to offer? Every culture has similar traditions. Are we letting the PWS know that such other options also exist? Lastly, if cost effectiveness is a consideration in modern speech therapy (-in India, it is-), let me share- this �consultation� cost me absolutely nothing! Would love to know what professors think about it.
From: Ellen-Marie Silverman
[[" . . .Religion has been given up as a purely personal and subjective issue in academic circles. But should we not accept and acknowledge whatever good it has to offer? Every culture has similar traditions. .."]] >>> Sachin, when religion helps us see ourselves as the inherently luminous beings we are so that we can rest in that awareness despite what we consider imperfections in our current behavior, it helps release any shame, embarrassment, and guilt we may be carrying, which deprives us of experiencing joy and giving it to others. Speech therapy, when well done, is but one way to facilitate the same outcome, but, obviously, it is not the only way to reach that awareness. Wherever you find it, be grateful. >>>
From: sachin
Couldn't agree more with you. I too was trained as an Allopath and for years my understanding and sympathy were limited to modern bio-medical system of healing and explaining it. Now, gradually over the years, I am beginning to see that there is more to it than what meets our eyes. Thanks for responding.
From: Vivian Sisskin
Thank you to those who have and will contribute to this thread! Recovery from stuttering often requires courage in the face of fear, self-acceptance, tolerance of imperfection in oneself and in others, patience, hope, consistency, practice — I could go on and on. I don't believe that speech therapy alone can provide the means to achieve all of this. Certainly, as an SLP, I can provide avenues through desensitization, cognitive therapy, counseling, etc., but I do believe that each person finds his or her own way to recovery, I just supply the fuel and the tools. I very much appreciate hearing about the sources of motivation and change for those who have made progress, as I believe that they are different for each individual and often quite personal. My clients are always eager to talk to others who have recovered from stuttering (with or without therapy), to hear their personal stories. I often drag my husband in for a few minutes to share his story of recovery from stuttering, as it does so much to light the fire that leads to change for my clients. On occasion, I share my own personal journal to acceptance as a parent of a child with severe disabilities. Please post. The stuttering community would love to hear more!
From: Andy @ RMHS
I have been taught ERA-SM since I started speech. But I want to know an expert's opinion on how effective this tool is compared to other speech tools? It has worked for me but i still want to know an expert's opinion on how effective it really is or if there is something better to use for stuttering.
From: Charlie Healey
Andy: Your question about how effective ERA-SM technique is compared to other techniques is somewhat difficult to answer. Does the easy relaxed and slow movement into a sound or word help? Many would agree it does and it has been advocated for a long time by the late Hugo Gregory, a professor of speech pathology and person who successfully managed his stuttering. So yes, it is one of many effective techniques that attempt to change the tension, timing and force that is needed for people who stutter. If it works for you, I would recommend you continue to use the strategy. However, it depends on your stuttering problem to know whether there is something else that you could use to be more fluent. The other thing to remember that no technique by itself will work if that's the only thing you focus on. A technique has to be used within the context of how you feel and think about your stuttering, how much you have accepted it, how much you are willing to try to speak in a new way around other people, etc. So, asking whether a technique works or not or asking if there is one better, the answer is a qualified yes because it depends on so many other things that we need to know about your fluency disorder.
From: nancy wariari
Would you rate the involvement of parents in children with stuttering? Do most or fewer parents generally assist their children in coping with stuttering?
