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From: ari from israel
My speech improved dramatically, after i passed fluency shaping treatments. But the fears steal remain very hard. I noticed that when i get anxiety- i almost never tense my vocal cords because of my gentle onset. But i am tensing very hard (and for a long time) -my tongue over my down teeth, until i can release the tongue from this place. This happen in most of the sounds including vowels - when the tongue don't suppose to interfere at all. what cause this kind of blocks? what can i do to change this behavior? thank you very much
From: Dick Mallard
Ari, you asked a very good question. The reason your fears remain after fluency shaping therapy is because that type of therapy does not address non-speech issues. There are two basic types of stuttering therapy, fluency shaping (which you had) and learning to control stuttering (which you apparently have not had). Learning to control the moment of stuttering is probably what you need at this time. Both approaches are important for a person to learn to control speech in a variety of speaking situations. I certainly wish you well.
From: ari from israel
thank you for your answer! it took me years to understand that like you say i need to deal with the moment of stuttering. I didn't find an expert on this treatment in Israel, so I started to treat myself - but it is very hard to me to calm myself, when the tongue is so tense. the feeling is that i won't be able to release the block ever, and for this reason the blocks take a long time.
From: Dick Mallard
Ari, try something for me. The next time your tongue gets stuck and you are in an appropriate social situation, just let your tongue stay in that position until the block ends. Don't try to move forward by saying the next sound. Just relax, feel what your tongue is doing, and see how long it takes until you can move forward. Let me know what you find out. Look forward to hearing back from you.
From: ari from israel
it could be that i move the tongue from the tensing place, instead to just calm down the tension. so i will try to hold on the stuttering. and i will see what happen. — I tried again to hold on the block until it go away, sometimes it go very well, but sometimes when it took a long time it make me very anxious . Maybe it will be better if when i holding the block and i feel exactly where i am stuck-i will try release the block by repeating the sound-instead prolong it further?
From: Dick Mallard
Ari, nice job. Desensitization occurs when you can hold that block and not feel anxious. Releasing the block before it ends by itself is what leads to struggle behaviors. My guess is that the more times you hold the block until it releases itself will cause the blocks to become shorter in time. You are getting control when the block ends by itself without tension. You will also learn not to panic and get anxious during the moment of stuttering. When you can stutter without getting nervous and anxious and trying to end the block, you are ready to get control. How is your eye contact during moments of stuttering?
From: ari from israel
some questions: What is best-to hold on the block until i need to take new breath, or if i see that i won't be able to release the block in the current breath(in the end of it) to take new breath(when i have less air, i have less chance to release the block-don't i?) second :in the sounds that can't be prolong like k,t,d and so on, did you recommend to repeat them (bounces)when i fear to say them ,or to do something else? And for your question: I started to stutter with eye content several months ago, and today it is very much easy than to stutter without eye content- like in the phone or when i read something from the paper, because when i keep eye content ,and the listener keep eye content(that is not always possible), i feel that i am in communication ,but without eye content i think to myself what the point to stutter if i lost the communication? thank you so much ari
From: Dick Mallard
Ari, being able to let the block end in a relaxed, controlled manner is a key element in learning to eventually control the moment of suttering. Take a breath during stuttering if you have to but do not leave the stuttered word until you are relaxed. Let your speech musculature stay relaxed and in position for plosive sounds (p,b,t,d,k,g). You are absolutely correct with eye contact and stuttering. Even if you cannot control your mouth during blocks, control your eyes. You will be surprised how much easier it will be to communicate in general if you have good eye contact. Best wishes to you.
From: ari from israel
Thank you very much Dick! I just started to see the beginning of success, I know that this is only the beginning. After 14 years of fluency shaping- i can give some credit to stuttering modification too.
From: Dick Mallard
Ari, fluency shaping has it place with certain people. My experience suggests that one must learn to manage stuttering and then fluency shaping procedures will be much easier. My best to you.
From: ari from israel
Dick-Today i am speaking faster then the past, in order not to speak fluently but to deal with my stuttering. My plan is that when i will be less frighten from my stuttering, I will have the option to speak slowly and to stutter less or to stutter more with not such a fear. Before i started to modify my stuttering, i had only one option to control my speech, and when i couldn't do it i loosed the ability to speak. I am very happy that your experience say that like i planned, it will helped me to control my speech when i will need it.
From: Greg Snyder
It sounds like you're essentially asking, "How can I better control secondary stuttering behaviors (such as tension, etc)." As the previous reply suggests, fluency shaping really doesn't address this type of issue. Instead, it has faith that if you won't "stutter" at all, then secondaries cease to be a problem. In any event, it's been my personal and clinical experience that the best way to address secondary behaviors (and avoidances) is through desensitization training and basic stuttering modification tools (like volitional stuttering, negative practice, bouncing, stretching, etc). Additionally, some drugs have been found to reduce the severity if the overt stuttering moment, should you be interested in that route.
From: ari from israel
Greg nice to hear from you (miss you at stuttertalk). this is the direction that i took (stuttering modification), after years (i am practice fluency shaping every morning 14 years)of trying to control my speech. but unfortunately i do it by myself without help of slp. and sometimes i don't sure if i am in the right road. thank you
From: Tom Brennan
Not being one of the proffs in this section I thought I would still offer an observation. I have had some success using emg biofeedback, particularly with the kind of blocks that you are having. This might be a way to go but, again, it will require access to a professional with the appropriate equipment. Remember, too, that in part what you are dealing with is a habit and habits are difficult to break even when there are reasons for them.
From: ari from israel
thank you for your suggestion.
From: David Shapiro
Hi Ari, You're asking a good question. I see that others who have already responded highlighted the difference between fluency shaping (which primarily addresses fluency behaviors) and stuttering modification (which addresses stuttering-related thoughts, feelings, and attitudes, in addition to behaviors). The focus of the interaction, however, has been on the disfluency, or stuttering. I recommend that you attend to what you are doing differently (thoughts, feelings, and behaviors) when you are fluent than when you are disfluent. Often fluency is characterized by evenness in rate, gentleness in onset, and natural-sounding inflection. Although disfluency tends to get more attention, I bet that you have more fluent speech than disfluent speech (i.e. more words spoken fluently than disfluently). In any case, by studying, understanding, and increasing what you do when you are fluent and learning how to do it even more often, fears often reduce as you gain control over the fluent speech, thus increasing the amount of fluency and decreasing the amount of disfluency. So often, although the majority of our speech is fluent, we forget to focus on the fluency, but rather focus only on the disfluency. You may want to try this. Sometimes that which seems most obvious can be overlooked. Good luck. David Shapiro
From: ari from israel
I want to add that for years-in some situations i was very fluent and in some situation i couldn't speak at all (after fluency shaping treatments). only in the last year, i understood what am i doing when i terrified about the possibility of stuttering. And i found that when i calm myself i can speak in this situations also. But i need to stutter very hard until i can calm myself, and after it i can speak very fluent for some time. And for this reason i asked the question. So i know that i can speak fluent (or almost fluent it didn't really matter to me) but this happen only when i am not afraid of stuttering (with specific people or when i passed a big block or when i feel that i can pull out from a block easily). But when the fear interfere i am starting to tense my tongue, in a lot of cases even before i am starting to speak. thank you for your direction!
From: David Shapiro
Thanks for your reply, Ari. From what you added, it sounds like both anticipation and fear have significantly influenced your communication experience. This is understandable. Typically, we interpret our present and anticipate our future on the basis of past events. So, one suggestion would be to create (or receive some guidance to create) opportunities in which you can achieve your fluency objectives in gradually increasing levels of challenge. It sounds like you have begun to do this (i.e., calming). The point is to continue to create opportunities for success; success begets success. Also, as you are discovering, success leads us eventually to predict, and thereby to experience, success. Old habits perpetuate until we create a set of alternative data (i.e., successful speaking experiences) on which we can begin to predict an alternative outcome (i.e., fluency, rather than fear and disfluency). We believe what we experience for ourselves. Nothing is more motivating than success. Creating such opportunities for success, in my opinion, is among the responsibilities of a speech-language pathologist. At first, these opportunities may be developed for you, then with you, and eventually by you. This is what I do professionally and, incidentally, what I have done personally. It would be easier in person to talk about how this is done. Keep up the good work. Good luck; you're in good company. David Shapiro
From: ari from israel
This is what i started to do, but importunely i do it alone and sometimes it is not so easy. thank you so much!
From: Edward
Hi, I am trying to decide between the Precision Fluency Shaping Program at Eastern Virginia Medical School or the National Center for Stuttering in New York City. I was wondering if you have any recommendations regarding which treatment program is better for me. Thank you very much for your help and advice.
From: Lynne Shields
Edward, The clinical setting that will work best for you will be quite dependent on the goals you would like to achieve through treatment. So, first, it might help for you to generate a list of the issues that you would like to deal with in therapy. From this, you can generate a list of questions to ask of someone from each of the programs. When you look at the responses you obtain from each clinical facility, you may be closer to knowing which is a better fit for you. If possible, you may want to arrange for a visit to each location. I wish you all the best, Lynne
From: Walt Manning
Edward, Lynn provided a good strategy for deciding which program that might be best for you. I'm sure that you would receive some benefit from both experiences. Everything else being equal - which it rarely is of course - I would recommend the one that you find to be most comprehensive. That is, it deals with behavioral and many aspects of the cognitive experiences of stuttering (anxiety, fear, avoidance, etc.).
From: Mario
What is better approach to overcoming stuttering? To work on controlling ones speech with various techniques or gaining on self-confidence? Or maybe both? If both, should PWS attend both SLT and psychologist? Thanks, Mario
From: Ken St. Louis
Dear Mario, This is a difficult question to answer. Stuttering involves behaviors, feelings, and thoughts, or as Gene Cooper used to say "the ABCs of stuttering" (Affect, Behavior, and Cognition). At its most basic level, the answer depends on what you want. Assuming you want to be more fluent, then it makes sense to find a speech-language pathologist (speech and language therapist) who has experience in helping people like you become more fluent. Most people would further assume that if you become more fluent, then the negative feelings and thoughts you may have will simply go away. That can happen, but our experience over the past 40 years or so suggests that most adults who stutter seem to hold onto many of their old fears (or they come back on their own) even after successful therapy in terms of becoming much more fluent. Therefore, I believe that dealing with the negative/counter-productive thoughts and feelings is an important part of any stuttering therapy for adults who have stuttered for many years. Should a psychologist carry this out? I cannot say for sure in your situation, but in the USA, my answer is generally "no." I say that because most psychologists have little if any training in stuttering and even a few of them still believe, erroneously, that stuttering is a symptom of an underlying psychopathology. A competent speech-language pathologist should be able to help you become more desensitized to your stuttering, that is, to be less affected by it regardless of whether or not you can decrease its occurrence. There are a number of papers in this conference that will offer good suggestions of how you can do much of that on your own. That is a beginning for an answer. I'm sure you'll get much more as you follow this conference the next three weeks. Good luck, Ken
From: Walt Manning
Mario, There are many good studies in counseling and psychotherapy indicating that many approaches are equally helpful in bring about successful change for people with a wide variety of problems. The most essential thing has to do with the quality of the therapist or clinician rather than the particular therapeutic protocol. In the last few years studies are beginning to be published that have found the same thing in the area of stuttering. One result of these findings is that people are better off looking for an experienced and wise therapist/clinician than they are in looking for a particular "brand" of therapy. Factors such as the experience and competence of the clinician and the quality of the therapeutic alliance - two people working together in a collaborative, healthy and trusting manner - are more influential than the treatment protocol. Finding that person, of course, is the tricky but essential thing.
From: Greg Snyder
Hi Mario. I think Ken gave a great answer. My only two cents (or perhaps even less) to add is that "overcoming" stuttering really does depend on what we're defining as the primary problem. The concept of "stuttering" is really a global issue with many variables. (And some of these variables are a bit insidious and counter-intuitive.) Point being... Success in stuttering treatment is only relative to your stated (realistic) objective. I want to feel no shame re: stuttering. I want to feel no fear re: stuttering in public. I want to stutter less. I do not want to feel limited by stuttering. We've yet to break the back of stuttering (clinically), but we can break each micro-objective one at a time. And then many over time. Ultimately, to me, that's when "overcoming" the stuttering phenomenon begins to occur.
From: Jessica age 11
Why do you think people stutter?
From: Greg Snyder
Hi Jessica! The honest answer is, "We're not sure." But with that said, the latest research suggests that our genetics play a big part of it...as does our brains (and how our brains function). So I'm going to go out on a limb here and make the following guess: I believe that genetics affect how our brains are structured, which affect how our brains work, which results in stuttering behaviors. Clear as mud? :) (I honestly wish we knew more to give you a better answer!)
From: Bill, age 21
I was wondering how is the cause of stuttering multifactorial?
From: Greg Snyder
To be honest, I'm not sure it is. We just don't know enough about stuttering...so we're making up narratives as we go along. The data strongly suggests a genetic component. The data also strongly suggests a neurological component. So far, so good, right? The problem comes in where there are situations that our data and narratives cannot account: For example, if one identical twin stutters (i.e., monozygotic twins), the data suggests a 90% likelihood that the other twin will stutter as well. (As well they should, they share the same exact genetics.) But about that other 10% that recovers? We can't account for this--other than to shrug our shoulders and say, "Well, there's apparently some environmental factors involved w/ recovery that we do not understand." So my official unofficial answer is to suggest that people say stuttering has a multi-factorial cause because we're creating narratives to try and explain the phenomenon as we go along. In other words, we simply do not know enough to be specific about it...
From: Klaas Bakker, Springfield, MO
Bill, We don't know if anyone can say for sure if stuttering is multifactorial or one and the same thing, but it sure seems stuttering has many faces. There is the stuttering itself, anxiety and tension right before or when you stutter, things you do to not stutter, how you think about yourself, what goes on in your body during stuttering, and more. Depending on how you look at the problem it may seem to be something different. As we are not sure yet what specifically causes stuttering, it also still possible that there are different "contributors" to the problem. Genetics, the brain, one's grasp of the language and speaking skills. So, relative to what may be causing stuttering, we could also possibly use the term multifactorial. Hope this helps.
From: David Shapiro
Hi Jessica, You are asking a really big and important question. You probably know that many people who have gone to college for a long time have studied and researched stuttering in order to come up with an answer to your question. The answer, so far, is that we are not quite sure. There are many things we are sure about, however. For example, we do know that there are people all around the world who stutter, that help is available for people who stutter and their families from speech-language pathologists and self-help groups, and that people who stutter can accomplish anything they set their minds to. Indeed stuttering presents many challenges. But good things usually come when we confront our challenges with the help of our families, friends, and speech-language pathologists. Keep asking such good questions! You are on the right track. Good luck. David Shapiro
From: Pam
Hi All! I greatly enjoyed actively participating last year, and plan to be open and share again this year. I have talked with some of you (Joe K, Greg) about how it feels to be stuttering differently and the frustration I feel in not being able to figure it out. I have been "blocking" much more than I ever did - overtly, I should clarify. Maybe I was always blocking but didn't dare show it. As with most people who stutter, I definitely notice more of it on the phone, but overall the "block" just seems to show up whenever it feels like it. :) I have been making more of an effort (as suggested) to "feel" the block when it occurs. Sometimes I feel a catch of air in my throat,like I am holding my breath. Other times, I can feel the stoppage in my chest and feel tension in my shoulders and lips, as I try to push the word out. I was just on the phone a few minutes ago with a friend (who stutters) and I could not get the word "people" out at all. It came out "pe-pe-pe-pe-pe-pe-pe" until I finally said persons! We laughed, but I was frustrated. What do you all think about the changing nature, or evolution, of stuttering?
From: Vivian Sisskin
Pam, You are making some good observations of your stuttering pattern! The first step to changing a pattern is to become an expert on it. You can do this better than anyone else. Once you observe, consider what you might be doing to prevent yourself from getting on the sound of the word you want to say. Are you holding back (waiting) for the fear to die down and the point where you can easily release? Are you backing up to the previous word in order to get through the more difficult word? Are you tensing to the point where your speech mechanism becomes frozen? In your example, did you consider that you might be retrying the word until you can easily get the second 'p' in 'people' out? If this sounds right to you, I might suggest that you do the thing you fear the most and get on to the sound you might be holding back from. If you want to change the way you stutter, sometimes you have to tolerate it sounding a little differently, and this would happen if you didn't restart the word and went right for it!.
From: Pam
Thank you, Vivian. This is good advice. It seems right that I may be worried about the second "p", and maybe unconsciously I do have some fears going on. That is what gets me most about this, because it is new, and I had previously been unaware of a fear of getting stuck holding me back. Good food for thought!
From: Gary J. Rentschler
Pam... letting your stuttering out (stuttering openly instead of hiding it or not talking) is an adventure and a very positive step! Congrats. From my own experience as a person who stutters and an SLP, there was a world that I was unaware of regarding how I stuttered. Vivian is right... you are making some excellent observations... and I suspect that there are more to be made. As a "general roadmap", let me encourage you to continue.... as painful as it was for me, I found it very informative to watch myself in a mirror when I stuttered -- I observed many things that I really hadn't allowed myself to be aware of... like all of the struggle I was going through and all the the tension in my throat. I came to realize that I was doing it in reaction to my stuttering... that I was actually making my stuttering more pronounced than it had to be! The harder I tried, the worse it got. Once I took responsibility for having made the problem more severe, I looked to "ease up" and let the stuttering happen without trying to force through or overpower it.. kind of "going with the flow" more. The more information you have and the more responsibility you allow yourself to take for stuttering, the more power you gain over stuttering. Again, this is not a pain-free process. It took a fair amount of courage, but paid off handsomely. I tell myself that stuttering is not my fault; but its my responsibility to do what I can to minimize its consequences. I think that stuttering can get worse or you make make it better... but its always a challenge and often changing. You might find it helpful to go to a support group meeting, like the National Stuttering Association, so you can talk to others who stutter. Warmest regards and best of luck with your stuttering.
From: Pam
Thanks Gary, yes it is a process. I am actually very involved with NSA (for past 3 years), and attend meetings monthly. I am also involved with Toastmasters, so I am wholeheartedly working on it. But it doesn't make the changing pattern any easier to deal with. :) I have a great deal of support, for which I am incredibly grateful. And I also write about the process - blogging farily frequently my attitude, feelings, and fears. I know it is a journey, but there are some days when I just don't have time for stuttering, and its thpse very days when it chooses to make her appearance ever so felt. Thanks for sharing some of your personal story as well. I greatly appreciate that. Pam
From: Walt Manning
Pam, just a slightly different twist to the helpful you've already received. One view that I've found helpful, especially for blocking behaviors - no air flow, no voicing, holding your breath - is to "give yourself permission to stutter" and to experiment with different, easier ways of stuttering. Once you give yourself permission to play with your stuttering rather than trying so very much NOT to stutter, you'll have more "degrees of freedom" so that some experimentation is possible. The easier ways of stuttering that others have suggested - as long as you are becoming somewhat desensitized to stuttering - are easier for your listeners (which I'm not so concerned about) but easier for you too. Thanks for your .
From: Gary J. Rentschler
Pam... letting your stuttering out (stuttering openly instead of hiding it or not talking) is an adventure and a very positive step! Congrats. From my own experience as a person who stutters and an SLP, there was a world that I was unaware of regarding how I stuttered. Vivian is right... you are making some excellent observations... and I suspect that there are more to be made. As a "general roadmap", let me encourage you to continue.... as painful as it was for me, I found it very informative to watch myself in a mirror when I stuttered -- I observed many things that I really hadn't allowed myself to be aware of... like all of the struggle I was going through and all the the tension in my throat. I came to realize that I was doing it in reaction to my stuttering... that I was actually making my stuttering more pronounced than it had to be! The harder I tried, the worse it got. Once I took responsibility for having made the problem more severe, I looked to "ease up" and let the stuttering happen without trying to force through or overpower it.. kind of "going with the flow" more. The more information you have and the more responsibility you allow yourself to take for stuttering, the more power you gain over stuttering. Again, this is not a pain-free process. It took a fair amount of courage, but paid off handsomely. I tell myself that stuttering is not my fault; but its my responsibility to do what I can to minimize its consequences. I think that stuttering can get worse or you make make it better... but its always a challenge and often changing. You might find it helpful to go to a support group meeting, like the National Stuttering Association, so you can talk to others who stutter. Warmest regards and best of luck with your stuttering.
From: Pam
Thanks Gary, yes it is a process. I am actually very involved with NSA (for past 3 years), and attend meetings monthly. I am also involved with Toastmasters, so I am wholeheartedly working on it. But it doesn't make the changing pattern any easier to deal with. :) I have a great deal of support, for which I am incredibly grateful. And I also write about the process - blogging farily frequently my attitude, feelings, and fears. I know it is a journey, but there are some days when I just don't have time for stuttering, and its thpse very days when it chooses to make her appearance ever so felt. Thanks for sharing some of your personal story as well. I greatly appreciate that.
From: Manpreet (India)
Hello there, I was searching this question on the internet but there was no proper and justified answer to this question on the internet. So I thought to ask this question from the experts ..?? Please give a justified answer. Let it be a lengthy answer. It wud be better to understand.
From: Charley Adams
We have lots of ideas about why people who stutter can sing without stuttering. First, think about speech rate; if you listen to words in a song carefully, you will realize that they are produced much more slowly than they would be produced in speech. We know that dramatically slowing down your speech rate is a powerful fluency-inducing condition, so this is a partial explanation. Second, many people who stutter can read aloud with greater fluency than they can speak spontaneously; singing is much the same, as the words are chosen for you. Third, music has a more regular rythym than speech, which also tends to enhance fluency. Finally, and perhaps most compelling, is that speech and language are processed predominantly in the left hemisphere of the brain for most people, while music tends to be processed in the right hemisphere. So in an important sense, you are using a different part of your brain when you sing, vs. when you speak. I hope this helps - Charley
From: David Steiner
My stutter gets even worse when I sing.
From: Greg Snyder
Singing uses different neural circuitry, which (apparently) bypasses the stuttered neural fault.
From: Ed Feuer
Singing as in singing songs is communication neutral. Add a message in real-world communication and you have what these days they call a game changer. Van Riper had people who stutter go out into stores, singing their questions such as: "Do you have bananas?" etc. Very quickly blocks began to appear. The old adverse signal-to-noise ratio kicks in.
From: Greg S
I'd love to see that Van Riper citation... I've never heard that account. Thanks in advance... (BTW. If someone sings for long enough, I suspect that it would become the 'norm' of communication, and function like any other 'novel' secondary.)