From: Lynne
Nancy, I can't comment on the general practice of parental involvement and the rate at which parents are integrated into therapy for their child. However, in our practice at the university where I teach and supervise, we ask parents to be involved. How they are involved depends on the particular parents and child, and on the treatment that is being carried out. Just to give you an example, if a child is being asked to use voluntary stuttering, and has decided to do so outside of the therapy setting, then I typically will have the child bring his or her parents into the clinic room and teach the parent how to do voluntary stuttering. An outside assignment may be to have the child play a game of 20 questions with a parent and both the child and parent are to use voluntary stuttering. The same is true of other techniques--I usually like the parents to learn the technique and use it outside of therapy. It gives the child a partner in practice who is also doing the same task, and it helps the parent(s) realize how difficult it is to actually use a technique on a regular basis, so they can be more realistic about how quickly a child might transfer a therapy tool into their everyday speech. Parents may also be involved in advocating for their child at school. I talk with them about ways to engage the child's teacher in modifying tasks to make it easier for the child to participate in class. Eventually, I'd like the child to advocate for him or herself, but the parents can be positive advocates for and with their school-aged child. I also like parents to talk about stuttering with their child, so we may have activities in clinic where we all explore different topics about stuttering. So, I think it is important for parents to be involved in their child's treatment. It may be harder for that to occur in some settings, such as schools, but I believe it is important to make attempts to get the parents integrated into therapy. Regards, Lynne
From: Barbara Amster
Nancy I want to add to Lynne's great response that we also want parents to understand the nature of stuttering and to understand the goals of the treatment for their child. One of the problems with therapy in the schools is that it is often quite difficult to communicate with parents in order to get the parent involved with treatment and if they don't understand the goals of the therapy they may actually interfere with it.
From: Vivian Sisskin
Nancy, Lynne and Barbara have already provided great ideas that I also find helpful for successful treatment. I will add a note about teens. I work with adolescents who stutter and spend a lot of time listening to teens in the context of group therapy. Many of them think that their parents "don't get it" even though their parents have been helping them practice speech targets at home, have been involved in the therapy process for years, and have read a bit about stuttering. They often say that their parents think that they don't practice their targets enough and they would be fluent if only they did. I am lucky in that I also have the ear of the parents in their periodic support group meeting. They admit they know very little about how their child's stuttering problem affects them on a daily basis. They are unaware of the covert strategies their teens have developed (word substitution, pretending to think, avoidance of situations and opportunities) and how complex the problem has become. Therefore, for teens, I put them in charge of educating their parents. They do this at their own rate and comfort level. Each week in group they devise an assignment which includes one thing they will teach their parents about stuttering (this can be about the nature of stuttering or about their own pattern, fears, thoughts, worries). When it comes from the teens themselves, the parents seem to �get it�, and they enjoy the connection that these discussions encourage.
From: Walt Manning
I certainly agree with Lynne and Barbara and would like to add a couple of comments. I used to believe that I could overcome the lack of parent involvement when working with a younger child, or even a teenager. And sometimes that is possible to a degree. But having parents (as as many others as possible) involved is often critical, especially for long-term change. One of the best aspects that likely contributes to the success of treatment programs for children is the role of the parents as with, for example, the demands and capacities approach or the Lidcombe Program where parents play a central in the therapy. I think that many of the common factors that contribute to success in any therapy program relate to such things as the parents' levels of understanding, learning, & commitment; the parents� active participation & resulting reduction of anxiety; increased parental locus of control; parents being able to openly acknowledge and normalize stuttering and the parent and child learning techniques in the child's everyday environment.
From: Ellen-Marie Silverman
Hello, Walt. I appreciate your candid disclosure about your experience as a clinician working with children when parents/caregivers were intimately involved in treatment services and when they were not. I wonder, if like me, you sometimes considered postponing or even refusing to offer therapy to a child (preschool, school-age, teen) because it was most likely there would be no committed, on-going parent/caregiver involvement.
From: Lourdes
Thanks for giving of your valuable time to answer questions. Is anyone aware of any possible links between selective mutism and stuttering. Certainly, people affected by the two disorders experience great emotional pain in using oral language to communicate. I would appreciate any feedback.
From: Walt Manning
Lourdes, I don't know of any investigations of stuttering and selective mutism but it is not surprising that a PWS would choose this option, at least in particularly threatening communication situations. A brief description by James Earl Jones of his choice to respond to stuttering in this way may be found in his book: Jones, J. E., & Niven, P. (1993) Voices and Silences, Charles Scribner's Sons: New York.