From: Ed Feuer
Greg, you want the Van Riper citation. Well, I believe I heard it from the man directly back when I was at WMU in 1974/75. He may have said it in one of the sessions I had with him or in one of his grad classes in which he let me sit in. But I don't understand why it would surprise that blocking would appear when singing by people who stutter ceases to be communication neutral. In that regard, I invite you or any other fluent SLP here to sing your communications to store clerks. I think you would find that exercise instructive concerning this topic.' Ed Feuer
From: Manpreet (India)
Ed, as u mentioned that people do stammer when they use the singing style of saying something. Like if I go to a store and ask them "Do u ve bananas..??". But this might not be the case for each and everyone one of pws. coz when I speak in this style of singing, I don't stammer at all. The words come out with ease and there is no struggle.
From: Ed Feuer
Manpreet: Yes, we have no bananas. Are you using an actual song melody or a sing-song style? Sounds to me like it's the latter which is likely a temporary distractor effect. Temporary distractors come in all shapes, sizes, even gizmos such as The Amazing StutterMaster (not available in stores). Unless your stuttering is very moderate, there's no substitute for genuine and thorough desensitization, healing and strengthening. And yes, as long as singing is communication neutral, as in singing songs, many people who stutter can sing. But add those melodies to real-world communication and you've got a hurtin' song, as they'd say in American country music. Doesn't work. Try it, you'll see. ' Ed Feuer, edfeuer@mts.net
From: Manpreet
Hi Ed, I am not talking abt the actual song melody. I use sing song style and i never get stuck or blocked in this way. But we can't speak in sing-song style every time. It looks very odd. I ve read it somewhere on the internet that some experts have discovered a new method to eliminate stuttering fear memory cells from one's brain. but it is also having some side effects. We can also loose other parts of our memory also. But for God sake, at least this stuttering will be over.
From: Dick Mallard
Healey, E. C., Mallard, A. R., and Adams, M. R., "Factors Contributing to the Reduction of Stuttering During Singing," Journal of Speech and Hearing Research, 19, 1976 (475-480).
From: Klaas Bakker, Springfield, MO
Manpreet, It sounds like you already have a lot of experience with speaking in a sing songy manner and what it does for your speech fluency. Also, your received some great answers already, but I believe some possible explanations are still missing. Singing differs in many ways from natural speech, and so any physical difference of singing could be part of the explanation of why you don't stutter (as much). When someone sings, or speaks in a sing songy manner, you may bypass some of the brain centers you typically use for speaking (I don't think people sing from the right brain entirely though). When you sing, usually much of the expression is in how you produce the vowels of your speech (they have a certain pitch, intensity and duration, while their stress is related to a rhythimical pattern). All of this could explain why there is less stuttering. Finally, often singing involves speech already formulated by someone else, so it comes from memory. However, if you speak in a sing songy manner, like you described, obviously you are still in control of that. These would be some of my first thoughts looking for an explanation. But any explanation would still need more research to definitely tell. Hope this helps.
From: James Clarkson Australia
My question is directed to Judith Kuster. Being a stutterer myself but also having bipolar disorder, I have found personally it to be very scary that health professionals appear quite oblivious or have not the available time to consider the implications that this may or may not have. This applies in both directions ie speech professionals and psychiatrists. To this end would it be possible sometime in the future to encourage an addition of more freely available information on this topic on the Stuttering Homepage, to help stutterers and their families.
From: Judy Kuster
Jim, There is a section on the Stuttering Home Page that has some links to information for physicians http://www.mnsu.edu/comdis/kuster/infoaboutstuttering.html#pediatricians There have also been a couple of past ISAD online papers the talk about anxiety disorders: Stuttering and Social Phobia (Social Anxiety Disorder) by Larry Molthttp://www.mnsu.edu/comdis/isad6/papers/molt6.html What is Stuttering? -- defining stuttering from the speaker's viewpoint by Mark Irwinhttp://www.mnsu.edu/comdis/isad11/papers/irwin11.html There are also a couple of links to websites addressing bipolar issues under the section on the SHP I have about suicide (http://www.mnsu.edu/comdis/kuster/suicide.html If I am directed to or find reputable, freely-available material on the Internet about stuttering and concomitant mental health disorders, I would certainly consider adding it to the section for physicians. In the mean time, if you type the following key words in schoar.google.com stuttering OR stammering +"bipolar disorder" you will find several research articles that may be of interest to you. Some relate information about medications used to treat bipolar patients that may either exacerbate stuttering in some patients or have the opposite effect. You might also address questions about this issue to Dr. Nathan Lavid, a psychiatrist who is on this panel of experts this year.
From: Tom Weidig (thestutteringbrain.blogspot.com)
Is there any of you who does not believe that persistent developmental stuttering has a neurobiological origin in the vast majority of cases?
From: Ben
Right, stuttering has a neurobiological origin or is neurological...that's what the early pioneers thought (early 20th century). All Speech or language disorder is neurological, something wrong with the brain....saying it has a neurobiological origin is NOT very helpful. Let's be more specific...
From: Klaas Bakker, Springfield, MO
Your question specifically asks for beliefs. So, I'll express just that. I believe that in a large number of cases there is something neurological in origin that sets of a development of stuttering. Whatever is neurological itself I don't think is very visible, or noticeable, in one's behavior and may not ever lead to a problem. It may be enough of a trigger in some speakers, or significant others, to start reacting to it which initiates the "step 2" of the development which I belief is not neurological (or neuro biological?) in nature. This is my belief! But it doesn't have specific convincing and consistently replicated evidence to support it. In short, I believe both are true in many cases, but not all.
From: Tom Weidig (thestutteringbrain.blogspot.com)
OK, I was just asking about the origin. So you are saying that there is a necessary (but often not sufficient) neurobiological cause for stuttering in the majority of cases?
From: Ed Feuer
My question is for Dr. Nathan E. Lavid, whom I note is a clinical and forensic psychiatrist with a special interest in stuttering but NOT an SLP. A long-standing problem in treatment is that while some SLPs know something about stuttering, they lack the necessary tools. Those with the necessary tools know nothing about stuttering. I have advocated that SLPs and others with relevant expertise not only talk to each other but work together in a coordinated multidisciplinary team -- a collaborative team working in ongoing close liaison according to the individual needs of the stuttering client. The therapeutic model I favor is that described by Charles Van Riper in The Treatment of Stuttering, a book with which I assume you are familiar. SLPs lack the knowledge and time to do it themselves -- that's basically why nobody does the full regime of what Van Riper describes. This new paradigm for treatment delivery would have those with relevant expertise outside speech-language pathology accept the Van Riper model and apply their needed expertise in modular fashion as requested by the SLP facilitator. They would be "in" on what the SLP hopes to achieve and would work with the client to help the SLP achieve those goals. So, my question to you: if the funding were there, would what I suggest be viable? I must tell you that I have found many SLPs tend to not very much like my modest proposal. In fact, they see it as simply unthinkable, a zero-sum game, an existential threat that would bring down their monopoly edifice. Hopefully your view will be different although be aware that an affirmative answer would most likely render you unpopular in those quarters -- but not unpopular with people who stutter.
From: [no name]
I want to note that the Van Riper book is out of print.
From: Nathan E. Lavid, MD
Every patient that I've cared for who stutters has had or is in treatment with a SLP. I haven't had any problems collaborating care with SLPs or other clinicians.
From: [no name]
Dr. Lavid: "Has had" treatment with an SLP means, I take it, their referral AWAY of tough cases which is not new. What is new is the present tense: "is in treatment with a SLP." That is intriguing. You also say you "haven't had any problems collaborating care with SLPs." If that means that you are working with the stuttering client to provide what the SLP cannot while that SLP is doing what he or she can do, that would represent real progress. I always predicted that the coordinated multidisciplinary team approach would begin with small steps. Have you published anything on your active collaboration with SLPs in the treatment of stuttering describing how the division of labour has functioned? ' Ed Feuer, edfeuer@mts.net
From: Nathan E. Lavid, MD
PARAGRAPH
From: Nathan E. Lavid, MD
As a specialist, almost all of the care I provide in my clinical practice is in concert with other clinicians. As for the means of communication among providers, including SLPs, I rely on letters, though; I reach out with the telephone when appropriate. With stuttering, a typical consultation is to assess if medication is an appropriate adjunct in treatment and if there are any comorbid conditions.
From: Ed Feuer
Dr. Lavid: Still sounds rather more distant and "referral away" than what I'm talking about but correct me if I'm wrong. What I would like to see is a closer, more immediate, more "nuts-and-bolts" collaboration with SLPs. It would mean first of all that the psychiatrist and psychologist members of the treatment team would need be familiar with what the SLP is trying to achieve. (Have you read Charles Van Riper's "The Treatment of Stuttering"?) Specifically, if the client runs into difficulties during the motivation, identification, desensitization, modification or stabilization phases, the SLP would bring in the member or members of the team with relevant expertise, in this case the psychiatrist or psychologist to help the client overcome particular hurdles. Do you, Dr. Lavid, regard the above as viable? (And to those scoffing SLPs who say this guy's dreaming in Technicolor, I say you have nothing better -- and furthermore, you know that, although some of the bill-payers might not.)
From: James
If my stuttering is severe enough, what kind of medications can I take for stuttering? Does anti-anxiety medication work? I heard of Pagoclone, does Pagoclone reduce my stuttering? Thank you
From: Nathan E. Lavid, MD
In brief, some of the factors taken into account when considering medication; are age, severity of stuttering and prior treatment response. Severity is just one factor. Also, the standard for offering any medical treatment is a face-to-face evaluation. The type of medication offered, if deemed appropriate, really depends on the individual patient, so I'm sorry I cannot write of a recommended medication. To note, no medication is FDA approved for stuttering, but they do have a place for some patients as off-label treatment or directed at secondary symptoms. As for anti-anxiety medications, they do not affect stuttering directly, but may be of help for some with anticipatory anxiety as adjunct to speech therapy. Pagoclone is medication that may or may not help alleviate stuttering. The clinical trials are ongoing.
From: joe donaher
James, As Dr. Lavid said, there are no FDA approved medications for stuttering at this time. However, some people have found success with various medications or combinations of medications which their medical professionals prescribed for their specific symptoms. This off-label use dictates that an individual works closely with their own medical provider in a attempt to determine what is best for them based on their own unique presentation. Finally, pharmacological management will get better with time but it will most likely always be used in combination with other therapeutic activities. Best of luck. Joe
From: Ed Feuer
My view of the "pink pill" is that it would prove more efficacious to give anti-anxiety medication to the listener rather than to the person who stutters.
From: Joe Donaher
Ed, I like the idea of giving everyone anti-anxiety meds. Perhaps it could go in the water like fluoride!
From: Nathan E. Lavid, MD
In brief, some of the factors taken into account when considering medication; are age, severity of stuttering and prior treatment response. Severity is just one factor. Also, the standard for offering any medical treatment is a face-to-face evaluation. The type of medication offered, if deemed appropriate, really depends on the individual patient, so I'm sorry I cannot write of a recommended medication. To note, no medication is FDA approved for stuttering, but they do have a place for some patients as off-label treatment or directed at secondary symptoms. As for anti-anxiety medications, they do not affect stuttering directly, but may be of help for some with anticipatory anxiety as adjunct to speech therapy. Pagoclone is medication that may or may not help alleviate stuttering. The clinical trials are ongoing.
From: Jimmy
Hi, maybe a stupid question, but can someone explain what is considered the stuttered neural fault? What is stuttered neural fault? Thank you for your reply.
From: Dale Williams
Hi Jimmy. I've seen the term 'neural fault' used in conjunction with stuttering &mdsh; referring to a proposed defect in the brain. Where did you see 'stuttered neural fault'?
From: Greg Snyder
There are any number of functional studies that document the stuttered brain just not acting like fluent brains during speech and language production. I'm not sure how much detail to cite, but certain parts of the brain are: (a) over-active; (b) active when they should be dormant; (c) dormant when it should be active. But this is relative to function. There are other studies that look at specific neural structures and note differences, on average, between stuttered and non-stuttered brains. So the term "stuttered neural fault" is a general term, suggesting that there are neural differences between the stuttered and neural brains that result in these structural and functional differences. Happy to go into greater detail, if needed.
From: [no name]
Are there any studies regarding children who stuttered, appeared to recover and then begin stuttering again during adolescence? Thank you
From: Ken St. Louis
I am not aware of any studies that have documented this carefully. To get such information would require a longitudinal study of many children who stuttered and then follow them for many years. In the 1960s such a study was done in Newcastle Upon Tyne, England. I do not believe they documented such cases, i.e., children stuttering, remitting, and then beginning to stutter again. On the other hand, I know of several individuals clinically for whom this happened. I cannot be sure that they completely remitted from stuttering after a surge in early childhood, but several have told me that their early stuttering went away and then emerged again during adolescence, especially during the end of high school and college when academic/job stresses increased. There are probably a few case studies in the literature that describe this phenomenon, but I don't know of any. Perhaps someone else will know of one (some) and pass on the reference(s) to you. Ken
From: Ed Feuer
Would the professors here support the establishment by ASHA of a dedicated ombudsman for the treatment of stuttering? Such a separate office would investigate complaints from consumers about violations of ASHA standards including the failings and deficiencies I cited in last year's Online ISAD Conference at http://www.mnsu.edu/comdis/cahn_mnsu_edu/11profin/_disc3/000000aa.htm The stuttering ombudsman would also provide an effective avenue for whistle-blowers within the profession regarding the above. My view is that a dedicated ombudsman for stuttering would prove far more accessible to all concerned than ASHA's existing "procedures."
From: Gary J. Rentschler
Ed: I'm glad you remain active in the ISAD conferences and continue to press for better services for those who stutter. I don't know that a "bureaucratic" approach would provide a solution to the problem as you see it. In my opinion, the existing structures of ASHA are quite sufficient. As you recall from previous years, I don't experience the same degree of discontent as you allude to. Instead, I see a core of dedicated professionals earnestly in pursuit of the common goal of helping those who stutter. So, is that half empty or half full?
From: Ed Feuer
So Gary, I've waited four days now and you're the only professor who's replied on this question. That would mean all 23 other professors agree there's nothing wrong with ASHA's complaint procedures, with the implication that there's no need for a dedicated ombudsman for stuttering because those very rare cases of dissatisfaction with practitioners on the part of those very rare individuals who strangely even saw any need to complain, have been handled adequately and effectively. On the other hand, your 23 colleagues agree, with their silence, that the glass is only half full rather than say 60, 65, 70 or 75 per cent full. They even agree, apparently, on the content of whatever it is that fills part of the glass. You know, it's all kind of hard to swallow (and that's not a swallowing disorder, students).
From: Joe Donaher
Ed, Before establishing a dedicated ombudsman, we would need to show the need for such a position. My guess is that ASHA does not receive a large number of complaints dealing with the 'violations of ASHA standards including the failings and deficiencies' that you outlined. This is not because services are lacking at times but because consumers are not aware that they have an avenue to follow. This is most apparent when families tell me things like 'speech services are not offered at our school' or 'the school said that we do not qualify for services for stuttering.' To me, the first step is educating the public that they have rights and that there are ways for them to report concerns. Perhaps instead of an ombudsman for stuttering, we would be better off starting a parent-advocacy position that could walk parents through the various processes while outlining their rights.
From: A Parent...
In my association with stuttering self help groups for helping myself and my child, I have learned ASHA does not require - and the vast majority of university programs do not prepare - masters level graduate SLP's entering the public school systems to even remotely implement basic therapy for kids who stutter. Forget the ethics part --It should be a criminal act to deliver "therapy" to children when the "professional" does not have even the basics in knowledge of stuttering, let alone treatment. Failure of ASHA and State Education Departments to police the school professionals is also a serious problem is the public schools. Mr. Donaher is correct regarding educating parents, but ASHA does so poorly at being ASHA, and the Public Schools protect their own kind. When will the specialists start blowing the whistle on the problems in the public schools for therapy with CWS? Money and lawyers would change the situation in the long run, but who has the money? What ever happened to "Do No Harm" like in the medical field? The school experience for therapy is terrible.
From: Ed Feuer
Joe, you say: "The first step is educating the public that they have rights and that there are ways for them to report concerns." Here's what this naive consumer recommends: Think of posters in the offices of every SLP who professes competence to treat stuttering, posters that read: "We at ASHA want you the public to know you have rights. If you have concerns, contact ASHA's ombudsman for stuttering at 1-800-_ _ _- _ _ _ _." Questions for the silent professors: Why does one have to be naive to think the above can and should happen? Doesn't the posting from "A parent" tell you the above is needed?
From: Michael Retzinger
I am not one of the professional experts here, but I am a person who stutters. As a member of self-help organizations for people who stutter, I have listened at many conferences over the years to parents who voice frustrations with the lack of quality speech and language therapy for children who stutter in the public school setting. As well, I believe there have been a number of studies done - perhaps even by some of the noted panel of professional experts involved in this ISAD - that would seem to indicate that the level of competence and training needed to deliver quality therapy to/with CWS in the public school setting is less than adequate/satisfactory. I understand, and at a certain reactive level agree with, what Joe feels is the correct professional responsibility to be "The first step is educating the public that they have rights and that there are ways for them to report concerns." But at a deeper level of understanding of the professional responsibility entrusted and expected of SLP's by parents of CWS, and I would suspect expressed in the ASHA Code of Ethics, it does not seem unreasonable for the public to expect adequately trained therapists when delivering therapy services to a child who stutters. And if not trained sufficiently, to refer to a professional who is! Unfortunately, for whatever reason, it does appear that there may be professionals lacking in expertise in therapy for stuttering that do not share their lack of expertise with parents prior to providing "therapy" to CWS in the public school setting. My thought is this: Rather than first reacting and sharing with parents their rights as to recourse, I believe the professionals in question should learn first above all else - during their training and professional preparation - as the parent said - to "Do No Harm". Refer out to a professional who might actually know how to provide meaningful therapy! As I understand it, the Specialty Board on Fluency Disorders is now urging parents of CWS initially searching for therapy to seek "specialists" rather than working with "generalists" in the school setting.
From: Jack McDermott, age 18
I am curious, just a quick question. I've read and seen so much on the mainstream media which points the future of stuttering therapy to the pharmacy. New tests on several drugs have yielded decent results in terms of success rate. My question is this: do you think that speech therapy will embrace these pharmaceutical advances? Will they eventually replace traditional modification/fluency shaping therapies? Do you see them being used in unison as complements to one another? Your thoughts.. Thanks.
From: Gary J. Rentschler
This is such a great question Jack. I'm happy to share my opinion after being an SLP (and PWS) for many years. In that time, many innovations in treating stuttering have come along. Some have showed more promise than others, but the problem still remains. My thoughts are that we need as many "answers" to stuttering as we can find. Even though we haven't found one single answer for everyone who stutters, the possibilities we've come up with have been satisfactory for many who stutter. and I'm all for that. While I don't know that there will be a pharmacological answer to stuttering, I certainly support the experimentation to find out and learn more. If it can help one person, then it has value. I believe that an SLP needs to be pragmatic in working with stuttering and trying to find the best end result for each individual who stutters.. whether its medications, devices, traditional therapies, or whatever lies ahead in the future. If we don't continue to find new possibilities, we won't find the answer. I enjoy helping people who stutter and I don't think I'd be doing my job well if I become overly dogmatic about the approach to treatment.
From: Charlie Healey
Hi Jack. Thanks for your great question. I read Gary's and agree with what he has said but I would like to add a couple of of my own. First, I have been asked this same question by other people who stutter and I get the impression that what they really want to know is if, in the future, there is a pill that a PWS can take to get rid of their stuttering. I think the answer is no just like there isn't a pill that totally eliminate someone's anxiety. But, just as we take some pills to "calm us down" there is still a need for us to get through tough situations by what we do. The same is true for treating stuttering. I think there will be some medication in the future that will work on modifying the biochemical processes that are creating some chaos in the neural systems that control speech production. I think this will work for some but not others and I think we will get to a point of knowing which medications work for which clients. I doubt that any medication will work for everyone who stutters. Second, I think that even if there is a pill that one could take to help manage stuttering, behavioral methods will still be needed. Just like we have to try and manage other motor acts like creating the best golf swing or tennis stroke, I think the same is true for modifying and monitoring how one's motor system is working during speech. I think there are some very effective strategies PWS can use if there is a lot of time spent learning the strategy with a high degree of self monitoring used in order to help one's motor system respond the best way that it can. Over time, things get easier and a little less controlled. So, medications can help in this learning process but that's why it takes years to change how a system works...just like developing into a better golfer or tennis player.
From: Carlos Montes
Is the feeling of knowing when we are going to block, a feeling that we are actually feeling? or a feeling that we are creating? Is there any research on the topic?
From: Barbara Amster
Carlos What an interesting question and one that is not easy to answer. I am not sure whether there is any specific research on the topic but certainly our thoughts and feelings can influence the way we speak and can certainly influence our-self concept. For instance, if we have had some experience that certain sounds or words were difficult in the past to say, when these sounds or words come up in conversation we may feel that we are unable to say them and a block or stutter may occur. Repeated experience with stuttering can influence the way we think about ourselves and can even turn into self-fulfilling prophecies. If a person thinks 'Oh no, I have to introduce myself and my name is so hard to say. I just know I am going to stutter on it' the person is more likely to approach saying his name with apprehension, tension , or struggle and this may make his name more difficult to say, increasing the likelihood that he will stutter on it. Similar things can happen when we tell ourselves that a speaking situation is a difficult one or the person we want to talk to is a difficult listener. Because our thoughts can affect our speech some PWS may benefit from examining how their thoughts influence the way they feel and there are several approaches that can be helpful in doing this such as Cognitive Behavioral Therapy and Rational-Emotive Therapy. A self-help book that also helps in exploring thoughts is the "Feeling Good Handbook" by David Burns (1989). Hope this is helpful. Barbara
From: Francesco
Hello I am an Italian student, I have a degree in psychology In University Vita-Salute San Raffaele (Milan) and I am attending the last year of Neuroscience (a Specialization). I am interested in conducting research about stuttering but I don't know what can be useful for me to study for having a good preparation in this area. I don't know people who can counsel me about this problem. Substantially, in my school, I have studied the general basis of linguistics, brain structure, philosophical theories about mind, a bit of genetics. I would be grateful to you if you briefly could counsel me about the matters that you consider important for me to know to conduct research about stuttering. Can you counsel me some books? Do you retain the knowledge of informatics languages important in conducting research about stuttering? Thank you Francesco Fuse'
From: Ken St. Louis
Dear Francesco, Thank you for the inquiry. You ask a very good question, but my answer would have to be, "You have a great deal to learn about stuttering before you begin to focus on a specific area of research in stuttering." Your question is very broad, and anything I might tell you to do would reflect what I believe is important. Still, I know that you want to avoid doing something that is trivial, already done, impractical, etc. All of your areas of expertise can be applied to stuttering. There are a number of very good sources of information. I suggest you try to get the new Handbook on Stuttering by Oliver Bloodstein and Nan Ratner. There are many good books available on stuttering, but this one summarizes a lot of research. Maybe some of the other "experts" here will be able to give you good advice. Good luck. Ken St. Louis
From: Josh Denault
Hi Vivian Sisskin, I heard your presentation at the NSA conference with your panel, and it really struck a chord for me, more so than any other presentation. The avoidance reduction model really seems like a great model to incorporate. Is there anywhere I can get more literature on this? Online? or Books? (btw I am the one who came up and introduced myself as the guy who had worked quite a bit with Vivian Sheehan) Thanks Josh
From: Vivian Sisskin
Hi Josh, Good to hear from you again! Unfortunately, there is not a lot out there specifically on avoidance reduction therapy, although I keep meaning to write a clinical handbook. I guess I am too busy with therapy and teaching, which I love. The materials that are available don't seem to capture the essence of the therapy, which is less about strategies or techniques and more about the process of self-acceptance as a PWS. When I say acceptance, I am really talking about a process' acknowledgement is not the same as acceptance. The process of acceptance includes acknowledging, but also tolerating, welcoming, and eventually embracing stuttering. This requires guidance and support. You are eventually changing your basic outlook on what is success and what is failure. Through the process of acceptance, success is no longer tied to fluency (or even comfortable speech), and failure is no longer tied to fluency failure or not living up to your own expectations of what you 'should' be able to do in any speaking situation. My work with Joe Sheehan (my mentor) changed my notion of what stuttering is. He helped me see that it is a disorder of social self-presentation more than a disorder of fluency. His readings are full of humor, analogies and nuggets that will really drive home some of these points. Unfortunately the readings also contain information that we know is no longer valid, as we have learned so much from recent research from brain imaging, genetics, etc. However, in my opinion, the readings are timeless from a therapeutic perspective. If you can get hold of these two books (from the '70's) from a used book store they will be a treat. 1. Sheehan, J.G. (1970). Stuttering: Research and therapy. New York, NY: Harper & Row. Read chapter 1 which is the only chapter still relevant. 2. Eisenson, J. (1975) Stuttering, a second symposium. NY: Harper and Row. Sheehan has a chapter (100 pages!), and well worth reading. If you can't find them, check in with me in a while. I will be happy to put them in pdf format on my website for you to download. I think I will do that' I think there are many people who will enjoy them. Best of luck on your journey to self-acceptance, and may you let go of 'all controls' on the way!
From: [no name]
Hi, Besides you. Did Dr. Joe Sheehan have any students? Any students from his days as Professor at UCLA that you know of?
From: Vivian Sisskin
Joe Sheehan was a professor of psychology at UCLA from the late 1940's until his death in 1983. There had not been a communication disorders (speech sciences) dept. at UCLA (or any of the UC campuses) since the 60's. All of the programs ended up in the State University system, for example, California State University, Los Angeles (where I taught during the 80's and 90's). That said, Sheehan's doctoral students were studying psychology. Many of them did publish in the area of stuttering, as this was Sheehan's main area of research interest. I worked with Sheehan over a period of 10 years as an undergrad (psych) and also as a graduate in the school of education, and beyond. There were others like me who spent time learning about his unique approach to treating stuttering. I have remained in contact with some of them over the years, none of whom would say they focus on stuttering today. They have developed other clinical interests in the field of speech and language therapy. Some of my best sources for collective memory regarding the Sheehan legacy are the clients we had in the clinic, many of whom consider themselves recovered from stuttering (my husband, Peter Kupferman being one of them), as well as his children. There have been a number of SLPs who have worked with Vivian Sheehan over the years in the clinic that she kept going after Joe passed away. Vivian was a wonderful clinician and mentor, and these clinicians were fortunate to be exposed to Vivian's talent and the therapy that Joe created. I am friendly with many of them, and I know that they would have loved to have had the opportunity to watch Joe in action (leading the group). Thank you for asking, and for allowing me to reminisce a bit!
From: ari from israel
I saw the great movies about sheen treatment (Amik Holzman). And i want to ask :your husband Peter said something like "we believe that there inst physical problem". Did sheen believe that stuttering is only psychological problem? What was unique in his approach?
From: Vivian Sisskin
Ari, You are referring to 'No Words to Say' produced by Allan Holzman and Ron Amick. It features Vivian Sheehan and my husband facilitating group therapy. Alan did a wonderful job on this film and I think there were some great moments. I particularly like when Peter tells the story of the guy who complains that he can't get a date because he stutters, and then when he recovers from stuttering, he still can't get a date! This story was meant to demonstrate the notion of 'the giant in chains'' a person who sees himself trouble-free if not for the chains of stuttering. Sheehan always said he believed in a genetic predisposition to stuttering. He also believed that the initial cause was related to something more than psychological, however the technology at the time did not allow for the interesting findings that are coming out of today's research. In any case, Sheehan based his treatment ideas on the notion that regardless of what causes stuttering, much of the struggle (physical and psychological) is related to learned behavior and response to conflict. I think this is why I feel it is so important to separate 'stuttering' from 'struggling'. From my perspective as a clinician, the road to struggle-free speech is clear and attainable, but the road to stutter-free speech is not so apparent.
From: ari from israel
I think that Allan Know his profession very well, because the final monologue of him in the end of the movie is so great, I always cry when i see it, I even publish it in the stuttering forum in Hebrew. If i understand true, today there are very few experts that claim that our problem is only psychological problem. Thank you for your answer!
From: Josh Denault
Thank you Vivian! I will try to hunt those down. I do have some of his material I remember Vivian gave to me years back but I don't think it was that. If I can't find them I will be in touch...thanks again...Josh
From: Rachel
I have a nine year old son who has stuttered for 3 years. We had been to a private SLP in the earlier years but with not much results. We are currently with a school speech therapist who is not knowledgeable about stuttering. My question is are there SLPs who specialize in helping children to control their stuttering and become effective communicators? I am within a somewhat close distance to the Children's Hospital of Philadelphia. For a child,would it be better to go to a Hospital setting for therapy or a private SLP? Is there any way to evaluate the effectiveness of the therapy received? Or should I initially base my evaluation on achieving a healthy relationship between the therapist and child? Essentially my question is how do I go about establishing a plan of action for my son who stutters because up to this point I don't feel he is getting the help that he needs. Thank you.
From: Joe Donaher
Rachel, You asked the question that many families struggle with; what is the best therapy for my child and how do I know that we are making progress. Certainly working with someone who specializes in stuttering and especially works with children who stutter and their families, is a good place to start. You can find a list of specialists at www.stutteringspecialists.org But remember that the SLP is just one member of your team. Next, in order to gage progress, it helps to have your goals clearly defined and understood by all parties. This means that the family, the child, the teacher and the SLP have coordinated their approaches and are working on the same things. By promoting collaboration between team members, you are ensuring that everyone knows what they should do (and what not to do) , what they should be measuring and what messages they should be sending to the child. Lastly, instead of searching for the perfect plan, I would suggest that you search for signs that things are progressing. These may include a reduction of stuttering behaviors, an increased willingness to communicate in various settings, reduced communication anxiety and various other barometers that you and your child are moving forward. Best of luck. Joe
From: David Shapiro
Hi Rachel, Your questions are excellent. I see that Joe Donaher provided a thorough and thoughtful reply. I just want to echo his sentiments and agree with both of you that the relationship between the therapist, the child, and the child's family, in addition to all others involved on the intervention team, is essential. Also, the clinician's competence, commitment, and compassion are essential as well. I relate to your concern not only as a speech-language pathologist, but also as a person who stutters and as a parent. I hope that you have shared your concern with the clinicians who have been involved in your son's treatment so as to provide them an opportunity to consider adjustments. Most intervention is tailored to fit the uniqueness of the child who stutters on the bases of his communicative and personal strengths and challenges. That is why your active involvement is so important; no one knows the child better than the parent. Your role is most essential as you pursue what you know is best for your child and for your family. Help and resources are available. Thank you for being so involved in the intervention process. Good luck. David Shapiro
From: Dick Mallard
Rachel, have the clinician at your child's school read my article about what I do with children in a school setting. The article is part of this conference (Simplifying Stuttering Therapy in a School Setting). If I can be of help to that person, have them contact me at info@familystutteringprogram.com. I'll be glad to be of help if I can.
From: [no name]
It is late 2009, and it is still OK for people to make fun of stuttering, imitating stuttering and mocking stuttering. The general public still think it is OK.... Bullying is a major for kids who stutter in the schools. Can the Professors please do something? What do you think should happen to Sheila Johnson. Why do people associate stuttering with stupidity? The bottom line, why is stuttering bad and fluency good? The problem is often times not the disorder itself (not the stuttering) but people's reaction to it.
From: Pam
I too was shocked at the image of this woman mocking a political candidate, intimating that he can not do the job because he cannot communicate. The previous person asked what can the Professors here do to stop this type of mockery. I think it is up to us - people who stutter - to get out there, raise awareness and teach people about stuttering. I agree that bullying is a problem for kids in schools. Its a problem for adults in the workplace too. I visit schoolls in my community and teach about bullying prevention strategies, using my stuttering story as an example. It works. Especially if we target kids young enough. We need to do our part, and express outrage when public figures blatently mock people who stutter.
From: Karl
The issue is some Stuttering professors think stuttering is bad and should be eliminated 100%. But that is often not possible no matter how hard the PWS tries. The person is motivated, but still stutters. For example, one prominent professor compared stutterers in NSA as happy stutterer who did not receive adequate therapy for cancer. "If the person had cancer, he would get treatment" The academic opinion that stuttering is undesirable and unacceptable. Bad analogy comparing cancer to stuttering? Maybe a good analogy....
From: ari from israel
In the past -i was told that stuttering is interruption on the vocal cords, today i know that this is only one secondary behavior of stuttering. so what is the main core interruption of stuttering?- and if we don't know what is stuttering-maybe the differences between severe stutterers and mild stutterers is only in the stuttering secondary behavior - but we all suffering from the same exactly problem? and maybe even there are several people that "stutter" but they speak like normal fluent people-and they don't even know that they "stutter"?
From: Greg Snyder
The honest and short answer is: We don't know. My personal guess is that the core of the stuttering phenomenon occurs at the central level. It's a CNS issue, in which our body tries to correct/compensate w/ behavioral-motor activations. Now--Where is the CNS error? It's really tough to know. There's so much abnormality going on in the stuttered brain that it's tough to know if we're viewing the pathology, or the compensation/result of the pathology (which lies further upstream). Oh how I wish there was a better answer. Perhaps someone smarter than me will chime in...
From: Tom Weidig (thestutteringbrain.blogspot.com)
I believe that the main interruption is a delay in speech initiation (the go signal to send the motor code) leading to all kinds of reactions.
From: Greg Snyder
I think you're right, Tom. However, R Salmelin had a really nifty study back in 2000 (I think) that used MEG to detail the order of activation patterns in PWS and norms. If I recall, there was activity in (broca's area) prior to completion of linguistic formulation (pre-frontal). So in that sense, we may be trying to initiate a non-signal (or an incomplete signal).
From: Tom Weidig (thestutteringbrain.blogspot.com)
Salmelin did this nine years ago. Why has there been no other MEG study? She said herself that MEG is very tricky because one needs to reconstruct a 3D map from 2D data. And this inverse problem is very difficult to solve. So I would wait for more or better MEG technology for a more definite conclusion. Also, I am also concerned that abnormal function could either be due to structural abnormality or due to the running of a learned behaviour. So we might activate differently because we work differently or because we activate differently due certain triggers. I view stuttering as delay being the bottle neck, the dysfunction shared by all stutterers, but caused by different causes and leading to different reactions.
From: Greg Snyder
You're exactly right, Tom. The truth is that all we *truly* know is that stuttered processing is "messed up". How it's messed up and why it's messed up really is open to the speculation and fodder of people that try to believe they know the answers. *sigh* It's frustrating...
From: Charlton Knowles
It appears that changing stuttering patterns which are the incorrect patterns if we want to produce fluent stuttering/speech has many analogies to other psycho-motor behaviours, and it appears that golf probably mimics stuttering vs non stuttering best. I recently took up golf, aganist the advice of a good SLP friend of mine who claims that he was a scratch golfer in his day, anyhow, the subtlies the correct contact with the ball is analogous to hitting the correct target in stuttering modification. Recently I have been working on trying to stutter more easily and have found that although my onsets are not as hard, (tactilily)the movement (kinestic) from sound to sound creates my difficulty. I have been focusing on relaxation and moving slower through the word. This I realize is the solution, however, the anticipation of stuttering and the resulting conditioned fear makes success more difficult. In lower hierarchy situations the control is much easier. I have a ways to go to be able to maintain this control in much more difficult situations. your Vivian and Gary would be appreciated.
From: Joe Donaher
Charlton, We can learn so much from the world of sports! The field of sport's psychology, in particular, is ripe with lessons regarding stuttering. Best of luck on the links! Joe
From: Vivian Sisskin
Charlton, I love sports analogies even though I am not any good at sports! They are meaningful in the area of stuttering because in many ways we are trying to change a motor behavior (speech). From my perspective, there are two ways in which sports analogies might help you problem solve to reduce struggle. The first relates to compensation. If you have a sore arm, and you want to avoid the hurt, you might hit the golf ball in a way that reinforces an inefficient way of getting the ball into the hole. The analogy for stuttering would be holding back on onsets for fear of showing what you might consider to be 'ugly stuttering'. The second relates to habit. Once a motor pattern is practiced, it often becomes established. And if you consider that anything that you do that results in release from a moment of stuttering is incredibly reinforcing, it's easy to see that the habit of holding back can become a habit. But just for fun, let's say that your difficulty in moving through a word is maintained NOT by old habit, but by fear of trying something different that MAY not end up being more comfortable. If relaxation and slowing down has helped you achieve more fluency in the past, I am not surprised that you would try them again. But those things tend to induce fluency for the moment and may not be addressing the core problem: The desire to suppress stuttering. Suppose you did some paradoxical assignments, and instead of trying to slow down and relax (advice that has been around for years without good outcomes), let go and do the very thing you fear the most'. struggle?! You might find that going ahead and giving yourself permission to do the thing you fear the most results in taking the wind out of the struggle. You won't have to TRY to move through the word anymore.
From: Charleton Knowles
Vivian, That is the clearest description to best lay out the path to learn how to stutter more adaptively (easily) I have heard. Its analogous to not stopping the stroke in Tennis and Golf for fear you will make a mistake. much appreciated.
From: Charlton Knowles
Vivian, I have spent the last few days thinking about your response to my posting and conclude that it is quite interesting, your/Sheehan's approach to dealing with the stuttering moment. The few times that I followed your suggestion, the result was good. However, due to my years of trying to substitute the moment of stuttering with a more fluent form of stuttering takes over.I mean it only makes sense, if fear is causing you to hold back, then attack the fear and move forward. Same applies to being more efficient in sports- no?
From: Vivian Sisskin
Hi Charlton, Your question is very interesting. What is actually holding you back? Or better, why are you holding back? Fear certainly is one possibility, as fear has a wide variety of physical correlates including increased heart rate, tension, sweating, etc. Being 'frozen from fear' is sometimes the way people talk about it. However, there are other possibilities that you have touched on. Many PWS experience severe blocks even in their lowest feared situations! Sometimes the holding back can be from habit, that is, holding back is a learned reactive strategy that has not only been practiced for years but has been reinforced by it's ability to allow the person to avoid (postpone) showing the kind of 'noisy' stuttering that they do not want to show. While it is not very effective at truly hiding the stuttering, that doesn't matter. It might have worked at one time, even a long time ago. I find that blocks can be changed into more forward moving forms of disfluency. This is a choice that the PWS can make by choosing to show the thing they are trying to hide, noisy (or 'ugly', or however the person characterizes the stuff they don't want to show) stuttering. Of course, not easy without adequate support and guidance, but certainly very do-able. This choice may be a difficult one, but once made (with trusted listeners) the PWS slowly becomes desensitized to the 'ugly' stuttering, which leads to less struggled, comfortable disfluency. You might try a cognitive strategy to help: Prepare yourself mentally to experience 'ugly' (or however you characterize the stuff you don't want to show) stuttering and tolerate it! This tolerance may lead to acceptance and end the contention, and the accompanying struggle!
From: Charlton Knowles
Vivian, thanks for the response. I am confused about one thing, and that is are you advocating that PWS who subscribes to your approach should be holding onto the word,syllable, sound until they gradually move through the word in a controlled manner ( similar to Dick Mallard's advise to Ari in the tongue blocks section) or to acknowledge that you are stuttering and work through the word even if you incorporate fluency shaping techniques? I hope the point I am trying to get at is clear? thanks.
From: Vivian Sisskin
Charlton, What I think is helpful is moving forward. That said, going backwards (stopping and restarting for example) would be counter productive. Holding on to the sound may be an indication that there is fear of moving forward to the vowel (in most cases) because that would trigger more struggled stuttering, so many hold on until the fear dies down and they can move forward. I think it's best to move into the feared sound (make the transition to the vowel) and face the fear. In essence, reduce the avoidance there too. Hope that helps!
From: Charlie Healey
As an avid golfer, I have used golf as an analogy to stuttering with many of my clients...at least the ones that play or have played golf! I think there are a lot of similarities between the onset, timing, coordination, and execution of a good golf swing and what it takes to say something fluently. However, what we also have to understand about golf and stuttering is that our cognitive, motor, and emotional systems are geared to a certain level of performance and we have to be comfortable with what can and cannot happen. With golf, you can go to the driving range and hit a ton of balls but that might not translate well when you get on the course. Just like stuttering, trying to use techniques when it's easy or comfortable and there is little cognitive and emotional baggage, speech can be pretty fluent. But, it all changes when you are in a tough speaking situation. So, just like golf, the best place to practice your swing is WHILE you are playing golf during a round just like practicing speech skills to help yourself be more fluent or as Vivian says, letting go of the emotional reactions or struggle WHILE you are talking in a speaking situation that is difficult. Focus on the effort to do something you haven't done before is what is helpful, not the outcome. Making an effort to improve given the skills that you have is what's important , even if you stutter in a particular situation. Take comfort in knowing that what you try to change might not always work but at least you tried and you will learn from that experience.
From: Tom Weidig (thestutteringbrain.blogspot.com)
Hi Charlton, I am NOT one of the expert, but you might be interested in looking at the ROPANA website http://www.ropana.de/english_information.htm The author is Roland Pauli, a tennis coach with 30 year experience, and he has also developed a stuttering therapy based on his experience as a coach and his experience as a heavy stutterer who has recovered to a point of being able to speak fluently in most situations. His idea is to work on extending the fluent periods and ignoring the stuttering (inspired by his coaching methods) rather than producing fluent speech with fluency shaping or working on stuttered speech. I will probably blog about Ropana on my blog this week.
From: Ed Feuer
Charlton and Charlie, to make these golf analogies with stuttering complete, you'd have the gallery throwing beer bottles at someone trying to make a shot. That might be closer to what's going in the adverse signal-to-noise ratio in our speech system that makes us vulnerable to communicative stress. And don't forget lots of divots and no mulligans. And Joe, you will not doubt recall that I'd have a sports psychologist on the coordinated multidisciplinary treatment team. Tom, anyone who would ignore the stuttering makes the same mistake as PFSP. Our blocks are not simply random spasms but as Van Riper tells us are idiosyncratic, highly conditioned with stimulus and response, with beginnings, middle and ends and the product of years, even decades. To ignore the blocks in treatment has the same long-term result as trying to paper over a volcano.
From: Tom Weidig (thestutteringbrain.blogspot.com)
Ed, I never said it is random spasms. First of all, precisely because the brain has learned a lot of associations that trigger directly or indirectly stuttering (on top of neurological jamming), it is best to ignore stuttering events and try to react as little to them as possible. In sports, the key to unlearn associations / habits is to ignore your old habits as much as possible and enhance and build good association with your new habits. Any emotions on your old habits just signal your brain that it is important. Second, your volcano analogy here is flawed, because an eruption needs to be reacted too or you are dead. But if you don't react to a block or stuttering, you are not dead. Think about 100s bees swarming around your body. The key is to ignore and not to react. Even when one stings you. And moves away. Third, it cannot be as you say a mistake for everyone as I have seen it working well in people. Again, it is a different approach to fluency shaping and dysfluency shaping (stuttering modification), it is dsyfluency neglect and natural fluency enhancement.
From: Ed Feuer
Tom, discussing this in heavy detail is way beyond the scope of the online conference. There are no quickie fixes in the crucial unlearning, learning and re-learning processes. To see where I'm coming from on this, I suggest reading (or re-reading) Van Riper's chapters on Identification, Desensitization and Modification in The Treatment of Stuttering. And while you're at it, read (or re-read) the other chapters, too. Then contact me directly if you'd like.
From: John Paskievich
Tom,Ed A stutterer's anticipatory anxiety of speaking may not result in death but it can come close. One study found that 1/3 of stutterers have experienced what Charles Van Riper called le petit mort, little death, wherein the stutterer is so traumatized that he has an out of body experience. Sport psychologists can only be of limited help because most stutterers unlike most athletes are traumatized individuals. They are traumatized to their very neurons. Joseph LeDoux and others have shown that these traumatic memories can never be totally extinguished although our reactions to these memories can be modified. Once a stutterer reaches adulthood the chances are that he will always stutter but he can learn to stutter in an easier less reactively conditioned way. Stuttering should I believe be considered and treated as a form of PSD, Post Traumatic Stress Disorder. That it isn't I find astounding.
From: Feuer
John: Did you say death? That raises another question for the professors: Will there be stuttering in heaven? But seriously, yes, every instance of stuttering is a trauma, some bigger, some smaller. But dealing with post-traumatic stress disorder is beyond the pay grade of garden-variety SLPs. That's why experts in PTSD should be available for the treatment team, depending on the needs of the client. As for sports psychologists, their assistance would be valuable in maintaining consistency and motivation, as needed.
From: Tom Weidig (thestutteringbrain.blogspot.com)
Hi John, it is not treated as PTD, because stuttering is not a PTD. In traumatic events, the brain itself is damaged due to extraordinary abnormally high level of certain neurotransmitters. So these people have probable recovering normal brain function and sometimes need fully recover. People who stutter are in stressful and painful situations, but it is not extreme stress like wars, accidents, assault or rape. There is no doubt that stuttering has a lot of learned behavior like associations, but they have been learned by a normally functioning learning system. It is a response and reaction to stuttering which has its origin in neurobiology in the speech system.