From: Judy Kuster
Walt relates part of the history of James Earl Jones who chose not to speak rather than stutter for a period in his life. Van Riper also chose to be mute for 2-4 weeks one summer, applying for a farm job in Wisconsin. He saw a sign saying, "Help wanted" and applied for it with a note saying, "I'm deaf and dumb but I'm a good worker and need a job." After doing what he called "hard, dirty work" for nearly a month, he wrote a note, quitting. The farmer never heard him speak all that time. Van Riper talked about leaving that job weeping, but then after walking 8-9 miles, sat down to rest. An old man stopped his car near him to talk to a farmer plowing his field. Van Riper broke his nearly month long silence and asked the man for a ride, stuttering. The man laughed at him, which made Van Riper very angry. But that experience also changed Van Riper's life when the man told him that he was a stutterer, too, but too old and tired to stutter so hard any more so he "just let the words leak out" now. Somewhere I also have an old handout from a state convention in Michigan where Van Riper talked about a man named "Jim" who was in prison and decided to be mute for over a year rather than stutter. Van Riper also sites Freund (p. 139-140, Psychopathology and the problems of stuttering, Springfield, IL, 1966) talking about "hysterical stuttering" where Freund says, "Histories of complete mutism as the initiating feature are not uncommon." (from Van Riper's The Nature of Stuttering, 2nd edition, p. 64). So there are historical references, which are interesting. But according to the DSM IV, selective mutism is "not diagnosed if the disturbance is better accounted for by embarrassment related to having a Communication Disorder (e.g. Stuttering. . . ."
From: Rick
A lot of children just naturally recover from childhood stuttering. Probably because of brain development and etc. BUT, I was wondering why some people don't stutter anymore and recover in their 20's and early 30's when they should have been chronic stutterers. Ex. John Harrison and etc. Also, a lot of retired people report that their stuttering is better than ever. Is it that older people just have thicker skin??? "When the man told him that he was a stutterer, too, but too old and tired to stutter so hard any more so he "just let the words leak out" now."
From: RML
I have a question concerning the determination of syllables on the SSI-3. According to definition in SSI-3 the following is a stuttered behavior: "repetitions or prolongations of sounds or syllables (including silent prolongations) accommodate the types of disfluencies that are atypical or abnormal in children and adults who do not stutter but are found more frequently among people who stutter"......."Behaviors such as rephrasing, repetition of phrases or whole words and pausing without tension are not counted as stuttering. Repetition of one -syllable words may be stuttering if the words sound abnormal (shortened, prolonged, staccato and tense etc,.)" So using this definition the utterance below would be counted as 8 syllables and 3 stuttered moments so 3/8. " I I I I went went to the ssstore with mmmmommy." Is this correct? The "I-I-I" is counted as a stuttered event and then assuming the word "went" was an easy repetition. Question is do you count the word "went" twice as 2 syllables or only once?? when the word is NOT considered stuttering but repeated.
From: Greg S
Based on what you have written--I would agree with your scoring. (That's how I would do it anyway!)
From: Lynne Shields
My read on the sample sentence you gave is that you would count the stuttered syllables as you indicated, assuming that 'week' was an easy word repetition. There are a total of 8 syllables in the sentence, in terms of the actual intended message. I would not count the second 'week' as a syllable in the total count in the sentence. Repeating 'week', even a normal repetition, does not constitute an addition to the message. Hope this is clear. Regards, Lynne
From: talibasi
Hello, i'm writing from Croatia. I'm interested in how would you approach child age 6 who stutters and has articulation problems?! should therapist work on articulation problems (they don't influence speech in a sense of intelligibility of speech, but one can here that something "strange" is going on with articulation) or it's better not to "touch" articulation problems because of stuttering?!
From: Greg S
What a great question! An entire book could probably be written on this topic. It's been my experience that an SLP should work on both artic and stuttering, because progress may be limited if one is attended to the exclusion of the other. A perfect example is a client I once had. His stuttering did not seem all that severe, but his articulation was extraordinarily severe. So much so that most SLPs believed that he had developmental apraxia. (And that was a tempting diagnosis to make, even by my own admission.) However, the longer I worked with the client, I realized that his artic errors weren't artic errors at all--but rather stuttering secondary behaviors that were out of control. So we worked on bouncing and prolonging sounds (i.e., stuttering treatment) while working on the articulation errors. And by using volitional stuttering to scrub away the secondary behaviors, most of the artic errors were �fixed� also. So in summary--by all means, work on both.
From: Dale Williams
You can work on both, but be careful HOW you work on them. I have seen so many children begin stuttering during traditional artic therapy that I routinely ask about it now. Something about that intense a focus on speech production seems to bring out stuttering in some kids. I would advise a less direct approach to artic--play therapy or Cycles, something like that. A side benefit is that you don't spend half the session teaching/modeling a relaxed speech pattern and the other half making the client concentrate on articulator placement, manner, voicing, etc.
From: Chanel Monroe (SUBR)
How difficult is it to assess and treat a person who stutters when English is their second language? Should treatment be done by someone who is fluent in their first language, and if it is not necessary to do so, what tools are out there that could assist with that?
From: Brian Humphrey
In an ideal world, we would be able to assess and treat thoroughly in both languages. In the real world, we do what we can. Even bilingual clinicians may be asked to evaluate a bilingual client who speaks a language unfamiliar to the clinician. The difficulty of doing a bilingual assessment and the quality of the assessment depend on the languages spoken, the language proficiencies of the SLP, the SLP's training and experience in assessing people of other languages and cultures, and the training given to interpreters who may be involved in the assessments. According to resources and need, I have used the following assessment strategies at various times. L1 is short-hand for the client's first language: 1. Assessment in English and L1 (Spanish or French), by using a bilingual graduate student clinician trained by me to conduct a bilingual assessment. 2. Assessment in English and L1(Hmong) by collaborating with a school-based interpreter trained to work with SLPs and other special educators. 3. Assessment in English and L1 (Thai), by locating an interpreter in the community, orienting her to fluency disorders, and then collaborating with her to complete an assessment. The interpreter provided a descriptive analysis of dysfluencies in Thai, but not a quantitative analysis. Additional information was gained by asking the interpreter to compare the client's stuttering in English with the client's stuttering in Thai. 4. Assessment in English and obtaining a fluency sample in L1 (Polish); asking the client and his wife to complete rating scales for stuttering in each language, and scoring the fluency samples on my own. Note: one must be careful to discern which dysfluencies are stuttering dysfluencies, and which dysfluencies are the result of less proficiency in a non-native language. We need more evidence about the abilities of monolingual judges to identify dysfluencies in unfamiliar languages. A study I conducted to address this question yielded encouraging preliminary results when monolinguals identified dysfluencies in Spanish in South Florida, but much more research needs to be done. Regarding treatment, four adults I studied became more fluent in English, the language of treatment; and they made good gains in Spanish or French, their untreated languages. Again, much more work needs to be done. If treatment is to be conducted in only one language, I would consider home assignments to practice fluency skills in both languages, and having the client use a rating scale to rate his/her performance in both languages outside the clinic. — if an SLP is not comfortable with assessing or treating a bilingual PWS, and a bilingual SLP is available who speaks the languages of the pws and who is comfortable with assessing and treating fluency disorders, referral could be considered. In some circumstances, a collaboration or consultation could be explored.
From: Jiri Mazoch (Czech Republic)
In the answer to comment "Trouble with certain sounds" by Greg S was mentioned that for pronunciation of sounds such as [k] the bounce is the best approach. Could you explain to me what does the bounce exactly mean? Does it mean that when I am saying the word e.g. computer, I have to say co-co-co-computer? I have usually big trouble with sounds as [k, g, t, d, p, b] and smooth prolonged speech doesn't always help me, I have silent blocks. I feel that I have little coordination in articulation of the first consonant and the second sound which is next. And how do you recommend to say the word e.g. tree ? Two consonants at the beginning are even more difficult to say and such words are also very common in Czech language. Thank you for your answer.