From: John Paskievich
Tom, Ed are interested laymen. Are there any experts here who would like to comment on the notion of stuttering as a form of Post Traumatic Stress Disorder? I know that in the past Dr. Woody Starkweather wrote about stuttering being strongly related to PTSD. It as true, as Tom says, that the brain chemistry of those afflicted with PTSD is different from people without this affliction. The levels of stimulating hormones are very high in people with PTSD. Have their been any studies on the levels of stimulating hormones in the brain chemistry of stutterers to see how they compare? A litany of symptoms like guilt, self-blame, shame alienation,lonliness, anger, depression, hyper vigilance, avoidance, self medication and high use of anti-anxiety and anti-depressant drugs are common to those with PTSD and those who stutter. PTSD has been simply defined as "a state where you can't stop remembering". Stuttering can, in the same way, be defined as a state where you can't stop forgetting (that you stutter).
From: Judy Kuster
John, Woody and Janet Givens wrote an article for a previous (2003) online conference "Stuttering as a Variant of Post Traumatic Stress Disorder: What We Can Learn." The direct URL is http://www.mnsu.edu/comdis/isad6/papers/starkweather6.html Please note that is not intended for protracted discussion on a topic. There are other venues for that, including Tom's blog where discussion about Woody and Janet's paper might want to continue. Thanks for your participation, John, and personal greetings from Minnesota! Judy
From: John Paskievich
Thanks for the link, Judy. Do any of the experts want to comment on stuttering as a variant of Post Traumatic Stress Disorder?
From: joe d.
I think we are tripping over a similar problem that arises very often when people discuss stuttering. That is, stuttering is highly individualized and manifests differently in each individual who stutters. So, it is difficult to create a one-size-fits all approach to therapy. So, if you ask me whether every PWS needs CBT, I will most likely say no. However, if a specific PWS is struggling with anxiety or dealing with their stuttering, I may use CBT strategies or even refer them to a CBT practitioner ' if that is what their unique presentation suggests. Do I think many PWS present with reactions similar to those seen in PTSD, certainly and when I see that, I either address it with the tools I have or refer them to an appropriate professional. Do I think that many CWS present with attention/focusing concerns, certainly and when I see that, I either address it with the tools I have or refer them to an appropriate professional. The most important thing is that a professional be able to identify when comorbid conditions are negatively impacting progress. At that point, they need to either consult with or refer to a professional in that area. This entails that a therapist be knowledgeable on various disorders that can occur in tandem with stuttering and develop a strong network of referral/consultants with whom they trust.
From: Judy
Please share published information and personal anecdotes regarding : 1. the possible relationship between asthma/allergies and stuttering & medications for asthma/allergies and stuttering; 2. possible medications for anxiety that could be appropriate for teenagers who have made progress with fluency shaping and stuttering modification but experience soooo much situational anxiety (sometimes in conjunction with a high level of trait anxiety) that they simply cannot transfer their skills to specific academic tasks such as participating in classroom discussion or oral reports. Any new information available on either of these topics? Thank you.
From: Ken St. Louis
Dear Judy, I was hoping someone more knowledgeable than me would reply to your questions about medications and stuttering. There are a number of good sources of information available, but I will share a couple of thoughts. First, although numerous drugs have been used to alleviate stuttering symptoms (including anxiety), the side effects of most of them were worse than the benefits achieved, if any. That being said, there are a few drugs that have shown promise in recent years. One that is currently undergoing a large clinical trial is Pagaclone. As I understand it, it makes stuttering less of a problem both physically and experientially, and the side effects are less pronounced than many of the earlier drugs that have been tried. Second, I have had at least one youngster who was learning disabled and on Ritalin or a related drug, and that seemed to make his stuttering worse. Maybe someone else can give you more information. Ken
From: Nathan E. Lavid, MD
I apologize for not responding to your question earlier. Regarding the association of stuttering and medications for asthma/allergies, the association relies on the mechanism of action of the medication. For example, an antihistamine, such as Benadryl, has no potential to disrupt fluency as the mechanism is inhibiting the process of inflammation by modulating the actions of a specific white blood cell. Inflammation has no effect on fluency. Whereas, the use a stimulant mediation, such Sudafed, is effective by inducing constriction of blood vessels to alleviate congestion. A potential side effect of this stimulation is anxiety, which and exacerbate stuttering by this secondary means and, rarely, a primary exacerbation of stuttering, where the mechanism is not well understood, but probably by a mechanism similar to the exacerbation of tics found with Sudafed. As for the use of medications in adolescents with anxiety, the medications of choice, the selective serotonin reuptake inhibitors (SSRIs) have a number of potential adverse effects and carry a black box warning from the FDA regarding these risks. The mediations are not dispensed cavalierly to patients as a whole and require a face-to-face evaluation and assessment that includes a physical work-up. If these medications are being considered, a referral to a psychiatrist or pediatrician comfortable prescribing psychotropic medication is appropriate.
From: Pam
Hi all! I had an interesting conversation with a good friend who stutters last night. He was describing a tough speech day he had. I encouraged him to share what had been frustrating for him. He blocked on a word, for longer than he can ever remember doing. He felt uncomfortable, because his listener was an authority figure. My friend was unable to finish the word, and the listener correctly guessed what he meant and supplied the word. My friend casually said, "sorry for that" to his listener. I found myself gently chastising my friend, that he should not have to apologize for stuttering. He said he wasn't - that use of the word sorry in this context was just acknowledging that it may have been inconvenient for the listener. I have heard PWS apologize for stuttering, and wonder where this really comes from. Is it shame? Or are we just unconsciously trying to account for the longer time it takes to speak when stuttering. I also don't like it when people supply words or phrases for me, assuming that are being helpful. But some PWS have told me (in my blog - it was a lively topic on there) that it's not such a bad thing to have a listener finish the words. It helps move the conversation forward. Thoughts?
From: Dale Williams
Hi Pam. Good questions. You are correct, some PWS don't mind when listeners finish their sentences. I would be willing to bet, however, that the overwhelming majority feel the way you do. As for apologizing for stuttering, I don't believe one should be obligated to do so. In this case, however, it may have been reflexive--like saying "sorry" after coughing or forgetting a word while talking (i.e., it's just being polite; the speaker is not actually sorry about anything).
From: Lynne Shields
Pam, You don't like people finishing your words or sentences and your friend doesn't mind. I think it is important for speaking partners to find out what a person's preferences are, and do their best to follow those preferences. Hence, when I work with someone who stutters, I ask them to decide what they want and then consider informing their speaking partners, so that their preferences or expectations can be explicit. That will help prevent 1) frustration on the part of the partner who stutters, as others know what they prefer and, 2) anxiety or uncertainty on the part of the partner who doesn't have to wonder 'should I help out or wait'. Getting things out in the open, or working toward establishing more open communication about preferences, is sometimes a goal for children or adults with whom I am working. Lynne
From: Vivian Sisskin
Pam, Hmmmm.. the question then becomes, What do you do when the listener fills in a word you did NOT intend? I guess we can call them 'listener word substitutions'! Do you let it go by, say the word you intended after the fact, or take the opportunity to 'advertise' a bit? All 3 options are good choices based on the situation and whether or not the PWS decides that this is high-stakes communication (where the topic of stuttering does not need to surface), or a low-feared situation (with a friend or family member). An opportunity to advertise one's identity as a PWS, if seized with enthusiasm, can go a long way toward changing both the speaker's and the listener's perception of the problem. A positive tone in the advertisement, done in the right company with the right attitude (for example, 'Hey, I stutter' I'm the one who is usually doing the word substitution!') can sometimes neutralize negative attitudes for both listener and speaker.
From: David
What is cluttering and how is it related to stuttering? If you are a stutterer, is it more likely that you will also clutter?
From: Ken St. Louis
Dear David, Cluttering is different from--but often coexists with--stuttering. There is no risk of one disorder causing the other. The definition of cluttering is less well accepted than that for stuttering. Forgive me to "tooting my own horn," but following is my most recent of several "lowest common denominator" definitions of cluttering. DEFINITION: Cluttering is a fluency disorder wherein segments of conversation(a) in the speaker's native language(b) typically are perceived as too fast overall(c), too irregular(d), or both. The segments of rapid and/or irregular speech rate must further be accompanied by one or more of the following: (1) excessive 'normal' disfluencies(e); (2) excessive collapsing(f) or deletion of syllables; and/or (3) abnormal pauses, syllable stress, or speech rhythm. NOTES: (a) Cluttering must occur in naturalistic conversation, but it need not occur even a majority of the time. Clear but isolated examples that exceed those observed in normal speakers are sufficient for a diagnosis. (b) This may also apply to the speaker's mastered and habitual non-native language, especially in multilingual living environments. (c) This may be true even though syllable rates may not exceed those of normal speakers. (d) Synonyms for irregular rate include 'jerky,' or 'spurty.' (e) These disfluencies are often observed in smaller numbers in normal speakers and are typically not observed in stuttering. (f) Collapsing includes, but is not limited to, excessive shortening, 'telescoping,' or 'over-coarticulating' various syllables, especially in multisyllabic words. (ST. LOUIS & SCHULTE, IN PRESS) I hope this helps. Ken
From: Pam
I work in a high school and meet with students in small and large groups daily. I have to do a lot of presentations. Sometimes I am very open about my stuttering right away and advertise or use voluntary stuttering right off the bat. Other times, I don't and prefer to use a wait and see approach, and see how my stuttering is going to behave. Mostly, I choose this because I want the focus to be on my students and the topic at hand, not about stuttering. Sometimes I don't want to make every moment a teachable stuttering moment. . . . But I do usually respond right away if someone laughs or mimics me. I try to do it in a matter of fact, quick manner - say something like, "you need to know I stutter and I am ok with that, but I am not Ok with you making fun of me. You might want to ask me some questions about stuttering. If not, lets move on to our topic." I've noticed that sometimes when I do that, the "offender" looks very embarassed or slighted that I have "called them out" like that. I feel I need to do that, to set boundaries with my students and model what is acceptable and what is not. Do you agree? Or is there a different approach I could or should take? I want the focus to be on my students, not on me or stuttering.
From: Charlie Healey
You are doing exactly the right thing Pam in approaching the disclosure of your stuttering. Self disclosure is very hard to do for some people who stutter and as clinicians, we encourage our clients to do so. Some feel comfortable doing it and others don't. Waiting to see if the moment is right to disclose your stuttering is also a good approach. I did a study recently on listeners' reactions to a person who stutters disclosing his stuttering at the beginning of a story he was telling and in another condition at the end of the story. Listeners saw no need for the PWS to disclose at the end but did find it helpful to know at the beginning of the story that he stuttered. The other interesting finding was that many listeners didn't find disclosure of stuttering that important so we concluded from that finding that the value of self disclosure is for the PWS, not the listener. So, if it helps you to disclose your stuttering, do so and it's neat that you also are not letting negative listener reactions affect you and are dealing with that effectively. Good for you!
From: ari from israel
The problem is ,that most of the talking is short conversation, and the listener expect a short answer ,or if you ask the question a short question, and it seem inappropriate to self disclosure in such situations.
From: Michael Retzinger
Pam - Really an interesting situation you share. Charlie's response was interesting as well. Sounds like you are handling it effectively. I know I'm not one of the professional experts here, but I am a person who stutters. Just my thoughts --- As a youngster and young man between the ages of,oh,5 and 17, I was - on numerous occasions - bullied, verbally ridiculed, slapped up, beat up and subject to some really intentional, terribly embarrassing, and purposefully hurt filled emotional, mental and physical behaviors from peers because of my stuttering. I was an easy target. I grew afraid because of this, and turned coward, cried and ran as I got older. But as bad as that garbage that was inflicted on me was, the thing that hurt me the most was that I didn't fight back... Everything in me as a guy knew I should fight back, but I was so afraid that I'd let others hurt me. My "man" instincts as a child, youngster and adolescent were squashed by fear. When I was 18, I had a life changing experience regarding this situation and stuttering. By the time I was 18, I had physically grown up quite a bit and had developed an "I don't give a s***" attitude. I was in a situation where a group of guys was attempting to bully me because of my stuttering, and I responded with my fists. I proceeded to do a pretty good job of inflicting some serious pain on the bastards, and ended up going to jail. Contrary to what one might think, the "jail result" was one of the best things that ever happened to me to change my view of having a "victim" mentality. As I sat in the cell, I knew I had stood up to it and didn't run, coward or cry. I smiled quite a bit at myself in that cell. I knew from that moment on nobody was going to be able to make fun of me because of my stuttering ever again without having to pay a price. I was never so proud of myself as when my dad said to me "It's about time you did that; I'm glad you did.' Then he sent me some money for bail!!!! After many years, I've come to feel sorry for that particular group of guys, as I recognize I made them pay for all the pain I had stored up all those years. I'm all for figuring stuff out and being nice, but I also know a good slap upside the head or a direct blow to the nose of the one (s) bullying seems to be very effective during the moment of another's "negative " towards me about my stuttering. I have a "3 time" rule now... I'm nice the first time... I am more verbally direct the 2nd time... Third time, you gotta know s*** gonna happen. I know this flies in the face of what is being proposed as the "politically correct" response to bullying. I can only say this has been my experience, and it was the most positive effect for me personally in changing my "victim" mentality regarding bullying about stuttering. It is one of my "Frozen Moments."
From: Pam
Thanks Michael for sharing that. Since last year, I have periodically visited middle schools and talked to students about teasing and bullying prevention, using my stuttering story as an example of how kids are teased and bullied. I can so totally relate to what you share. As a girl, I didn't have those instinctual responses to being picked on. But I always remember feeling disappointed with myself for NOT standing up for myself. I just didn't know how, and like you, felt fear. I feared standing up for me would make things worse. . . . . . . I don't think your story is politically incorrect. It is what it is. It was a life moment that has stayed with you. I would think kids and teens who stutter could benefit gretly from hearing your story. Yeah, using our fists is not the answer, and you paid a consequence. But that is a life lesson. And kids who don't stutter can learn fromthis aas well. Bullying is so pervasive in the schools. It is often hidden, or right under our noses. In my community, at a high school last year, 5 teens killed themselves. It was determined that at least 4 of the 5 had been bullied. I am going to be co-facilitating a training for school staff in the Spring on Bullying. The schools are requesting that training be made available to staff. My assistant principal and myself volunteered to run an in-service,a nd we were asked to open it up to all 10 school districts. We will cover: bullying in schools, work shouldn't hurt (bullying in the workplace), and how to reclaim yur dignity if you are a victim. I am still incredulous that I can do this - as the one who stutters! But it will offer real life context, and trainings are always better when there is a personal connection. Thanks so much for sharing ths. I posted a couple of entries on bullying on my blog. Check it out when you can. If OK with you, I would love to post your story, with full credit to you, of course. Pam
From: Charley Adams
Pam, On the contrary, I think you are the ideal person to teach others about bullying. Your experiences afford you a victim's perspective, so you recognize not only the damage bullying can do but the importance of addressing it. Mike, I really enjoyed your 'coming of age' account - you must have done the right thing, because I got goose bumps reading it. Thank you both for sharing your insights into great pain, and great recovery. Charley
From: James Clarkson Australia
This question is directed to David Lavid. If a stutterer was to have particular social phobias or apparent social indifference. would it be pertinent for a therapist to ask for, or indeed a stutter to also ask for a psychiatric assessment. I ask this question because there appears to be more than the average spattering of comorbid afflictions amongst stutterers, myself included. Probably here in Australia you would be more likely to be referred to a psychologist rather than a psychiatrist. In contrast to the USA were I beleive it would be the other way around.
From: John Tetnowski
I hope you don't mind if I jump in. I believe and have written about the multitude of co-morbidity of stuttering with so many other disorders/differences. They range from articulation and language, to ADHD, reading and other learning disorders/differences, to psychological/psychiatric disorders/differences. I think that social anxieties and social phobias can extend well beyond our scope of expertise and need referrals to professionals, such as psychologists, psychiatrists, counselors and others. I believe that we need to treat what we can treat, refer for what we cannot treat or don't understand......ALL BASSED ON THE NEEDS OF THE CLIENT. A blanket statement cannot be made about referrals. I do think that the SLP needs to have many tools in his or her toolkit. Whenever they don't have the right tool to treat or evaluate a client, it is their job to find someone who does. Thanks for the question, and I hope you don't mind that I jumped in.
From: Nathan E. Lavid, MD
In light of the premise of your question, I fully agree that a referral is appropriate. Simply put, if a patient is not improving, I will seek a second opinion from a colleague or will refer for an assessment from a nonpsychiatric clinician. And, this type of clinical decision making is appropriate for those who care for a patient who stutters. For example, if a patent who stutters has more anxiety than typical and is refractory to speech therapy, a referral to a mental health professional is appropriate. In this scenario, the referral would be to answer the question if the anxiety is a product of a primary anxiety disorder and to consider treatments directed primarily at the anxiety.
From: Ed Feuer
How do the professors view assessment of outcomes by independent third parties? One poster ("A stutterer ... who continues to stutter ... ) on last year's ISAD conference on the Code of Silence thread at http://www.mnsu.edu/comdis/cahn_mnsu_edu/11profin/_disc3/000000dc.htm went to the heart of the matter: "The failure in therapy for stuttering is never the fault of the therapy or the therapist ... It is always the fault of the client or parent." Many SLPs do in fact use this defence. But this highly unsatisfactory situation should not stand. The results of the work of any SLP who claims professional competence in treating stuttering should be assessed -- after the regulatory board sets out what should be assessed. And independent third party assessment (ITPA) is needed because the original practitioner has a vested interest in putting the best face on outcomes. As well, the Hawthorne effect can skew the data of that original practitioner interviewing the former client. That is why ITPA is vital. I would go further. In true evidence-based inquiry, assessors would also speak to the subject's family, friends and work associates regarding how he or she handles speech. This would necessitate the subject waiving privacy rights but accurate appraisal demands no less. And assessment one year, three years and five years after treatment is not unreasonable -- if the practitioners are willing to stand behind their work. The ITPA results would be made available to prospective consumers. As President Reagan said: "Trust but verify." But if practitioners feel their work cannot bear scrutiny, then maybe they should consider change.
From: Lynne Shields
Ed, I think you've heard this from this panel in years past, but I'll respond to your claim that "'The failure in therapy for stuttering is never the fault of the therapy or the therapist ... It is always the fault of the client or parent' Many SLPs do in fact use this defense". I certainly cannot speak for all SLPs, nor can you, I suspect. I have never made such a claim and would never suggest that a client was 'at fault' for treatment being unsuccessful. I have suggested to families that they may freely seek a second opinion, and I consult with other fluency specialists when I want another view on treatment. While I do not in any way oppose the involvement of another party, routinely doing this would entail additional expense for the client. So, I would see this as being useful and reasonable only if the client wished to engage someone else in their treatment. I work with other professionals routinely when a child or adult is being treated by another practitioner or specialist, so that we can coordinate our efforts. I also frequently contact teachers or school SLPs to coordinate efforts. Any consultation or coordination is always done only with the client or family permission. I am not saying that there are no cases of SLPs being defensive, and when this occurs, it is an example of poor practice. Thanks for posting your question. Regards, Lynne
From: Ed Feuer
Lynne, With all due respect, you have not answered my question which Is: How do the professors view assessment of outcomes by independent third parties? I'm all for genuine coordination in treatment and I applaud anything you do in that regard. However, in this question I ask not about coordination or second opinions. I'm seeking the views of the professors here concerning credible third-party assessment of outcomes achieved by practitioners in order that bill-payers including potential clients have credible consumer information to help them decide who to hire. If anyone wants to peruse the importance of independent third-party assessment of professionals' performance in other fields, I invite them to Google ("independent third party assessment" medicine) or (independent third party assessment" psychology).
From: Pam Norton
I have a very bright 7 year old boy with moderate dysfluency whose expressive vocabulary (as tested on the CELF-4) is very high (18) but word structure is somewhat delayed and he has moderate to severe wordfinding based on TWFD (Diane German) (especially in discourse). He uses substitutions (38% of the time in a 53 utterance sample), reformulations (40%), insertions, repetitions (non-stuttered, 33%), and empty words (20%). He seems to have difficulty putting several ideas together in sentences using clauses. He's very labile and can begin crying if his ideas are misinterpreted or misunderstood. His dysfluencies are characterized by sound insertions (uh! ih!) and repetitions as opposed to prolongations of internal vowels in words ("di-i-i-ives") and final syllables ("thinking-ing", "for-ra-ra"/for). An example of his circumlocution is "And you had to thin of...animals and draw pict-, five lea-, different leaves and five different a-animals and you have to draw pictures of them and wri-i-tethe animals that it was." I've never seen this internal vowel or final sound/syllable repetition before. A colleague has suggested that he has Asperger's (??). I suspect he's a clutterer. Any thoughts on this? Thanks! — P.S. on Possible Clutterer
This boy also has difficulty regulating his volume and ends up with glottal fries at the ends of sentences. His voice is often quavery or tremulous.
From: Ken St. Louis
Dear Pam, Thanks for the inquiry. What you describe sounds like cluttering to me, but there might well be more. The unusual disfluencies such as final syllable repetitions are not typical of either stuttering or cluttering, although some have been reported in case studies in the literature. I can't be sure about Asperger's Disorder, but I don't believe they are typical of those either. Nevertheless, the mazes, the excessive normal disfluencies, and the rapid rate sound like cluttering. Perhaps you might want to watch the Stuttering Foundation of America DVD called "Cluttering" that Florence Myers and I prepared. I think that might help you decide about whether or not your youngster clutters. Maybe someone else will weigh in here and add another perspective. Thanks again for the question and thorough description. Ken
From: "associated" voice issues
Hi Ken, Thanks for your response. I've had about 5 clutterers in my time in practice, and I'm pretty sure he qualifies. I've just never seen the tremulous or quavery voice before, though I have seen the glottal fry with kids who clutter - and who stutter. I'm assuming it's another neurological symptom but not too sure how to deal with it. It doesn't seem like something breath support work would help, and it appears to be pretty "random" - I can't find a pattern so far. Is this associated with cluttering at all?
From: Ken St. Louis
Pam, I really don't know what is causing the tremulous voice. If you find that it is intermittent and does not seem to improve after you teach better breath support in the context of relaxed speech, then you might want to consider an evaluation by an ENT doctor who specializes in voice. Sorry I can't be of more help. Ken
From: ari from israel
In fluency shaping-always when i get anxious i was told to speak more slowly, So this is what i did, and when it also didn't work i spoke slower and so forth. Today i think that this is also a kind of avoidance, that is: avoid dealing with the fear of stuttering. I think that if i can speak in this rhythm all the time it is wonderful, but if i am trying to speak slowly when i am anxious it increase the fear that i can't use my normal speak. So what do you think: slow speech -when you fear is high-its good advice or it increase the fear?