From: Greg S
Hi Jiri. I didn't want to suggest that "bouncing" is the *best* stuttering treatment, but it certainly can be effective if used appropriately. Based on your previous post, it seems that you have difficulty on initial (i.e., pre-vocalic) plosive sounds--which is something that I can identify with. So if you bounce on these sounds, what you're doing (in essence) is volitionally stuttering on these syllables on purpose. Volitionally stuttering with complete gentle control. (And if you don't begin in control--you continue bouncing until you gain complete gentle control.) Another thing to remember is that many people bounce with a central vowel. (i.e., puh-puh-puh-paper.) I don't recommend this at all; what I do is repeat the first syllable as it is supposed to sound (Pay-pay-payper.) Something else to think about is that the bounce can actually evolve into it's own secondary; so if you always bounce twice and then the word, this may lose its effect. To counter this, I try to randomize the number of times that I bounce. It's not about the number of times, as it is continuing to bounce until you've gained complete gentle control. In time, if you integrate bouncing into your normal speech, you'll find that it will scrub away many (if not most) of your older secondary stuttering behaviors (associated w/ the plosive sounds).
From: Andy Floyd
Hi Jiri - Greg does a great job explaining about the bounce tool. Another way is to stretch out that sound. It's a lot harder to stretch on stop sounds like /p/, /b/, /t/ and /d/, but it can be done. However, when you stretch them out, it tends to warp the sounds into ones that are easier to stretch. For example, if you stretch the /d/, it turns into a /z/. If you stretch the /t/, it turns into an /s/. You had specifically mentioned the "tr" combo. When you're saying "tr," you're really saying "ch." For instance, saying "trip" and "chrip" sound exactly the same. The "ch" is another one of those sounds that can be stretched, but warp into another sound - "sh" in this case. Good luck and try out as many tools as you can to see which one fits you best :)
From: Greg S
Hey Andy, A lot of people certainly do prefer the stretch; my thinking is that they feel that it may be more resistant to evolving into its own secondary. I've not found that to be the case, provided you bounce w/ the correct succeeding vowel sound (not a schwa), and the number of bounces is varied (i.e., until one has complete gentle control). Another thing to think about is the reality that stretching or bouncing on a voiceless sound isn't nearly as effective as a voiced sound. Because of all this, I've historically suggested bouncing on the plosives, stretching on the first available voiced sonorant.
From: Jiri Mazoch
Hi Greg and Andy, thanks for your advice. I will try to practice both methods, especially the bounce tool. The bounce tool was not used during my therapies, so I haven't had any information about it. Regards, Jiri
From: Judy Kuster
Gary Rentschler also describes a fluency enhancement technique called "Light Articulatory Contact" which may be helpful on the plosive sounds you describe as having trouble with, Jiri. From Gary: Description: Emphasis is focused on a placing only minimal pressure at the point of contact made by the lips, tongue, teeth and palate during articulation. Symptom Relief: Reduces excessive muscular effort used while articulating phonemes: often most pronounced on plosives or other blockages of airflow in the oral cavity. May also be effective in managing repetitions. Benefits: Promotes appropriate amount of muscular effort while articulating, builds proprioceptive feedback of the speaking process, develops oral-motor awareness, and slows rate of speaking.
From: Jiri Mazoch
Hi Judy, many thanks for your advice. ISAD is really full of useful information. I'll continue reading the papers and even after the end of on-line conference.
From: Sarah Longo
I had a client who had a difficult time with the sounds /k/ and /g/, but as his stuttering progressed it seemed all vowels became even more of a challenge for him. Would you say in general are vowels more difficult to overcome than consonants? Or is the client's opinion of his or her speech really what makes certain sounds more difficult?
From: Brian Humphrey
Sarah, troublesome sounds vary from pws to pws, and they can change over time. The best we can do clinically is to help each client define his/her current problems and work to solve them. In my experience, client's opinions of which sounds are difficult develops from experiencing difficulty with certain sounds. Sometimes, anxiety about certain sounds may develop and become part of the problem.
From: Gunars Neiders
As a person who stutters, who had an extremely hard stutter, I can verify that stuttering for some persons changes over time depending on what at that time the person becomes afraid of and starts avoiding or circumlocuting. The name and country of birth gave me my stuttering fears of g and l, vowels became an issue with "I" and "es", Latvian equivalent of I. I have during my decades of severe stuttering stuttered on vowels, plosives, sibilants, hard constants, you name it. In latter years voluntary or volitional stuttering on the feared sounds and non-avoidance, even searching them out gave me freedom to say these sounds fluently. I, for instance, still answer the phone "Gunars speaking" and when calling "Gunars here. Could..." Somewhat awkward, but sure beats stuttering. I also sometimes use "Gu-gunars..."
From: Jen
Hello...I have several students that I have been working with who have had speech therapy for a number of years prior to working with me. (I'm at a middle and high school.) At what point does stuttering became something that they will live with for the rest of their lives? Can stuttering be totally "fixed" even after a person has stuttered since being a toddler? Also, what is the impact of also having a family member who stutters? Maybe it's me, but I have never totally "fixed" an adolescent who stutters. Do I not have the correct tools? Is this something they will have to deal with for the rest of their lives and that is the reason for providing them with strategies?
From: Gary J. Rentschler
Jen: We see that upwards of 80% of children who stutter significantly improve (with or without treatment) to the point where they are no longer considered to stutter. However, the window of this recover seems to "close" around 12-13 years of age, and for most, earlier than that. Unscientifically, it seems that stuttering becomes "fixed" as concern and angst begins to grow over its existence and minimal ability to control it. I would call this a "trend", however, rather than a proven fact. It seems to be when stuttering impacts the person (he/she thinks of themself as a person who stutters) and begins to integrate into the personality, that it "sets" and never completely goes away. One can learn to manage it effectively, but there is almost always at least a component of stuttering lurking about in the thoughts or speech of the individual. We also know that there seems to be an hereditary component to stuttering is about half the people who stutter. So if you have a relative that stutters, the likelihood may be greater that an offspring will also stutter. My thoughts about stuttering therapy are that the speech techniques we use serve to enable the speaker to gain more control over their stuttering. They then fear the consequences of stuttering (involuntarily) less, become less anxious about speaking, and stutter less. This is sort of reversing the cycle that often cause stuttering to become more pronounced. More normal attitudes about speaking can return, replacing the fears associated with stuttering. So I look at using the speech techniques as an intermediate step, rather than the end goal. My personal philosophy is that stuttering will never go away, so be as completely prepared for its return as you can.
From: Ken St. Louis
Dear Jen, You are asking questions that many, many speech-language pathologists ask. I will try to reply in two ways: (1) with my best answers and (2) with some questions of my own. Since stuttering often runs in families, we can generally say that a person's prognosis, especially for spontaneous recovery as a child, is most likely negatively affected by having one or more close relatives who stutter. "Cures" for stuttering, i.e., forgetting all about stuttering and never stuttering again, is not at all uncommon among preschoolers who stutter, but it is not very likely after a person reaches adolescence. Late recoveries can happen, but I don't think I would lead the client to expect it PROBABLY WILL happen. There are some people who believe that you can make a person who is a chronic stutterer totally "fluent" from therapy. I have seen that happen, and in fact, and almost that fluent myself. But this is a controversial area. Just because a person can speak without stuttering, e.g., with fluency shaping, does not mean that he or she will never stutter. Sometimes the person simply cannot exercise that degree of mental effort or control all the time. Sometimes, life situations change such that the person experiences increased stress (not uncommon in adolescence). We all wish we could "fix" all of our clients such that they would never again suffer from their communication disorders. Unfortunately, most of our disorders (with a few exceptions) don't work that way. Therefore, I don't think you have failed in terms of learning the wrong strategies. Stuttering IS often chronic, and some stutterers spend a good portion of their life going back from time-to-time to get refresher skills. The second part of my response deals with the question, "Why do we as SLPs think that we should be able to cure all stutterers?" I have taken the liberty to change your question to make a point. Here it is: "Hello...I have several students that I have been working with who have had speech therapy for a number of years prior to working with me. (I'm at a middle and high school.) At what point does a language disorder became something that they will live with for the rest of their lives? Can a language disorder be totally "fixed" even after a person has had it since being a toddler? Also, what is the impact of also having a family member with a language disorder? Maybe it's me, but I have never totally "fixed" an adolescent who has a language disorder. Do I not have the correct tools? Is this something they will have to deal with for the rest of their lives and that is the reason for providing them with strategies?" Jen, how would you answer these questions? Good luck with your work. You are clearly a caring person who is asking important questions. Hopefully my answers--and maybe my questions--might put this into a realistic and helpful perspective.