From: Joe Klein
Hi Ari, great question. In my personal and clinical experience, it is my belief that you cannot "slow down" your speech if you are going 100 miles an hour on the inside, either due to stress, excitement, anxiety, whatever. It's really not possible. In order to speak slowly, you need to be calm on the inside, as well. So, I think you are right that this is generally poor advice for someone who stutters and has anxiety about their stuttering. Speech modification tools like cancellations and voluntarily stuttering will actively calm both your anxiety about speech and your speech rate together over time. You are asking good questions! Take care.
From: Michael Retzinger
Good Question Ari...I am not one of the professional experts here, but I am a person who stutters. I understand Joe's answer to you, but I do disagree with him re: "Speech Modification tools like cancellations and voluntary stuttering will actively calm both your anxiety about speech and your speech rate over time." Perhaps that has been Joe's personal and professional experience, and I am glad for him if those were/are his goals. My personal experience with those type of stuttering modification goals being targeted in therapy for me dramatically increased my anxiety about speech AND stuttering! As well,over time -- as a result of these and other stuttering modification therapy target goals -- they seriously affected my speech rate as well...I chose silence rather than all that stuff. I have come across other PWS that have had similar experiences as me, but this may be just a "minority of PWS" response. Good luck in your search for effective therapy, Ari.
From: ari from israel
when i was Little kid i didn't know that i am stutter and i had happy life. My fathers was concern because of my stuttering and i started therapy with slp. the slp ask me to record my speech and to here it, after i heard my speech i didn't wanted to speak anymore. So when i pass fluency shaping and today that i try also stuttering modification i don't have nothing to lose. because the fear is so big that i avoid a lot of situations. i think that sometimes to deal with your stuttering could be very pain and if you are happy with your life it is not always smart thing to do.
From: ari from israel
Joe-there are times that like you say, it is impossible to slow my speech, but there are times that i have a speech or short monologue and i can speak 3- 4 sentences very slowly, until the pressure fade away-and in the past i haven't any other choice, because in fluency shaping you are not dealing with the stuttering himself. Today i prefer not to speak so slowly to practice dealing with stuttering, and to proof myself that i can speak even when i feel very anxious. thank you for your comment, you are a big inspiration for me, i love to hear you in stuttertalk.
From: Gary J. Rentschler
My personal experience has been that slowing my speech DOES serve to slow my "motor" down. For example, at the beginning of making a speech, I intentional speak at a rates significantly slower than is my habit. As I listen to myself at the beginning of a presentation, I hear a slow, relaxed voice which is very soothing. The slow rate is in contrast with how fast my mind is racing because I'm anxious, but by focusing on the soothing aspects and letting my tension go, I become more relaxed and confident. I see slow rate as a tool rather than an avoidance. Unlike Mike, the more I think about stuttering and the speaking process, the more confident and controlled I become. But I recognize that people can react in different ways. Regards, Gary
From: [no name]
Gary-but when you slow your speech-your anxious got down, so you never deal with speaking when you are anxious. and my problem is that i cant always calm myself -like Joe said, there is a lot of cases that i cant slow my speech, and i need to deal with speaking in a very anxious mode.
From: ari from israel
i want to add that after fluency shaping therapy, i had comfort zones that i could slow my speech, and speak totally fluent, without any fear of stuttering in most cases. But today i try to speak in such situations a Little bit faster, in order to deal with my stuttering, because it is easy to practice in such situations than the real world. A lot of my friends don't understand me , they say: if you can speak fluently what the point to stutter, but i think that if i wont do it i, will return to the pattern: that i have situations that i am total fluent, and situations that i cant speak what do you think?
From: Vivian Sisskin
My observation is that slowing speech rate will increase fluency. It can also lead to a monotone speech quality. I find that if PWS spend a lot of time and effort on slowing rate, they end up thinking about 'how' to speak, rather than what they wish to communicate. Sometimes nonverbal aspects of communication are lost, and we no longer enjoy the personality of the speaker (wit and sarcasm, for example, that are lost in slowed speech rate). I prefer to offer a cognitive strategy rather than a motor strategy: Resist self-imposed time pressure; take the time to stutter and say all that you want; enjoy the moment that you have the floor; and take care to listen to your communicative partner (efforts to slow rate also take a hit on one's ability to 'give' in a communicative exchange). Planning (the operative word) to resist self-imposed time pressure often creates a less hurried approach to communication, where rate is slower in a natural way, and where pauses are tolerated at natural phrases.
From: ari from israel
Thank you! It really makes sense! Some people when they speak slowly, the brain interpreter this as relaxing the system. But when you are over the limit of anxiety, this doesn't help and you need to do something that directly down the pressure. For me sometimes the slow speech doesn't work at all- until i get to the first block that most frighten me, and sometimes i can speak fluently, but inside i feel so tense that i hate to speak like that, and i am glad when the conversation end.
From: Joe Klein
I think Mike and Gary both make great points here. I think this conversation gets at the heart of stuttering in some ways. Steve Hood once wrote about "superimposing fluency" over the top of stuttered speech, and pretending like everything was fine. For some people, slowing down reduces their speech demands (doing something slower is generally easier to do), and results in increased fluency, and can be really calming. For others, trying to speak slowly is just another motor demand that they are trying to do, on top of all the other things that they are trying to do with their stuttering, and it ends up being even harder to talk. Don't be afraid to play with your speech, see what works and what does not. Good luck!
From: Barbara Amster
Interesting discussion Joe, Mike and Gary and one that should remind us that there is no 'one size fits all' for stuttering treatment. I hope it encourages both PWS and SLPs to be flexible in experimenting and see what works for the individual.
From: [no name]
Is it my imagination, or is it getting hard to tell who is asking for information from the professors, and who is posting answers from outside this group? I keep having to go back to see who was invited to answer questions and which are people who are giving essentially unsolicited advice. This is bound to be confusing for people who cannot judge credentials.
From: Lynne Shields
I think that checking back to the list of invited folks is your best bet in knowing who is on this panel. If you have a printer, you might want to cut and paste all of the names from the list to a document and then print it out for an easy reference, if you'd like to have a way to check. There are quite a few of us, so it's hard to keep it all in memory. I'm glad that you are participating in the conference. Regards, Lynne Shields (one of the official 'Prof Is In' people)
From: Klaas Bakker, MSU, Springfield MO.
Just wanted to add to Lynn Shield's answer that other than the invited professors there still are many others with excellent answers and who cannot be checked against the list of "invited professors/specialists". This forum is very unique and on the one hand brings together the largest possible audience, and the largest group of specialists (of course, if they turn on their computer and login to the conference) together. Despite this incredible potential there is the problem of accountability in terms of where the information is coming from. I am convinced that many of the specialists (whether they are listed or not) are following all questions and answers even if they are not inclined to participate in a thread of discussion. So, if unqualified or erroneous information would show up on this list, there WOULD be a response to it.
From: Walt Manning
I agree with the earlier posts indicating that nearly everyone has something to contribute about the nature of stuttering. People who stutter are, at least in some ways, experts about their story. Many people who are not professionals in the field have accumulated knowledge that is often valuable. I have heard on a few occasions, people from other fields who happen to stutter and give workshops say that Speech Pathology and Audiology is a difficult field break into. It seems to me that most fields are like that, and should be, especially if you don't have at leat one degree in the discipline. I do believe, however, that real experts, beyond having some useful information, understanding and experience about a topic, also know enough to know that they don't know everything. It may be worthwhile to remember Bertrand Russell's comment that "The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."
From: Tom Weidig (thestutteringbrain.blogspot.com)
Here is my non-expert opinion (and had you asked the question 3 years ago when I was on the panel, I would have given you an expert opinion :-). First, the truth of a statement does not depend on who proposes arguments in favor or against but how good the arguments are. But you could argue that a professor's statement is more likely to be correct but you cannot argue that a statement is correct because a professor has made it. I have seen so many professors getting it wrong. And also some became professors because of their political, managerial, networking or bullying power and not because they are good scientists. Second, being an expert on the panel is a political and social process controlled by our Dear Leader Judy :-). Someone needs to decide. This is especially true for key speakers at conferences. Some are really bad speakers (and scientists), and others who are very good do not even get a prominent workshop spot. Third, stuttering affects a broad range of areas, and NO ONE is expert in all of them. And even if you work in one area, you might just be a bad expert. Fourth, we cannot really measure expertise well; if you are a good chessplayer, we will see it by you beating everyone else. If we had to measure expertise by understanding stuttering, or curing stuttering, there would be no real experts!
From: Walt Manning
Yep! But Bertrand was still correct.
From: Tom (thestutteringbrain.blogspot.com)
I agree with Russell to some degree. That's what I told my mother when she said that scientists are cocksure. I told her that in fact scientists in non-social sciences and computer programmers are always in doubt of their own abilities due to the reality checks they get from maths, computers or experiments. Then she asked me, but then how come you always disagree with me on anything I ever say about science or computers. And I replied: Because every single time you are completely wrong! ;-)
From: Ellen-Marie Silverman
[[Bertrand Russell's comment that "The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."]] >>> Perhaps, Russell would appreciate the lines by the Poet Rumi that advises "Beyond the gates of right and wrong, there is a field. I will meet you there." I know I do.
From: Patty Jarman
I am an SLP working with a 5 1/2yr. old boy who is stuttering. Analysis of his conversational speech (150 syllables)shows an average of 7% syllables stuttered consisting of initial part word repetitions (3), prolongations (1-3sec)and laryngeal blocks. Secondary characteristics are frowning, tight lower jaw, and at times reduced eye contact. I have implemented easy speech,loose contact, stretchy speech, pausing and talking in phrases. He is able to use these strategies at the word, phrase and sentence level with picture prompts to produce fluent speech. Mom is present during all the therapy sessions and practices the easy, stretchy speech daily with him (making up fun games). I've been seeing him 2xs a week since August. His parents report a significant improvement with his speech. Every session I do a speech analysis of his unstructured speech and I don't see a significant reduction of stuttering. He doesn't appear to be concerned about his speech and has not mentioned his stuttering. I haven't introduced any stuttering modification (bouncing) or voluntarily stuttered. I'm not sure how to improve the therapy. I would appreciate some help. Sincerely, Patty Jarman MSCCC SLP
From: Ken St. Louis
Hi Patty, Nothing succeeds like success! It seems you have developed a program that is working, at least in the parents' eyes. If the child is becoming more fluent and less concerned about his stuttering both while the parents have noticed improvement, I believe you can assume you are making progress. The fact that stuttering frequency might not be changing in your probes is a bit puzzling, but it could be due to lots of things. Have you considered severity? It is possible that frequency might even increase while judged severity decreases (as in fewer hard blocks replaced by more easy repetitions). Also it is possible that stuttering will appear when accessory behaviors such as "successful" postponement devices or word substitutions are no longer being used. It is POSSIBLE that the parents are not giving you the whole or correct story, or telling you what they think you would like to hear. However, I have very rarely found that to be the case. Generally, parents know what is going on. Finally, I would say that it is common for stuttering to gradually diminish and even disappear entirely after rather gentle intervention. I obviously cannot tell you what to do, especially not having seen the youngster, but I rather doubt that I would change a thing at this point. Ken
From: Pam
I wrote an interesting piece on my blog about PWS who sometimes apologize to listeners. It generated a lot of discussion. I have done it, and wound up kicking myself after - it was almost instinctual. Others say they feel the need to apologize for making listeners feel uncomfortable, for taking too much time, or just simply as an acknowledgement that the listener was being patient, and the apology was not meant as an apology. I have felt disappointed in myself when I realize I have apologized. Any thoughts? How would you handle a client who feels the need to apologize for stuttering? What advice might you give?
From: Lynne Shields
Hi Pam, You say that you are disappointed in yourself for apologizing. If I were working with you, I'd be interested in exploring with you what is behind your apologies. Are you apologizing because you feel that your stuttering is bothersome to others? That it takes 'too much talking time'?--I often wonder how much time is too much time, really. If the apologies are in any way connected to your feeling badly about your stuttering or guilty for 'inflicting' your speech on others, then perhaps a change in how you respond may help you focus on your listener and your stuttering in a different way. For example, if you truly appreciate a listener waiting patiently while you finish your talking turn, what other types of responses might help you give you a more positive spin on the situation? Telling them 'thanks for waiting for me to finish', or, 'you're a good listener', rather than apologizing is the first thing that pops into my mind. That seems a more positive response, since you are showing appreciation for your listener, rather than showing discomfort with your stuttering. Certainly, there is no need for you say anything in such a situation, but it may be hard at first to not say anything if you have been in the habit of apologizing. Whatever you do or say, identifying the feelings that lead you to apologize, and then challenging yourself to modify those feelings in some way, may be beneficial in helping you reduce or eliminate apologizing for other than things for which one truly ought to apologize. Regards, Lynne
From: Gary J. Rentschler
Pam.. I think it depends upon "why" you are apologizing. As an acknowledgment that you are stuttering seems like you are offering a chance to start a conversation about your stuttering.. which would be a positive affirmation. In other social interactions we apologize for things that really don't require an apology... these are also often things that aren't really apologies, but acknowledgments or "testing the waters"... "I'm sorry, I seem to be monopolizing the conversation; why am I doing all the talking?" Its a way of asking if its okay that I'm running on at the mouth! Truly apologizing for stuttering isn't such a positive statement about one's self. It seems to say that I did something wrong or I feel I did something wrong. Most people ARE pretty understanding, once you tell them that you stutter, and they aren't looking for you to say you are sorry. If something's not your fault, I don't see there's a need to apologize for it?.... but I think as a way of acknowledging your stutter, this is a socially acceptable action.
From: ari from israel
Pam : For my experience: after years of avoiding stuttering ,it picture to me that the reason we apologize ,is because we get use to manage without "disturb" people with our problem-and when we stopping hiding, we feel that ok we did the change, but why the listener need to suffer from it. I think that when we will understand, how damage the avoidance makes, we will understand that we stutter because we are stutterers and not because we are doing something wrong. This is my point of view.
From: Walt Manning
Pam, I think the comment from Lynne and Gary got to the core of the issue and you did also with your comment about avoidance. I think that most anything that makes us want to avoid or apologize to the listener is not the most useful coping response to the situation. I suspect that rather than apologizing it might be better for the listener, and certainly for you, to acknowledge the stuttering on occasion. This is more of a cognitive rather than an emotional approach for coping with the situation. Acknowledgment(which I don't think is the best term)is probably most effective when done in a genuine, forthright manner, perhaps with humor. Although a little of this goes a long way it makes it acceptable for the listener(s) to be OK with stuttering, and perhaps discuss it if they would like to. Approaching, rather than avoiding or attempting to apologize isn't likely to work well for the reasons mentioned by Lynn and Gary. Of course, the speaker has to be desensitized to their own stuttering before you can expect others to see it that way also. An interesting issue Pam and thanks for asking.
From: KELEN K
Hi Pam, If you are to ask me though am not one of the professors, I would look at it at a different angle. Apologizing is not accepting who you are. Even though some person may say its a nice way to make peace but i don't see anything wrong you did that you had to feel that terrible to apologize. You are just too conscious of your stuttering and possible many people you have come across might have made you understand you too take much time for your message to go through. We should all learn to accept us just as we are, we are all lacking in one way or the other. Its all about accepting people the way they are and learning to accommodate all. What can i say, let your jaws not fall because of what people might think of you. I might not have the appropriate words to explain this but ,i think you can understand the message i wish you understand. Remain blessed.
From: Charlton Knowles
Pam, I am not a professional SLP but would certainly qualify as a "professional stutterer." I have stuttered for over 50 years and I have been through the ropes regarding all the psychological/emotional stuff. Those times when I felt the urge to apologize, (I never explicitly had done so) but have instead said that I stutter but those times when I did that it was coming from an apologetic mind set.After a lot of years of self and professional therapy I am at the point with myself where I accept myself as a stutterer and just move on. My listeners sense my self acceptance and they just wait for me to finish my block and continue the conversation. Resolving stuttering, in my opinion, is not just being "fluent" but making also psychological/emotional adjustments to stuttering. A self accepting person (not implying that you are not) doesn't feel the need to apologize for stuttering,neither shame or guilt when they do stutterer. My last hurdle in becoming a more fluid speaker is to dilute the fear infused with feelings of failure to a point where it is not relevant. Walt Manning makes a good point when he says if you could find humour in your stuttering and yourself, then you are on the road to weakening the psychological/emotional hold stuttering have on us.
From: Margaret C.
I am an SLP in the public schools. I have a child on my caseload, a 9 year old girl, who I have been seeing for fluency. At this point, she has the ability to speak fluently and very naturally with me in and out of the therapy room. She appears expressive and confident, has never exhibited avoidance or physical concomitants. I wanted to dismiss her this year however her mother and teacher report that she exhibits stuttering when she is in a hurry and speaks very quickly. I did observe this last school year, but very infrequently. I talked to her about this and she told me she still stutters sometimes when she is in a hurry. Last year we talked about using easy speech versus hard speech, did some role playing, identified what she does when she is dysfluent ( initial sound and some syllable repetitions) and talked about using a walking speed rate when she is dysfluent. I also talked to her mother and teacher about how they interact with her etc. I do feel my job isn't done as mother, teacher and my student have all expressed that she stutters in some instances. I'm considering having my student keep track of her fluent and dysfluent speech for short periods of time prior to coming to see me and discussing when and with whom and then try to talk about how she could use the fluency shaping techniques of easy speech , breathing and using a walking speed to be fluent in those situations......... Do you have any other suggestion for me?
From: Lynne Shields
Margaret, I'm wondering if it is O.K. with this girl that she sometimes still stutters. If so, then perhaps she is ready for a maintenance program, rather than being dismissed outright. Would you be able to visit with her periodically, if she is interested in dismissal, to check on how she's doing? Over time, she may develop additional concerns, as her talking needs and requirements will change with age and maturation. So, keeping an IEP for her, thus allowing her to re-enter active treatment at some point in the future, may be the best way to go. I'm sure others will have some thoughts to share with you, as well. Best regards, Lynne
From: Margaret
Lynne, thank-you for your response. You make some very good points for me to think about i.e. how my student feels her stuttering and considering a maintenance program due to changing communication needs as she gets older. I appreciate your input. Margaret
From: Joe Klein
Hi Margaret, I think Lynne makes an excellent point here, and that perhaps you could also have a conversation with the teacher and the parents about what is "good enough". Being more fluent is nice, but you don't want to get to the point where she is stressing to be more fluent, leading to an increase in real stuttering... If she is comfortable in class, and is contributing as she would if she did not stutter, and is participating fully with only mild stuttering, I agree with Lynne that your job is only to make sure that that continues, rather than to reach some fluency ideal that those around her may have. Hope that makes sense. Joe
From: Meredith
I'm in 8th grade, and I'm 13. do you have any ideas for me to read aloud from a textbook with more fluent speech?
From: Vivian Sisskin
I don't know you, but I do know many other teens your age faced with the fear of reading aloud in class. Sometimes reading in class is fearful because of past experiences with reading aloud where you had an embarrassing block. Naturally, the dread of that happening can increase the fear of reading. It's also possible that you get by in conversation by changing words around, and it's harder to do that when you read and everyone is listening. Reducing your fear of a speaking situation can also reduce your struggle. By doing a lot of reading aloud, first in very low-feared situations (to a parent or to a close friend), and then gradually more fearful situations (your family, a small group of friends), you can make a fearful situation much less feared. We call this desensitization. It takes time, but can be helpful for many people who stutter. So, reading aloud till you wear out the fear might be helpful for you.
From: David Shapiro
Hi Meredith, Boy, are you asking a good question! Isn't it interesting that, for many of us who stutter, reading aloud by ourselves can be so challenging? One thing I found easier, and even fun, when I was your age was to read aloud in unison (i.e., in chorus) with other students. Have you noticed that when you and your friends say the same words at the same time, stuttering seems to disappear? You may have noticed this happening when you say the Pledge of Allegiance in class. Anyway, in some classes, reading aloud is practiced in this way. Here's another idea. Have you noticed how when you read or speak alone, stuttering again seems to disappear? Well, what if you began by reading alone and then, when you felt ready, maybe you could read with one special friend or teacher? Once you felt comfortable doing this, maybe you could add another friend, and so on until you were reading among more and more people. One more idea, related to the second one, might be to try to read in smaller reading groups of increasing size before you read in front of the whole class. Usually it is easier to accomplish challenging tasks in smaller steps. That enables us to experience success. When we experience success, then we feel more comfortable to try again. Before long, the challenge gets easier and easier; we experience more and more success; and we have more and more fun. Maybe these ideas will help, or maybe they will enable you to think of other ideas that would make reading easier. It is really good that you are working to overcome this challenge. Feel free to let me know how things work out. Good luck and keep up the good work. David
From: Meredith
Thanks guys! both of you were really helpful. my therapist recommended something that is really helping me. for the past few weeks, we have been practicing running our words together. she said that this helps you loosen your face, therefore stopping stuttering. its hard to go it in class, but ive had to read aloud twice and i sorta tried it and it helps. i took some of your guys hints into consideration, and i will try them next time!
From: RM
How is stuttering started in a family?
From: J Scott Yaruss
Hi RM - You've asked an interesting question. We don't know exactly how it starts, but research shows that stuttering does tend to run in families. Not always, but much of the time, it is possible to identify other family members who stutter. Who the "first" one was is probably impossible to determine! In my family, for example, my grandfather stuttered, as did my uncle. My dad did not, and neither did I, though my older daughter did. My younger daughter did not. That's just sort of how it goes. Was my grandfather the first one? Who knows? He didn't know his grandfather... As for what causes stuttering to start in a particular individual, well, that's an even tougher question to answer ;-) We know that there is a genetic predisposition in many cases, as mentioned above, but that still doesn't really explain why it starts for a particular child. I'll let others comment from here.