From: Ellen-Marie Silverman
[[". . . Maybe it's me, but I have never totally "fixed" an adolescent who stutters. Do I not have the correct tools? Is this something they will have to deal with for the rest of their lives and that is the reason for providing them with strategies?"]] >>> Jen, You already have received some sound advice. At the risk of being a little redundant, I'd like to adress your belief you should be able to "fix" people because clinging to that unrealistic notion causes a lot of frustration and anger, which readily morphs into stress for both you and your and clients. Sometimes we want to help people so much that we want to make them trouble-free. And that desire increases if we happen to be therapists and feel judged on the basis of our ability to do that. But the reality is no matter how much we care, no matter how informed we are, no matter how skilled we are, we can not single-handedly change another into the person we would like them to be, which is a pretty good thing because other people may want to change us! (Smile.) I'm sure you get the picture, Jen. So what are we as therapists to do, especially with often taciturn adolescents for whom we feel responsible? --- The only thing we can: Help them help themselves, if they want to. And, if they don't seem to want to at a particular point in time, refrain from judging them. Encourage them to come (to you) when and if they wish or to another therapist now or later on. The fact is we can all change what we think and do throughout our lives as long as we are in good health. And, while its true that the older we get, the harder it is, changing our beliefs to accomodate healthy growth and learning new skills to replace troublesome behaviors can be an exciting life-long adventure. >>> So, Jen, be easy on your self. As the caring, responsible person you seem to be, ease-up on yourself. See the strengths you bring to therapy, and rejoice in your passion for wanting to help others. Replacing judgment with self-acceptance can rub-off on the students you encounter, and, teach them a great deal.
From: Gunars Neiders
Ken, you have come up with the best definition of cure that I have ever read: "Cures" for stuttering, i.e. forgetting all about stuttering and never stuttering again. Bravo! Your definition implies 1) no memory, 2) no (or minimal) irrationally negative beliefs, attitudes, thoughts and self-talk about stuttering, 3) no (or minimal) unhealthy disruptive emotions when there is a minor disfluency in a person's speech (i.e. no speech anxiety, same , 4) minimal say 1% to 3% of disfluent syllables (no person is 100% fluent in their speech; not even the "fluenters".), 5) no (or minimal) struggling or forcing behaviors, 6) no avoidances in speaking of sounds, situations, and career and social challenges, 7) no (or minimal) significant physiological reactions in a speaking situation. I have included (or minimal) because demand for perfectionism is a psychological disease and tends to promote relapse or unnecessary distress. However, in case of memory a truly "cured" person would not recall their struggle with speech........... After a person reaches a certain age or stage in development is it possible to achieve all seven of the above? What is the optimum theoretical goal? What is the optimum practical goal? How do we get there?
From: Charlie Healey
Gunars: In my mind, you have nicely summarized the key elements of the successful recovery from stuttering. I might word things a little differently but the essence of your seven points is exactly what I think most us should strive for in treating children and adults who stutter. What we need are ways to measure objectively the seven points you have listed as successful outcomes...not cures. That's the challenge facing us researcher/clinicians in the field.
From: Judy Kuster
The live, threaded discussion part of the 2007 ISAD online conference is now closed. The responses made here during the conference will remain online. Thank you for stopping by. Judy Kuster