From: Tom Weidig (thestutteringbrain.blogspot.com)
Sorry, I am not on the panel, but I didn't like Scott's vague answer! Stuttering runs in families because those families have a genetic predisposition, which means that some genes in their DNA increases the probability of or causes the occurence of stuttering. A predisposition typically starts in one ancestor because some gene(s) in the DNA mutate(s) (changes) leading to such a predisposition. And this mutant gene(s) travel along the generations. Mutation is a natural process which drives Darwinian evolution, because it allows organisms to evolve from simple replicating molecules to complex organisms like ourselves. Dr Drayna is the genetics expert in stuttering, and can give you a more detailed answer. He studied such stuttering families in order to find the responsible gene(s). Best wishes, Tom
From: Scott
Well, Tom, I will yield to your expertise here. Obviously there is a more detailed genetic answer that can be provided... in this case, felt that the questioner was seeking something different from what you have provided and answered accordingly. I may have been wrong... at the very least, I was unable to satisfy you. Oh well. S
From: Nathan E. Lavid, MD
This is a great question, and genetics are not the complete answer to why stuttering would emerge in a family. While familial and twin studies of those who stutter reveal a genetic component, study of identical (monozygotic) twins does not reveal 100 percent concordance for stuttering, which means that some pairs of twins, who share the same genetic information, have a sibling who does not stutter. As with the many medical conditions with a genetic component that does not demonstrate full concordance in identical twins, such as Type 2 Diabetes, there must be some environmental factors that influence the emergence of the condition. What these environmental factors in stuttering are, is unknown.
From: Tom (thestutteringbrain.blogspot.com)
I do not understand your statement "genetics are not the complete answer to why stuttering would emerge in a family." It is true that stuttering in one specific individual of a stuttering family (meaning stuttering is present in many individuals of different generations) is not completely determined by genes, but also by random or shared environmental factors. But the reason why a stuttering family has become a stuttering family surely has to be only on genetics? Somewhere down the line of generations there was a mutation?
From: Bill
Well, are there subtypes in the big category of stuttering? The diversity of stuttering is incredible? Are there classification systems to group.... In order to isolate the gene/genes for stuttering. There are many stutterers without any family history....right? 50% have family history, 50% don't.
From: Joe Klein
Hi Bill. That's a great question about subtypes. The numbers seem to support that 70% of people who stutter have relatives who stutter and 30% of people who stutter do not have an identified relative who stuttered. Per Alm has done some great research and suggests that many more of the people who do not have a known genetic link experienced early head trauma, or difficulties at birth (lack of oxygen, instruments used, etc.) and that those without the link are also much more likely to show ADHD-like symptoms than are those with genetic histories... so there seem to be at least two paths toward stuttering. Whether one path is more likely to recover in any way or is different is still unknown. Take care, Joe.
From: Tom (thestutteringbrain.blogspot.com)
Following on from Joe's statements, I want to point out that the factors highlighted by Per's research are environmental factors but not related to nurture. This nature-nurture dichotomy is highly highly flawed. Nurture is only one part of the environmental impact. I also want to say to Bill that the diversity of stuttering is not obviously linked to different genetic influences. The very same gene(s) can lead to very different expression of primary and secondary stuttering symptoms or not lead to stuttering at all. However, there are likely tens of different gene(s) that can contribute to stuttering. For example, for deafness, geneticists have located more than 100 different genes.
From: Nathan E. Lavid, MD
Hello Tom, I apologize if my answer to the posted question was not understood. I'll expand on my answer here, but consider posting your queries as an independent post(s). This will allow myself and the other participants to specifically focus on your concerns rather than try to answer your questions in the context of the original question. Also, it will prevent your queries from being lost in the replies to the original question and possibly overlooked by other experts on this panel. To expand on my answer to RM's question, How is stuttering started in a family? I assumed RM was referring to developmental stuttering, not acquired stuttering. Developmental stuttering is an endogenous and heritable condition, and as such is orchestrated by one's genes. How a particular genetic make-up produces the phenotype, that is, the stuttering in the family, as demonstrated by the concordance studies of identical twins, requires some type of environmental influence. This influence could be a combination of many diverse environmental forces. No one knows. Though, once the gene(s) for developmental stuttering are found, there will be a better understanding of the protein(s) these gene(s) code for, and this information may shed some light why identical genomes may or may not lead to the emergence of developmental stuttering.
From: Dennis Drayna, PhD
Regarding JM's original question on how stuttering gets started in a family, many of the previously posted address this very well, I think, and I just have a few things to add. First, the generally accepted figure is that about half of stuttering occurs in the presence of a family history. For these cases of stuttering, we can make some good guesses as to how it got started in the family. One possibility, as Tom Weideg has noted, is that a genetic variant has arisen that somehow provides some advantage, but at the same time causes stuttering. This could certainly be true, but another possibility is that no such advantage exists, and such genetic causes of stuttering are simply nature's ongoing production of natural variation in our genes. The great majority of this variation is not helpful to the organism, but it can take natural selection many generations to eliminate it from the population. In fact, the figure of 50% of stuttering being due to genetic causes may be an underestimate. We know that using the presence of family history as a measure of gene frequency underestimates the true frequency of the genetic variants that cause many inherited disorders. So, a large fraction of cases of stuttering, even those with no obvious family history, could be due to genetic factors, and a "stuttering gene" may have previously existed in a family, perhaps for a long time, without being recognized. However in all cases, stuttering due to genetic causes comes from the appearance of a new mutation, which could have happened recently or at some time in the distant past. Now that we're beginning to make some progress identifying the genes that cause stuttering, it will be possible to answer some of these questions. I should also note that a large amount of stuttering is clearly not due to inherited causes. We don't understand these other causes very well at the moment, but of course these cases of stuttering typically occur in just that one individual, and are not passed down to anyone else in the family.
From: Umer Javed
Hello sir. I have a question. I can give presentation i can deliver speeches in toastmasters and most of time i get awarded BEST SPEAKER. But i don't feel that confidence when it comes to daily talking when it comes to handling phone and introducing my self. During my speeches i stammer with confidence but during normal talking stammering makes me feel anxious and worried. Isn't it strange?
From: Joe Klein
Hi Umer, great question, and no, it's not strange. For many people who stutter, me included, it's actually easier to be standing up in front of people talking, I believe because there is a great reduction in time pressure... you have the floor, you are speaking, and no one will interrupt you during the allotted time that you have. When you are in a conversation, however, there is a tremendous amount of time-pressure involved... someone speaks, you speak, they speak, you speak... it's very difficult and very fast... Does that sound true for you?
From: Umer Javed
Wow .you are right. At that time all i know was to take my time. And in actual conversation time pressure plays a role. True very true. Got it :) so we must learn to take our time while speaking
From: Joe Klein
Yes, and you can take your time by using speech techniques like volutarily stuttering, freezing or holding onto a moment of stuttering, pausing while you are speaking, or trying to slow down your rate... or, just trying to stay in the moment and realize that you don't have to give into that urge to hurry. And it may help to try to figure out where that urge to hurry comes from. Take care, Joe
From: Umer Javed
Hello everyone. Most people stammer on the first sound of any word. For me its like that i can start a word perfectly but i stammer in the middle e.g cotttttttttoon. Now T is my fear word. I can easily start a word starting from T but when T comes in middle of the word i stammer like TRACTTTTTTTTOR . Then i realized that i was pressing my tongue way too hard against my palate and my therapist told me about light contact. But no matter how hard i try with this light contact i am unable to speak t when it falls in middle of word although i can speak it when it comes at the starting. What should i do :)
From: J Scott Yaruss
Hi Umer -- You're right that people do tend to stutter on the first sound of a word... Another way to think about this, though, is that people tend to stutter at the beginning of a SYLLABLE.. .So, tractor, with two syllables, actually gives you two opportunities to stutter (lucky, huh?). From what you described, it sounds like you've practiced those light contacts for the initial "t" -- but then that middle one comes along and gets you. It's another initiation and another opportunity for stuttering. And, it also sounds like you've done some good work to understand what you're doing with your speech mechanism during the moment of stuttering (pushing your tongue, etc..). So, as to what to do with this...no easy answers, of course, and lots of different opinions. For example, some people find that when they're experiencing a lot of physical tension, they try easy "bouncing" or easy repetitions as a way of moving through the moment of stuttering and keeping the tension from building up too much... So, it could be something like "tract-t-t-or." These repetitions will be intentional - using stuttering as a way of changing stuttering. Another piece of the puzzle is to continue to work on desensitizing yourself to stuttering to help you reduce some of that lingering tension... Remember that the techniques can't do all the work. There is of course much more to say and others will add on.... S
From: ari from israel
When i had 12 years old -i had a treatment with the founder of the stuttering treatments in Israel, and he said to me something like "the speech tools don't help to overcome stuttering, so you need to accept yourself as a stutter" Did you think ,that is possible to severe stutter to overcome stuttering without the help of speech tools?
From: J Scott Yaruss
Hi Ari - Wow, you've asked a great question. You will see from this conference that there are a wide variety of opinions, and nobody knows the right answer! There are certainly some people who feel strongly that speech tools and techniques are the key to success. On the other hand, there are also people who feel equally strongly that speech tools are not the whole picture - or that they shouldn't be part of the picture at all. As for what works for you, well, there's nobody who can tell you that... For my part? (again, others will offer their own opinions), I feel that tools can play a helpful role for many people... tools are not nearly all that's needed, but for some people who want to learn to change their speech production in order to enhance their fluency, then tools may help them. They'll still need other components of treatment (to help with desensitization and acceptance, for example -- tools don't help much with that part!). Other people may want nothing to do with tools at all, and of course that's okay too. I guess my experience has been, too, that many people who go through a period of learning and using techniques ultimately stop using them, or use them less, as they become more comfortable speaking (and stuttering). Could they have gotten there without the techniques? Who knows... I'll look forward to reading what others write... S
From: Lynne Shields
Wonderful question and I agree with Scott — the answer can be different for different people. I think that the decision to learn and use any of the variety of management tools depends, in part, on how you define "overcoming stuttering". For example, if by the term you mean being a fluent speaker, then I think that you may find one or more of the tools quite beneficial in achieving your goal. If being O.K. with your stuttering is more important, then learning tools may not be the primary focus. Desensitizing yourself to your stuttering might figure more prominently in managing your stuttering. Many people who stutter benefit from taking both approaches--addressing fears and attitudes about stuttering and learning tools. There is no 'right answer', in my opinion, because everyone has different goals, differing amounts of time to devote to managing stuttering, and differing concerns related to their speech. Thanks for asking the question. Regards, Lynne
From: ari from israel
Thank you for your answers! My opinion is: that the 2 aspects speech production and desensitize have a strong linkage. When you work on one aspect, the other aspect is much easy to work to. So i think that slp need to give to the severe stutter the two aspects, of course depending of the need of the specific client. I think that slp's that don't treat at all at one aspect, (like most of the slp's in Israel) are don't doing their job properly. And also i think that the approaches: just go and stutter and everything will be all right, or from the other side :use your speech tools and just speak fluently or with easy stuttering-is not realistic to the most severe stutterers -they need them both.
From: Vivian Sisskin
Ari, Great question! Here's my take on it: I feel that ALL of these things are tools. Desensitization is a tool to reduce fear and reactivity, fluency shaping (enhancement) strategies are tools to change the speech signal to produce non-stuttered speech, and stuttering modification strategies are tools to change the way one stutters. Speech tools, like all tools, do the job best when used properly and for the purpose they were intended. Imagine using a power saw to cut a fingernail! Sometimes when tools don't work, it's because the person lacks a clear rationale for their choice of tool. For example, voluntary stuttering can be used to show oneself as a PWS when s/he does not have to. However, if it is used on stuttered speech, it can become a way to avoid another form of stuttering, resulting in a tense prolongation that becomes a new feature of the person's stuttering pattern. Or another example: An easy onset, when used properly, can prevent stuttering during a transition to phonation, but if used to 'fix' a moment of stuttering, it can lead to gasping and speaking on inhalation as a new feature of the stuttering pattern. The bottom line' you might want to consider all the tools available and how best to use them safely and effectively.
From: ari from israel
Thank you Vivian! You add interesting point ! So speech tools are very powerful, but we need to use them very carefully.
From: KELEN K
Goodday everyone, I am from cameroon and i have worked and still in in contact with Mr Lukong Joseph of SCAC. During the 1st ever african conference that took place in douala cameroon where i was given the opportunity to work with other scac members, to go to the national media sensitize people and create awareness on the activities of the conference and the objectives of speak clear association of Cameroon, and one of the interpreters during the conference. I am not a stutterer but am ready to devote some of my time to undergo some training with the hope to put into effect what i have learned to be at the service of those stutterers in cameroon and why not the world at large. During the conference i remember talking to Mr David Shapiro who inspired me on undertaking clinical service studies and be at the disposal of those in need back home. I wish to find out if there are any distant learning courses one can undertake while back in the country since my work does not permit me to take any study leave to facilitate my task.I am very willing and ready to take the challenge. This struggle to me is not only for stutterers if some of us decide to hold our hands and stand for the plight of all the stutterers, I think this world will be a better place for everyone and no more fun making discriminating most of you face in one way or the other. From those i manage to talk to, complained of the similar thing (that of being made fun of, shy away from the public, unable to accept it because they think it's like a curse from the forefathers and at times parents, cannot withstand slangs......etc) Ever since the online conference started i have been reading on a daily basis articles and previous ones people send and almost am the questions and answers. All of this to gather facts and see how i can be of help. I am looking forward to attend the conference in February in Australia because i might be on annual leave. I am looking forward to meeting all of you and ready to tell you all how i have been trying in my own way to talk to those i meet in the town i leave and at my place of work because i am at the customer service and encounter so many people. I equally informed Mr Lukong of SCAC and hope to meet him soon before the 22-october (this month).I am looking forward to hearing from you soon. Stay blessed.
From: Lynne Shields
Kelen, I am glad to know that you are interested in training to obtain clinical skills. There are some universities in the United States that have online coursework in speech-language pathology, but I do not know whether they are available for international students. You can go to the website for the American Speech-Language-Hearing Association to search for programs that have online programs and contact them about the possibility for you to study through their program. Some of the programs will be graduate programs, which require you to have an undergraduate degree, even if it is not in the field of speech therapy. There may be online opportunities in other countries as well. I wish you all the best as you seek ways to gain training. Regards, Lynne
From: David Shapiro
Hi Kelen, How good it is to hear from you again! I remember our meeting and our conversations in Douala in October 2005. I am so pleased to read of your ongoing commitment to understand stuttering and to be in support of people who stutter. We need more people like you. You are right; there are so many misperceptions of people who stutter. These misperceptions seem to perpetuate, despite the best effort of so many good people (e.g., Judy Kuster's coordination of conferences such as this is a prime example of what can be done by one person. She brings so many people together to communicate freely about a common interest. I think there is no better way to combat misperceptions and negative stereotypes than by open dialogue with the experts ' people who stutter, as well as families, speech-language pathologists and allied others). I think it is excellent that you remain in contact with Joseph Lukong. What he has done by initiating and coordinating Speak Clear Association of Cameroon (SCAC) is such a significant and positive contribution. I know Joseph has some ideas about developing opportunities to bring clinical education to Douala. You might want to speak with him about your desire and how both of you can work toward making this vision a reality. I would be interested to learn more as these ideas develop. Thank you for your commitment to the stuttering community. Your friend, David Shapiro
From: Bob
Hi, was Marilyn Monroe a person who stuttered? How come she never stuttered in the movies? Also, how can Winston Churchill be a stutterer and also a powerful, inspiring public speaker/politician at the same time.
From: Lynne Shields
Bob, I understand that Marilyn Monroe was, indeed, someone who stuttered. Some reports suggest that she used the breathy voice she is famous for as a way to deal with her stuttering. I don't know if that is true or just conjecture. There are a number of actors who stutter. While some of them report that they sometimes stutter while acting, in the case of film acting, a scene can certainly be re-shot if stuttering occurs. I would guess that this is what was done if she happened to stutter while saying a line. Actors rehearse extensively before a performance of any kind, so I suspect that they may stutter less due to their having practiced their lines so frequently--there is no novelty in the lines, and the motor programming is highly learned from many repetitions. Regarding Winston Churchill, he probably rehearsed speeches prior to giving them, so the practice effect may have helped him stutter less. I am not aware of whether or not he used any therapy tools to increase his fluency. Regardless of whether or not one stutters during a public presentation, one can be a very effective public speaker. A good speech, well delivered is not entirely dependent on fluency. It also depends on how you engage with the audience, the way you carry yourself, and what you have to say. So, someone who stutters may be just as effective (or more effective) than a speaker who does not stutter. There are quite a few individuals who stutter and are members of Toastmasters (and the equivalent organizations outside of the U.S.), many of whom do quite well in competition. I hope this answers your question. Best regards, Lynne
From: Judy Kuster
A bit of additional information -- audio archives of many of Winston Churchil's speeches rarely reveal stuttering symptoms, although some do (http://www.archive.org/details/Winston_Churchill Because my distant cousin (yes he was!) was such an effective speaker, some have wondered if Churchill was in fact a person who stuttered. Keith Sharp uncovered ample evidence that Churchill was in fact a PWS (http://www.stutterers.org/ He was also a very effective communicator. It has been said that he practiced his public speeches a LOT before delivering them and chose his words very carefully to avoid stuttering.
From: Pam
Yesterday, I had to meet with a student and the assistant principal about a rules infraction the kid had. It was pretty straight forward, and the kid was being cooperative. The assistant principal knows I stutter. The kid didn't - it was the first time I had interacted with him. While speaking to him,(I was sitting next to him, AP was across from us, behind her desk), I was making eye contact and got stuck in a good block. I don't remember the word, but it began with "k" and the block went something like, "k-k-k-k-k-k-k (dragged) then finally the word". I was able to finish the word. Then I finished my thought, and had several slight repetitions. The kid didn't say anything, but looked surprised and like he was wondering what was going on. I didn't acknowledge that what I had done was stuttering. Should I have? I did feel slightly self-conscious, but let the (long) moment pass.
From: Joe Klein
Hi Pam, I learned a long time ago not to should on myself. If it makes you feel more comfortable, then go ahead. If not, then don't. I think educating people, overall, is good. But we don't have to -- and honestly, we can't -- do that all the time. You certainly don't owe anything to a random teenager. I think it's important to realize that it's okay to feel uncomfortable, whether we are talking about ourselves as PWS or our listeners... heaven forbid we Americans feel uncomfortable for a minute. Keep up your good work. Joe
From: Taysha, 25
Hi Joe and Pam! I agree with you Joe. I do not stutter myself, but I am in a graduate class for speech language pathology and our professor teaches us to help our clients become comfortable with their stuttering. So whatever you are comfortable with. If you would be more comfortable acknowledging the block then do so, but if you are more comfortable just letting it go then do that. I think that the more comfortable you become with your speech the more natural the answers to these type of questions will come to you. Thank you for sharing your story!
From: Evan age 10
when i slow down i can really take control of my speech but i have a really hard time to slow down. any suggestions?
From: Lynne Shields
Evan, Your question is such a good one, and I think that many people who stutter would agree with you, that slowing their rate may be very helpful, but at the same time, it is SO HARD TO KEEP ON DOING IT. I think that the rate of talking that you typically use is what feels normal to you. Anytime we are used to doing something in a certain way, it is very hard to make a change. A few things you might think about could help you be more successful, if giving yourself more time to manage your speech helps you. Some people find it easier to speak a bit more slowly if they slow themselves down by putting more pauses in their speech. For example, saying "Hi (pause) My name is Evan (pause) and I am 10 years old". These don't need to be long pauses. On the other hand, if going a bit slower overall works well for you, but is really hard to remember, then you can work out some new ways to help yourself remember to go a bit slower. I don't know what you've tried, but some examples could be, 1) putting a little sticky note on your school planner, your bathroom mirror, etc. that has a symbol that means 'go slow' to you. These notes can be moved every few days, so you don't get used to them and start ignoring them(My teenaged sons actually write notes to themselves directly onto their hands, which could serve the same purpose.), 2) decide on two or three times during each day when you will focus on speaking at a slower rate for a brief time (one or two sentences)--when you first talk to your family at breakfast, when you answer a question in math class, when you greet the crossing guard at your school. This gives you a short time of practice several times a day. Once you feel that you are able to do this, you can add more short practices, or see if you can keep talking a bit slower for more than a few sentences--three, then four, etc., 3) ask another person to give you a signal (raised finger, touching their right cheek, etc.) at times you both agree on, to help you remember to go slower. You can probably think of other ways to help remind yourself that will work well for you, if remembering is the problem. And, it takes time, quite some time, to change a habit like how fast or slow you talk, so it is important to give yourself plenty of time to work your way up to where you would like to be. If going slower is hard because it feels uncomfortable to you--you think you sound odd, or you are not tolerating taking more time, then that's a different problem. More practice won't help if slow just feels, well, TOO SLOW. If going slow is important to you, then you may want to 'retune your engine' at bit. By that I mean, work on feeling that the new, slower rate of talking is really O.K. to you, feels comfortable. How could you do this? A few ideas come to mind: 1) tell yourself 'it's O.K. to go slow'--not allowing yourself to feel rushed, so that you'll want to talk faster. 2) telling your friends or family that you are going to work on talking a bit slower because it helps you with your speech--this would help you if you worry that others won't wait for you to finish what you are saying, or if you worry that they will think your new rate of talking is odd, 3) watching yourself talking on video, going at your slower rate, and getting used to how it feels and sounds. If you are seeing a speech therapist, you can ask them to help you work this problem out. You have an idea of what you want to do, which is a great place to begin--I wish you all the best as you figure out how to achieve your goal. Regards, Lynne
From: Yemi Akintunde
Here we are again celebrating ISAD this year. Judith this is a great work you are doing for this event please keep it up. We all owe you many thanks. My question is: Must a stutterer talk about his/her stuttering first when speaking to someone he/she never talked to before?
From: Gary J. Rentschler
I don't think that there is one answer for everyone. It depends upon a couple factors. For those who are afraid that their listener will find out that they stutter, it may be best to let them know early in the conversation. This often puts the person who stutters at ease (and the listener too) but getting it out in the open on your own terms. However, there is no obligation to do so; any more than the need to tell someone that you have a toothache or a sprained ankle. Its really your business. But if you feel the stuttering will get in your way, its often best to "get out in front of it" by letting your listener know about it. I have friends who stutter who tell their audience that they stutter right away; getting it out is such a relief that they then don't stutter! So I'd suggest that you to do what's best for you.
From: Yemi Akintunde
Stuttering has been part of me for a very long time, how would i know if am already growing out of it?
From: Gary J. Rentschler
Yemi: In my experience, outgrowing stuttering most often happens at two times in life, between 8-10 years of age and then with advancing age (60s and older). I've always dreamed that I'd outgrow my stuttering... I've waited 62 years... its better, but still there. You might be better off working to manage it, than waiting for it to go away on its own.
From: Bobby
why is the stutterer almost always most fluent inside the therapy room one on one against the clinician. Note that the stutterer is usually male and the clinican is usually female. Any studies that can possibly explain this phenomenon? This phenomenon is problematic because the speech therapist is trying to help the client but can not observe any stuttering? Finally, do you recommend therapy outside the clinic in real world situations? Is there a manual that teaches female speech therapist to help the stutterer with real stuttering in the "real world"? The clinic room is not real, so what if the stuttere has perfect fluency in the clinic room. And the PWS is asked to make this transfer to the real world and if he doesn't succeed, then he is not motivated. Some SLPs tnink her job is finished once the client has 100% fluency in the clinic room, and it is the client job to make it work. The issue is: the client may already be 100% fluent in the clinical setting before any speech therapy.
From: Ken St. Louis
Dear Bobbie, Good question...and one that we ask ourselves very frequently. Why is it that a person can be perfectly fluent in the clinic room one-on-one with the clinician but then walk out the door--or even open the door, stand up in the room, move to the other side of the table, etc.--and begin to stutter again? The answer is certainly different for every individual, but there is much that can be said to answer your question. First, the clinic room is a safe environment. The stutterer knows that stuttering will not be negatively judged or punished. Second, the clinician is usually helpful and encouraging. Third, the demands of the one-on-on clinical situation are greatly reduced from the normal daily communication environments. Fourth, training in speech targets, stuttering modification, or other "tools" occurred in that one-on-one clinical situation--not outside. Fifth, most people immediately carve out a "comfort zone" (See many of Alan Badmington's posts and articles) where they can be fluent (i.e., the clinic room) and, thereafter, changes in that comfort zone produce stress or anxiety. Sixth, stuttering is often highly situation-specific; past successes in the clinic room promote easier talking, and past failures outside promote harder talking. So it is wonderful if the stutterer can be/become very fluent in the clinic room as it can suggest what might be possible in other situations. Of course, that is just the first step. We call that first step establishment, instatement, etc. Any therapy worth its salt, however, will also have a transfer and maintenance component. Usually the transfer stage goes hand-in-hand with the establishment stage and, as your post mentions, involves going outside the clinic room to practice the skills learned there in different settings, with different people, and both of these together. In my view, therapy without transfer is like driver's training in a simulator with no real driving or instruction in white water rafting without the experience of rafting itself. Both are necessary. I won't say anything about maintenance, but these are activities designed to practice the skills over months and years so as to reduce (but not necessarily avoid altogether) the likelihood of a serious relapse. You also asked about the role of the female clinician and male stutterer. Personally, I have never seen that that made any difference at all unless there were other issues such as romantic inclinations, cultural taboos, etc. I hope this helps. Ken
From: Ed Feuer
Some clinicians may ask themselves that question frequently, but the long-standing question is: what do they do about it? What has been known to happen, and altogether too frequently, is the following. (And it bears repeating, students, and not just because stutterers do it repeatedly.) 1. A practitioner gets a stuttering client relaxed in the clinic room, greatly reducing dysfluencies; 2. The practitioner gives the client some "technique" in the clinic room; 3. The client leaves the clinic room into the real world and falls flat on his or her face; 4. The client reports that to the clinician in the clinic room; 5. The client is told by the clinician in the clinic room, "Oh, you're just not working;" 6. The clinician collects from the bill-payer. Given the nature of stuttering, what is needed (to prevent No. 3 above) is thorough, effective, systematic, in vivo desensitization -- outside the clinic room. But if clinic room fraud happens, that's when, ideally, a call to ASHA's still non-existent dedicated ombudsman for stuttering would come into play. Or you can try your luck with ASHA's existing complaint "structures."
From: Walt Manning
Bobby, you've already received some useful responses to your questions and I'll add just a few more . Other reasons why it's relatively easy to achieve fluency in the treatment setting is that the speaker adjust to the expected roles in that setting. The give and take of some treatment procedures quickly become predictable in what is typically a safe and accepting environment (as Ken St. Louis pointed out). I've often likened performance in the therapy setting to shooting baskets in your driveway or by yourself- its not difficult to have a high rate of success. Of course, what really counts is such performance under the distractions and time pressure of a real game when the price of failure can be high. As everyone has already pointed out, you have to practice the techniques under game conditions until the techniques become more than techniques - they become of who you are. You have to practice until you develop the confidence in your ability to respond successfully and eventually the ability to perform them automatically without even thinking about it. Your other question about the typical situation where the clinician is female and the speaker is male is something I've often thought of and an issue that probably should be investigated. I can see the situation where an adolescent male (or adult male for that matter) is unlikely to honestly discuss his anxieties and fears with a female (perhaps especially a young, attractive female). Clinicians should at least be aware of this possibility and devise a strategy or two to deal with this. Lastly, and related to the first question, the speaker is likely to produce fluency in the treatment session, especially if that is the primary thing or perhaps the only thing that is rewarded. Of course it is possible to avoid certain words and sounds and change or substitute words. I have no doubt that some clinicians unknowingly reward such avoidance if they are overly-focused on fluency as the only goal of therapy. Here is a quote from one of the people we included in a recent investigation that explains it nicely: When I was in therapy in junior high I would "substitute and I would not stutter and she [speech therapist] would think that I was making progress, but I was hiding it the whole time. I don't know why I would hide it from the speech pathologist you know, but it was just that I was ashamed of it, so any chance I could dodge a block I took it. So she thought I was making so much progress." You asked great questions Bobby and they show a lot of insight about the therapeutic process.
From: Dan in TX
Is there any suggested technique or method (other than lots of practice) to help with avoiding a hard block at the beginning or end of a phone call (the "Hello" and "Goodbye"), or upon introducing myself to someone ("Hi, my name is..")? It seems to be a learned response for me to these situations. With effort I am beginning to occasionally minimize it, but I am unable to do so consistently. I focus on keeping tension in my throat and mouth to a minimum while leading up to these situations but the tension always ramps up right as the person answers the phone, or I start to introduce myself. While I know there is no "easy fix-it", I am wondering if there is a suggested method/technique/mindset that might help me train myself to overcome this learned response in addition to my current efforts.
From: Greg Snyder
There are any number of different ways to try and avoid, control or better manage an effortful / uncontrolled stuttering moment... However, the one that I prefer (both personally and professionally) is the act of volitional stuttering. How can we best retain control over stuttering? Do it on purpose. And when volitional stuttering is used sufficiently, it also has a tendency to scrub-away some of the older secondary stuttering behaviors (such as hyper-activated muscles).
From: Lynne Shields
Dan, From your post, it sounds as if you are beginning to experience some benefit from your practice of reducing physical tension as you begin speaking. It seems that you are working on using an 'easy onset' to words, meaning you exert less pressure to form the sounds in your mouth or turn your voice on in a gentle manner. You guessed right that it will take quite a bit of practice to become more consistent in reducing the tension you use when you block, so seeing a gradual increase in the frequency with which your are successful is a very realistic outcome. When you find yourself in a block, another way to manage this is to use a 'pull out'. This entails slowly releasing the tension of the block, similar to slowly opening a clenched fist, allowing you to move on to the next sound of the word. That would give you two points at which to manage your blocks, the first being to reduce the likelihood of a block occurring as you begin to say a word (what you described in your post) and the second being a way to deal with a block, once it is already there. Another idea that some people find helpful is to begin talking with some voluntary stuttering. To do this, you might use some easy repetitions to start your introduction ("he-he-hello. My name is...."). This can serve several purposes. It can ease your own tension, because you aren't trying to avoid stuttering, and it is stuttering that you are choosing to do, so you are stuttering in a controlled manner, which may also reduce your tension as you begin to speak. It can be desensitizing for you, which is probably the most important outcome. It may also have a side benefit of alerting an unfamiliar listener that you happen to stutter. I wish you the best as you figure out ways that help you manage your stuttering. Regards, Lynne
From: Gary J Rentschler
Dan: You're right about it being a learned response. Lynn and Greg have offered some very sound advice about stuttering on purpose. What I've seen in my own stuttering and in the clients I work with, are the very powerful affects of emotional learning in this situation. You might video yourself speaking on the phone or ask a friend to help you to learn some of the behaviors you have that you are not aware of. For example, many of the people I work with take a rapid inhalation of air immediately before saying their name. When brought to their attention, it becomes clear that they were unaware that they were doing that consistently. It is a reflection of their apprehension; their fear that they will stutter. Its an attempt to "insure" that they will push through any block that might arise. Instead it insures they will stutter. Often under anxiety, what we do in our attempts not to stutter works against us, actually increasing the likelihood we will stutter. I've seen this learned response to be very strong and difficult to overcome. My best advice is to try to speak softer, easier and slower, rather than fast and hard. It can be diminished with practice, but don't give up, it can take a long time.
From: Holger Stenzel
A Pagoclone trial participant reports I wanted to give you an update as to my experience with the pagoclone study. I've been on it since around April or so. At least I suspect that I have been on pagoclone for at least part of this time. I was initially given a dosage of two pills twice a day, which lasted for the first month and then went down to a dose of one pill twice a day. I do believe that I experienced a modest improvement in my fluency, somewhere around maybe 40% better fluency, and then after the dosage change I experienced a pretty dramatic drop in fluency to almost pre-study levels. At my last visit, three weeks ago, I was informed that I am transitioning from phase 1, double blind study, to phase 2, open label study, and should find myself on the placebo during this 8 week period to accurately transfer to the open label phase. When this occurred, whether real or as a result of being informed by the Dr. that I would be on the placebo, my stuttering increased dramatically and am now definitely at pre-study disfluency levels or worse. So to sum up, I do believe that I have been on the medication for at least part of the study. I do believe that when I was taking the higher dose my fluency was MUCH better. I do believe that the lower doses and the placebo have had a dramatic effect on my speech to pre-study levels or worse. Since April I have experienced zero side effects. No headaches, weight gain, sleeplessness, nothing. Of course, I don't have a clue as to what my blood work shows but am sure if there was a problem, then the clinic would have most likely informed me. Overall, I have been happy with the results from the first part of the study and would definitely purchase this medication at the higher dosage level. At the lower level, if the price was cheap enough I would purchase the medication but it would have to be cheap as the rewards were minimal. I hope this gives you some idea as to how the medication is working for at least one person.
From: Ken St. Louis
Dear Holger, I always say to my students, "Nothing succeeds like success." It sounds like Pagaclone may well be responsible for some of your improvements. I won't offer any comment except thanks for providing this detailed personal commentary as a participant in the study. Best wishes, Ken
From: John Tetnowski
Thank you so much for sharing your outcomes. I find it fascinating and am anxiously awaiting the end results of the trials on Pagaclone. Here is something to think about that is based on the writings of Daniel Moerman, in his book, "Meaning, medicine, and the placebo effect". A placebo means that you received no effect. You do say that you got the drug (2 pills), you had a positive change. What would you think if you just received an inert ingredient (thereby, you got the effect without the actual active ingredient....this is referred to as the "meaning effect"). There are many studies cited in Moerman's book that show how this has happened. They cite examples of how "2 pills work better than 1 pill", "injections work better than oral medications", and even in some cases how "blue pills work better than pink pills". I am not doubting the effects of Pagaclone or any other medication. I am saying that there are often effects (both positive and negative) that are a result of something other than the drug itself. Just something to think about! I anticipate some controversy and have thought long and hard about posting this comment. I am just throwing it out there for discussion. I wonder what other are thinking??? John Tetnowski
From: Ellen-Marie Silverman
[[I am saying that there are often effects (both positive and negative) that are a result of something other than the drug itself. Just something to think about! I anticipate some controversy and have thought long and hard about posting this comment. I am just throwing it out there for discussion. I wonder what other are thinking???]] >>> Dan Moerman's from a medical anthropology perspective seem rather commonsensical, not controversial in the least. It is our beliefs, after all, that lead us to the experiences we have in life. That we come to helpers with certain beliefs about the manner in which help will be offered and its possible, even probable, effects is to be expected. There is no reason for us to believe our clients and students are any more "blank slates" than are we. I'm glad you reminded us of that.
From: Dan
Hi, do you think if the society had increasing positive attitudes towards stuttering, then there would be less stutterers and children who stutter in this world?
From: J Scott Yaruss
Hi Dan. It sure would be wonderful if the world were more educated about stuttering - more accepting, more understanding, more patient, and just plain less ignorant. There are a lot of good people working hard to make that happen, though education and outreach and experiences like this forum. Unfortunately, I don't think it would reduce the number of people who stutter, though, because stuttering is caused by genetic and neurological factors, not by the way people are treated. True, many people who stutter are treated badly, but this does not create the stuttering. (It can take existing stuttering and make it worse, but it doesn't create it in the first place...) That said, those people who stutter who would be living in this better world would probably be less negatively affected by their stuttering — they'd have an easier time communicating with other people because those others wouldn't come with misconceptions and misinformation about stuttering... SO, "stuttering" would be easier, but there would still be "stuttering." We can still work for that world, though. The benefits would be real, even if it wouldn't eliminate the disorder entirely... There is much more to say on the topic (e.g., how for a long time much of our field believed that stuttering WAS caused by the negative reactions of others...though today the majority of the field favors other explanations), and others may chime in as well...
From: Pam
Along the lines of the last post by Dan, attitude is definitely a big part of how we perceive our stuttering. Right? Right, I know it is, but it's hard to have a positive attitude when the stuttering sneaks up on you. I have been trying to be very gentle with myself as I experience blocks that are more overt. I have been trying to take the advice of trusted friends and professionals who are encouraging me to feel the blocks as much as possible so I can figure out satisfactory management. I was just on the phone and struggled big time with the word "see". I couldn't get past the "s", which is actually unusual for me, because when I do block, its mostly on class 4 sounds. I got very frustrated, and my patient friend gently admonished me to "ride it out". My mind tried to find another word to switch to, and that wasn't working either. I am a veteran stutterer, but still find these moments tiring and frustrating. Advice, thoughts? ... And what's the best way for an SLP to help someone through this?
From: Ellen-Marie Silverman
[[I have been trying to take the advice of trusted friends and professionals who are encouraging me to feel the blocks as much as possible so I can figure out satisfactory management ]] Hello, Pam. Let's get down and dirty. It seems to me, as someone who only knows you through the posts and paper you have contributed to this and last year's ISAD Online Conference that, like most of us, you are a bit impatient. And, like many of us, you believe that if you can just reason a way through an unpleasant circumstance you can rid yourself of it. Well, changing a speaking behavior calls for patience and, as I mentioned, getting down and dirty. A willingness to experience the stutter --- the thoughts, emotions, bodily sensations associated with it --- i.e., to recognize, renounce the tendency to resits, to relax into it, and to resolve to keep doing so for as long as it takes has helped (as I wrote in a 2005 ISAD Conference paper, entitled, Shenpa, Stuttering, and Me)or some sort of variation of this very experiential, non-intellectual work can help. So, what else is new? You know the ropes, you just need to determine to apply them as consistently as you can. Best, Ellen-Marie
From: Pam
Thanks Ellen-Marie. I will look at your 2005 paper. Hmmm, I guess you pegged me right. :) I am impatient. I have been ok with most of my easy repetitions and even minor hesitations, but these bigger stoppages, they need to stop!! Yes, I know intellectually what I need to do, but I find it hard to find the patience to stay with this. You're right - this is the down and dirty part that I am resisting. Thanks for the good advice, and for remembering me from last year!
From: Ellen-Marie
Ok, I just read your 2005 ISAD article, SHENPA, STUTTERING, AND ME. I must say, it grabbed my attention. I am new to owning my stuttering, as you may recall from last year, as I was extremely covert until May 2006, so for well over 30 years. During these last 3 years, I have been stuttering more and differently, than I was when trying to hide it all of the time. Interestingly, I saw a therapist soon after finally talking about stuttering, and she encouraged me to study mindfulness, and I read 2 of Zabat's books. But I was not focusing on stuttering then, I was focusing on symptom relief from a traumatic event. But even then, I saw the potential of a mindful approach to stuttering. So, yes, this idea of SHENPA makes good sense now. I get hooked, and immediately try to fight it. That's what I need to be more mindful of. Thanks again. I have printed it out.
From: ari from israel
Pam-as you know — probably my stuttering is more severe than your stuttering. And also i am trying to stay at the moment of the block, and it is very difficult to me too. I think that the reason is because when we hold in the moment of stuttering, we hold the moment of the impossibility to say the sound. When we feel that we can't say the sound, we want to do something, and it is very hard to just stay in that moment. I think that this problem causes the most of our stuttering behaviors. I guess that when you realize that in short time, you will back get the possibility to say the sound, the during time of the blocks will get shorter. But i neither am yet- in that stage.
From: Ellen-Marie Silverman
[[And also i am trying to stay at the moment of the block, and it is very difficult to me too. I think that the reason is because when we hold in the moment of stuttering, we hold the moment of the impossibility to say the sound. When we feel that we cant say the sound, we want to do something, and it is very hard to just stay in that moment. I think that this problem cause the most of our stuttering behaviors . ]] >>> Just a quick comment about staying in the moment with the stutter: Doing so means attending to how your body is feeling as you stutter as well as the emotions you are feeling and the thoughts you are thinking. It is being an observer of all you are doing while stuttering. It does not mean deliberately, as you put it, "holding the sound." It means observing without judgment and letting what transpires transpire. And, yes, it is not easy, but it is necessary. As the Dalai Lama has said, "Nothing is gained by doing what is easy." --- Ellen-Marie Silverman
From: Pam
Yes Ari, from what u describe, your stutter may be more severe than mine. But I don't think we should compare, whose got it worse, you know. I think to some degree, all of us who stutter feel those same things: shame, fear, trappped, choked, oh god, why again, or why now. . . . . I think Ellen-Marie offers great advice - we can't resist so much. We must feel what our body is telling us, so that we can figure out how to best manage. When I am most stuck, it feesl like I am holding my breath. I can even hear a little a little audible gasp. Haven't quite figured out yet what to do that, but I have indeed felt that, and I think thats what Ellen-Marie means when advising that we allow our body to teach us. We should keep in touch. Check out my blog when you get a chance.
From: ari
Thank you Pam and Ellen for your comments . For me the worst feeling of fear happens before i am starting to talk, and a lot of my stuttering behaviors are result of this feelings. To this fear- i didn't find any solution -just to talk even i will stutter hard, until this feeling will pass away. And Pam i certainly will look your blog.
From: Frank
Dear Professors, What is spontaneous recovery and what is the process like? (is it just kids who stutter who wake up one day and never stutter again???) What kind of speech therapy techniques (if any) might help with spontaneous recovery in children? Either help with making spontaneous recovery actually happen in a child or speed up the process. Of course, there may be 80% spontaneous recovery. But what can SLPs actually do to help with spontaneous recovery. The rock will fall or not fall eventually, but can you help push it some how? Any evidence? Also, is it ethical for SLPs to take credit for something she did not do, such as spontaneous recovery. 80% spontaneous recovery means that 80% of children who stutter will recover with or WITHOUT speech therapy.
From: Lynne Shields
Frank, Good question, and one that needs further research. Spontaneous recovery means that a child gains normal fluency skills over time with no intervention by a speech therapist, a parent or anyone else. Their fluency improves over time due to maturation and growth. If one tries to speed this recovery up, then one is intervening, and it would be difficult to say that any improvement was due entirely to spontaneous recovery. Even without formal therapy, it may be difficult to decide-did the parents intervene in some way? Did the child notice disfluencies and figure out a way to manage on their own (self-therapy)? Both of these are also possible outcomes. How do we know which kids will recover and which will develop stuttering? There is not, to date, a set of indicators that will predict the answer 100% of the time. But, there are known risk factors for stuttering, based on research. When I evaluate a young child for fluency, I look at a variety of factors, some of which are indicators for the development of stuttering and others suggesting that the child has high likelihood of becoming normally fluent with no intervention. If the latter is the case, then I do not recommend therapy. Instead, if the parents so desire, I help them develop a simple tracking system to evaluate their child's disfluencies. We chat by phone or email periodically to review their evaluations. If the child's number of disfluencies decreases over time and the types of disfluencies become more typical (versus stuttering-like), then follow-up can be discontinued when the parents are confident that their child is showing normal levels of fluency. For this outcome, I typically follow up with a family for anywhere from 3-12 months. If, over time, the child's disfluencies become more frequent and severe in nature, then intervention can be considered. I often begin with a short term treatment program, where the parents and I try to identify fluency-enhancing situations or behaviors for their child and the parents focus on those. If the child's fluency improves, we still won't know if it is due to the intervention or maturation--it's likely to be some of both. I don't take credit for the improvement--it is the parents and child who did the work. For that matter, when I work with an older child or adult, I still don't take credit when improvement occurs. I'm just there for organizational support--it is the client who made the changes in their speech. They did it themselves. I'm sure others on this panel will have input on this issue. Regards, Lynne
From: Ed Feuer
On ASHA's Division 4, Fluency and Fluency Disorders site at www.asha.org/members/divs/div_4.htm#stud, listed under "Professional issues" there is something termed "multidisciplinary interaction." I have heard that within the profession, there are differing interpretations of that concept. As a consumer, I would want multidisciplinary interaction to mean acceptance of the involvement of people from other disciplines in genuine coordinated multidisciplinary treatment teams to help achieve the goals of stuttering therapy(active ongoing collaboration, not referral away). How do the professors here interpret multidisciplinary interaction?
From: Klaas Bakker, Springfield, MO
Hi, I am not aware of substantially different interpretations of this terminology but would be glad to hear some different interpretations! In my opinion this section refers to the need for speech language pathologists to be able to interact with specialists from other disciplines and function effectively in team approaches. Where this is necessary in some stuttering treatments, it would allow the SLP to take into consideration the needs from other treatments that are going on, as well as provide the opportunity to make the other specialists aware of what is needed to improve a stuttering problem. I would assume that this refers to cases where there is more than one problem going on at the same time while treatments need to be coordinated. I am not sure if this section refers to the cooperation between different types of specialists who simultaneously work on the same stuttering problem? That would be a multidisciplinary cooperation I haven't heard of before although it could follow the same team approach. I hope this helps.
From: ari from israel
if i remember correct, I heard once from Phd Yairi that after the age of 65, there are 2/3 of the stutterers that spontaneously recover from their stuttering. Is this true? or i didn't understood true, because i didn't seen that fact in any other source?
From: Dave Williams
Ari, I have a vested interest in your question because I'll be 88 years old in December. I retired from teaching in 1986, and I don't know of any survey or research concerning spontaneous recovery after 65. Many speech pathologists believe that there is a tendency for stuttering to spontaneously diminish in older people, I know that Wendell Johnson was very fluent for several years before he died at age 59, whereas Charles Van Riper was still stuttering rather severely when he died at around 90. My own stuttering has decreased tremendously compared to the way it used to be, and I have no fears at all about stuttering. Why? I think it's because I learned not to fear what other people thought of me or the way I talked. Stuttering became just a minor nuisance in my life. I had other problems that were far more significant. My stuttering just gradually withered away. My only regret was the years I had spent fighting my stuttering, struggling to be fluent, trying to hide and avoid my stuttering, being constantly fearful and on my guard. I finally learned to "let go," to stop fighting and being scared, and toreally mean it when I said "To hell with it." Now I don't fear, I don't anticipate difficulty, I don't have to plan how I'm going to talk---I just talk. Whenever I do stutter--always briefly--I handle it as well as I can, then keep going, with no fear, no desperate effort to be totally fluent, I used to be terrified of the telephone; now if anything I'm more fluent over the phone than when talking face to face. It's a great feeling. I don't hold myself up as a shining example of anything. We all have to find our own solutions. Sorry I can't be of more help in answering your question. I, too, would like to know more about spontaneous recovery and a thousand other things about stuttering! Best wishes, Dave
From: ari from israel
Thank you Dave! Van Riper in his book -when he told the story of the old man said: that you don't need to wait until you are old, in order to stutter with easy stuttering. So i think that maybe in some cases, you can go back to the time that we stutter but it doesn't disturb us. But PhD Ehud Yairi talked about totally overcome , and he said that in his case ,it didn't work, he still stutter. (your article in Advice to Those Who Stutter inspired me a lot, and really helped me) Is a great honor for me, to be answered from legend in the field like you! thank you very much!
From: Michelle
Hi, I need some opinion and advice. My family and I are very upset. Please help. My son is 7 and has stuttered since age 2. I was in his school buying lunch tickets on Friday morning (16th). The principal was away, so our secretary made the morning announcements. It caught my attention since she started in a very negative way. "Its Friday morning and it has been a long, long, long, long week" She continued as I was thinking how negative she sounded. Her speech must have bounced because then (and I cannot recall the exact words) she said something like - "OH and now I'm stuttering!" She said this on the announcements to the entire school. We are trying to protect our son from negative comments. We feel she taught the entire school a lesson on labeling the behavior and to have a negative attitude about it. We know stutter is not a bad word, but I feel that she put a negative connotation into it. We are very upset. I think as a school employee, what she said was very inappropriate. Does anyone agree or disagree with me? I'd really like to know if this is no big deal, because the story continues. I called the principal. He didn't seem to find it odd. His first comment was "well did she?" I tried to explain by saying if she had a moment of confusion and said "oh, now I'm retarded" it would be completely unacceptable. He then told me I was blowing this out of proportion. Was I? I feel it was a very good example. He said he would talk to her and get back to us. My husband went to the school, a bit heated, but he didn't yell, he didn't swear or threaten. He said about the same example and asked why she would say something like that. She said it was just a joke. Later the principal called and said he talked to her and she was very apologetic. We thought, Ok, people are going to make mistakes, case closed. Case was not closed. At about 3:30 that day the head of human services for the district calls and leaves a very obviously not friendly message. She needs to see my husband in her office by 4:00 in her office to meet with her and the district police officer concerning his behavior! If she doesn't hear from him by 4:00 on Monday, the meeting will take place at the police station instead! I honestly can't believe this is happening. I feel it is so obvious that she should bend over apologizing and yet we're in trouble because she felt my husband "berated" her. Some of our friends think the district is trying to cover themselves by finding fault with us. We have the meeting set for Monday at 10:00am. But after talking it over this weekend, we have emailed the district superintendent and asked that we let the issue be resolved now. If he emails back clearly backing the secretary, we may ask that the meeting be postponed until we seek legal advice. I'm not sure I'm up for a fight. All we really want is for the secretary and the principal to think about it for a few minutes and apologize. This is so strange and upsetting. Any feedback would help. We feel what she did was so hurtful and yet, we are the bad guys for speaking up. Am I not seeing this clearly? Help in Wisconsin. by the way, our school principal is set to receive an award in Washington DC soon because our school is one of only 5 "blue ribbon schools" in the state.
From: Gary J. Rentschler
Michelle: You are right to be concerned by the secretary's words and the school district's inability to recognize their obligation as role models in respecting differences and diversity. While I believe the secretary "didn't think before speaking" (rather than having spoken with malice), the district's support of her comment is not excusable. You are right that everyone makes mistakes.. particularly verbal ones. The word "stutter" comes up infrequently in social interactions... like the term "stutter step" during a televised football game yesterday. Some people are more sensitive to the word, and often with legitimate reason. But in the end, we who are "thin-skinned" about it need also to develop some coping skills to deal with it. I think the actual word is less important than the intent of how its used. The error in this instance is less with the secretary's intent than with the school's failure to recognize and acknowledge the insensitivity of the comment. The situation is apparently escalating and becoming "bigger than life" and time has come to scale the incident down. I would be outraged at the district's acceptance of insensitivity! I recognize that it is unlikely that the secretary's comment was intentional, but the error needs to be acknowledged in a respectful way.
From: Charlie Osborne
Michelle: It sounds to me as though your public school personnel are over-reacting, to put it mildly. From your report, the school secretary put her foot in her mouth. I would have hoped that the school principal would have recognized her verbal blunder and apologized for it. I believe that you and your husband were acting within your rights, and your son's, to bring this to the school's attention. Ironically, I would have thought that the school would have been more concerned over how this reflected on the school (and perhaps on any child who attends the school that stutters), and that rather than the apparent defensive response you have received, they would have welcomed your criticism. The example you provided to the principal was, again, to me, entirely appropriate. This situation runs in a similar vein as the verbal blunder by Sheila Johnson a week or so ago, even though I bet the school secretary didn't overtly mean to be insensitive. I would suggest that you go the National Stuttering Association's web site, http://www.nsastutter.org/index.html , and look at their response to the comments Ms. Johnson made while endorsing a political candidate. The NSA's response may be helpful information to share. Good luck with your discussion with the school superintendent.
From: Judy Kuster
The incident itself was insensitive and a foolish blunder on the part of the secretary. You had every right (and even responsibility) to call attention to it, to raise sensitivity about stuttering. At that point, an apology from the secretary and the principal would have been appropriate, and they could have asked you for more information, or you could still provide it, about stuttering. The SFA and NSA both have good materials to hand out, such as is available at http://www.stutteringhelp.org/Default.aspx?tabid=631 (a nice brochure that can be downloaded) and http://www.westutter.org/whoWeHelp/teachers.html. Perhaps you can talk to your son's speech therapist about starting an education about stuttering program at the school. There are even ways your son can help do that when/if he is ready. But the part that really bothers me is when you wrote >>> Later the principal called and said he talked to her and she was very apologetic. We thought, Ok, people are going to make mistakes, case closed. Case was not closed. At about 3:30 that day the head of human services for the district calls and leaves a very obviously not friendly message. She needs to see my husband in her office by 4:00 in her office to meet with her and the district police officer concerning his behavior! If she doesn't hear from him by 4:00 on Monday, the meeting will take place at the police station instead! <<< If the school escalates this any further, trying to involve the police, they are really over-reacting and you may want to seek legal advice, not for what the secretary said, but for what appears to be harassment (or hopefully just another "blunder") from the human services office for your district. There is a Chinese symbol for "crisis" — it combines two other symbols, one for "danger" and one for "opportunity." I hope by now the issue is resolved, but still think that this incident has created a perfect opportunity for you and the school to educate about stuttering.
From: Feuer
Michelle, You're right to be concerned. It's the other side of the equation, the one that many clinic room-focused SLPs simply choose to ignore -- listener attitudes, in this instance caused by the noxious conversational usages of the terms stuttering and stammering used by ignorant fluent speakers including some in the media to connote lower intelligence, shame, failure or incompetence. Example: "I went for an interview today but I flubbed it because I was stuttering." That person was not doing what a qualified SLP would call stuttering. It's the difference between saying I feel depressed today and clinical depression. The most egregious example in recent years was provided in various forums by Bush-haters who thought that the worst possible invective they could throw at the president was to claim he stuttered or stammered in a speech (Google news: Bush stuttering). What they implied, of course, is lower intelligence, shame, failure or incompetence. But we know that Bush didn't scan ahead for feared words or sounds, he didn't avoid certain words on which he had stuttered in the past, he didn't violate speech mechanics, he didn't have real blocks. Trouble is, for most people, such noxious conversational usages are their only frame of reference about stuttering and stammering given the huge level of public ignorance about the problem. When they meet someone who actually does stutter, they plug into those noxious conversational usages and the resulting unfair social and vocational discrimination should surprise no one.
From: Judy Kuster
Michelle, For your information, Ed is not an SLP and is not on the official list of commenters, which you can see by clicking here. He is a person who understands stuttering from a personal perspective and certainly makes a valid point about the potential hurt inappropriate conversational useage of the term "stuttering" can cause. Judy Kuster
From: Ed Feuer
Michelle: Back on May 21, 2003, Joe Klein, who is on the commenter list, emailed Bob Ford, a sports columnist at the Philadelphia Inquirer about the latter's usage of the word stuttering. Joe later posted on the Stutt-l listserv. I saved it because I was impressed with the wording of Joe's note and the classy reply from the columnist which is how the school should have responded to you. Joe has given me permission to post it here: Dear Mr. Ford, I have been a fan of your column for many years .... I am a stutterer, and moved to Mobile to get my Ph.D in speech pathology to study this curious disorder. I was disappointed to read in your column today the very negative use of the word "stuttering": "Judging by degree of difficulty, the 76ers were somewhere in the middle, even as he [head coach Larry Brown] followed the stuttering legacy left by Doug Moe, Fred Carter, John Lucas and Johnny Davis." Over 1% of Americans stutter, and 5% of children stutter. Many children are teased about their stuttering, and grow up feeling very ashamed, and feeling like their stuttering is a terrible thing that they should try to hide. A big part of therapy is trying to get kids to see that stuttering isn't such a bad thing -- it's just a way some people talk -- and it makes them feel better about themselves, which allows them to use the techniques that they learn without shame, and as a result they stutter much less. Using the word [as the columnist did] is just one more rock on the pile of negativity that kids who stutter have to face every day. Please choose your words more carefully in the future, and perhaps don't use the word at all, unless discussing the speech of someone who stutters (like Kenyon Martin) or when describing a GREAT stutter-step move by Allen Iverson or Duce Staley. Thanks for your time, Joe Klein. [Bob Ford's reply:] Joe -- I am terribly sorry. I meant no offense and it didn't occur to me that any could be taken. I meant that the previous coaches led the team through a series of false starts and stops. In the future, I will certainly choose another word for that. Again, please accept my apology. Take care, Bob
From: D.J. WIlliams (Dave's wife) CCC-SLP (ASHLA)
Michelle: As a past public school speech therapist, I would suggest to you that (1) you ask why only your husband was invited to the meeting, (2) why is a police officer being invited and (3) why are the principal and secretary NOT invited. I would also want my son's speech therapist to be present. The suggestion of threat in saying that this is a police matter is, to me, unforgivable. If the police attendance is insisted upon, I would insist that the superintendent of schools be also included. You of course would be at the meeting. Best of luck, D.J. Williams
From: Dick Mallard
Michelle, if your son continues to stutter he will face situations like this. This is why he (and perhaps you and your husband) need to learn coping strategies to deal with issues like this. I am 67 years old and people still comment about my stuttering or about stuttering in general. I have to "get over it." Let me also add that I was teased terribly in high school. Learning to cope with the teasing and not let those who teased see that their behavior bothered me laid a greet foundation for being able to deal with the environment when I did get help at 22. We will have our 50 year reunion this year and I plan to do as I did at each reunion — talk to each one of those people and be absolutely in control, in this case fluent! The confidence gained by being able to handle a situation and not letting others determine how I will respond gives a child huge confidence. So, bottom line is in the future when (not if) your child experiences a situation that could be interpreted as negative, use that as a teaching moment that he can benefit from. He cannot learn to handle adversity unless he experiences it. Good luck. It is not easy being the parent of a child who stutters. That is why I insist that parents are the key personnel in stuttering therapy for children. You might want to check out my web site on learning to use problem solving (www.familystutteringprogram.com). My best to you, your husband, and your son.
From: RM - 11 years old
How can you effectively treat stuttering?
From: Dale Williams
Good question, RM, and one people have struggled with for a long time. Basically, stuttering is treated by either changing the way you speak or changing the way you stutter. The idea with changing the way you speak is to try to teach a controlled way of speaking where stuttering doesn't happen as often. Changing the way you stutter usually involves changing your attitudes about speech (so you don't worry about it all the time). Sometimes both can be done together. I hope this helps.
From: Michael Retzinger
RM - You ask a brilliant question for such a young person! I am not an expert on this panel, but I am a person who stutters. My therapies when I was your age focused on having me slow my speech down to try to speak without stuttering, and when that didn't work, the speech therapy focused on trying to get me to focus on changing or modifying the way I stuttered; that didn't work either. I chose to grow silent. Finally I met a speech therapist who focused on helping me figure out how to talk, rather than focusing how to stop or control my stuttering! Those are two very different goals and way different therapies!...at least they were for me. That is how my journey to effective deal with stuttering worked out for me. I am happy with the results!
From: Jason
Hi, What do you think the future will look like 10-20 years from now. The speecheasy, Pagoclone, and the Lidcombe program? Is Pagoclone going to be the pink pill? How is stuttering treatment going to be different or more of the same. What about the future of stuttering research....more neuroscientists studying stuttering?
From: John Tetnowski
Jason, I love your question. I think that stuttering treatment will have even more options in the future than there are today. There will be several breakthroughs due to new technologies. Pharmaceuticals will be better tested and will be prescribed for individuals that are likely to be helped by them (the research will determine exactly who those are). Devices will get smaller, be of even better quality, with new bells and whistles. However, since stuttering affects the total human condition, I think that improved individual (behavioral) treatments will still be available and necessary. I also believe that we will even be better at predicting who will stutter and who will "spontaneously" recover. This will lead to more efficiency of treatment. Consumers will be smarter, so SLPs and other professionals will have to stay ahead of the curve. In summary, I think taht the future will bring us be better understanding, but still no universal cure. There are too many variables to think that there will be a universal cure for all who stutter. I hope that I am wrong, but that's my prediction. Thanks again for the graet question.
From: Klaas Bakker, Springfield, MO
I am siding with John on this. We cannot clearly look into the future and predict, but we sure can work hard at getting the answers, and staying informed so we may catch new developments and emerging information. I think that would be more important than to even try and foresee into the future where ever it may take us. It is logical to presume, as John did, that the specific agents you were talking about (the pink pill or use of the Speech Easy) will provide partial solutions, and forms of assistance, which still require attention for attitudes, feelings/emotions, and frustrating efforts associated with the problem that has been going on often for years until such solutions are considered. The Lidcomb therapy is something else of course as it is considered early on in the development of stuttering. I think the Lidcomb therapy can be very effective as long as stuttering behaviors are the only problem and age and family situation allow the stuttering to be treated this way.
From: Ed Feuer
I would hope the future involves SLPs who are involved in the treatment of stuttering fully accepting the concept of multidisciplinary interaction, which as I've noted, has been presented as one of the professional issues on ASHA's SID-4 site. The way this consumer hopes that future will look can be seen in my brief futuristic essay In the Year 2025 which can be accessed on Judy's Stuttering Home Page at http://www.mnsu.edu/comdis/kuster/TherapyWWW/In2025.html Realistically, I believe we will get there by way of small steps, but we will get there. After all, pretty much everything else has been tried ...
From: Tom (thestutteringbrain.blogspot.com)
Kids imitate stuttering? Stutterers dont stutter in foreign language?
I have been interviewed about stuttering, my experiences and my blog for ISAD. I told them that most stuttering has a neurobiological basis (due to genetics or/and environmental impact like virus infection, birth issues, blow to head, etc) which gets magnified by learned behaviours and cognitive reactions. And the newspaper had the glorious idea to interview the National center of speech and language therapy. The result: A so-called expert told them that many kids start stuttering because they imitate someone who stutters. And stuttering must be learned because many stutterers do not stutter in a foreign language!! I am going insane... Any feedback?
From: Lynne Shields
Tom, I agree with Dale. The notion that children imitate someone else and learn stuttering in this manner has never been supported by research. I've heard that story occasionally over the years, but any 'evidence' has always been anecdotal and not supported in any way. I have worked with at least five people who were bilingual and also stuttered, two teens and three adults. In all cases, they stuttered in both languages and all but one had more difficulty in the second language. They each reported that they believed this was the case due to their having a smaller vocabulary in the second language and not being able to substitute words as easily. Regards, Lynne
From: Tom (thestutteringbrain.blogspot.com)
Thx Lynn for saying what I would have said! :-) No the "experts" are the director of the Luxembourg National Center for Speech and Language and the head of the Audiophonological Services. I am working with the British Stammering Association, IFA, a German professor and the German association to give a response. If any of the professors here want to become "famous" in Luxembourg, send me an email to tom.weidig@gmail.com, I can send you the press release once we have a draft and you can decide whether you want to support it or not! ;-)
From: Dave Williams
The belief that many kids start stuttering because they imitate a stutterer is 99% goofy. As for stutterers not stuttering when speaking a foreign language, I would say this does happen occasionally (I've known a couple of such cases), but much more commonly stutterers do stutter when using a foreign language---and frequently they stutter more frequently and severely. I'd like to see some research on these questions. And please don't go insane.
From: Tom
Regarding stuttering a foreign language, I stutter in all of them. But interestingly the better you know the language the more you stutter sometimes.
From: Preston
Hi, I would like to ask the experts, who have extensive experience of working SpeechEasy with their patients, its longterm efficacy. I saw different views on the website. I am a stutterer who also have an AV malformation in my right temporal lobe, which I think may serve a neurological basis. I am using a DAF program on my iPhone which has been helpful. This device is really expensive and I really appreciate your valuable ! Thanks!
From: Judy Kuster
There are long-term studies currently being conducted. Keep your eyes open for articles by Larry Molt who is currently doing a longitudinal study. In the meantime, you might be interested in reading an article from last year's conference authored by Ryan Pollard and John Ellis, The SpeechEasy: Emerging evidence for interested clinicians and prospective buyers (http://www.mnsu.edu/comdis/isad11/papers/pollard11.html . There is a chapter in Barry Guitar's recent (copyright 2010) Treatment of Stuttering written by Peter Ramig, Pollard and Ellis about the 'Application of the SpeechEasy to Stuttering Treatment: Introduction, Background, and Preliminary Observation.' Their chapter includes: 'We would like to conclude this chapter with our personal reasons for including the SpeechEasy as a potential treatment option within our clinical practice. . . . We were initially doubtful of the worthiness of the SpeechEasy as a treatment tool and felt that the only way to learn firsthand about the device was to examine it while keeping an open mind. Based on our experiences during SpeechEasy training, we agreed that the device had a positive effect on our fluency and thought that it could be of potential benefit to some of our clients.' p, 327-328. I don't think anyone in my profession is saying the SpeechEasy is the answer for all people who stutter. What I believe is that it may be an effective tool for some people who stutter, especially when combined with speech therapy.
From: Maureen, Pennsylvania
Our son is 17 & has been stuttering since age 5.It began mildly & the pediatrician at the time said to ignore it & it would probably go away. By age 12 it was getting more pronounced. He has been seen weekly by a SLP for over 5 years now. We are considering the Speech Easy as something alse to add to the therapy in hopes that it will work for him. The therapy he has had so far is only working some of the time. He has college interviews coming soon & is nervous about stuttering. What are your thoughts on these devices for someone his age?
From: Samantha from New Jersey
I have read about speech devices such as the stutter stop and speech easy that claim to be a "cure" for stuttering. I was just wondering if any of you have tried it or know anyone who has and if they really do work?
From: Charley Adams
Hi Samantha, I can tell you that there are clinical trials taking place for the SpeechEasy, but I don't know if they are concluded yet. Anecdotally, I can tell you that I have met or worked with several individuals who own a SpeechEasy, and most either use it very rarely or have abandoned it altogether. For some, the fluency-inducing effect appears to fade over time (J Speech Lang Hear Res. 2009 Apr;52(2):516-33). That said, I am in no position to deny any PWS access to intervention which they feel brings any relief, either in terms of increased fluency, confidence or otherwise. I just feel strongly that good therapy and support should always be given its due. Hope this helps - Charley
From: Lizabeth Curtin
What do you find is the most challenging aspect(s) in treating children who stutter? What about adults who stutter?
From: Charlie Healey
I find the biggest challenge for children and adults who stutter is having clients achieve enough success that they feel like they are improving their speech, attitudes, feelings, and thoughts about their stuttering. Long term change takes a lot of time and effort. I see many give up on themselves and the process of change that needs to take place. Frustrations and disappointment set in when the stuttering doesn't seem to be changing despite a long period of therapy. In my opinion, it comes down to the client being ready for change and accepting whatever improvements can be made, assuming of course the client is seeing a clinician competent to treat stuttering.
From: toleski
I work with toddlers and preschoolers. Over the years while treating a child for speech/language delay dysfluency begins to emerge. The child I'm currently seeing began therapy last year as a 3 yr.old for significant phonological delay. Within the last three months she has begun to stutter mostly whole-word repetition and prolongation. Articulation has improved a great deal but still needs work. Will continued emphasis on speech sound production increase dysfluency?
From: Ken St. Louis
Good question. The issue of coexistence of various communication disorders has been the subject of considerable research over the years, although it seems to have waned in recent years with respect to stuttering. Ed Conture, when he was at Syracuse University, along with several of his doctoral students, e.g., Linda Louko, investigated the coexistence of stuttering and phonological disorders. I don't claim to know all that they found, but one recommendation that came from their NIH-funded research was that maybe it was best to teach phonological processes (i.e., not specific phoneme [speech sound] training) when dealing with articulation errors in children who also stuttered. Focus on the sounds themselves can result in children beginning to see these sounds as "more difficult" and thereby beginning to fear them, as Wendell Johnson observed. Language problems can also coexist with stuttering, although I am not aware of research that has specifically tried to compare clinical strategies that are most/least effective when dealing with them simultaneously. In my own clinical experience--not research based--I have found that it is often best to give a child with a mild-moderate articulation disorder a "vacation" from articulation training while dealing with his/her stuttering. If the problem is severe and intelligibility is limited, then I have tried to follow Conture et al.'s advice in focusing on phonological processes. When dealing with language issues, I have found it is possible to work them into whatever material is used for the stuttering therapy.......I'll add another point. coexisting disorders are very common in the related fluency disorder of cluttering. It is possible that many young "stutterers" with coexisting articulation or language problems may have cluttering instead or--or along with--stuttering. In cluttering, almost all therapy deals with a wide range of problems. I hope this is helpful. Ken
From: joe donaher
Toleski, This is a great question because it is something that clinicians deal with frequently. I shy away from having a single policy regarding children who stutter because each child presents with distinct and unique issues. The first step for me, is to determine how each concern impacts the child. For example, I frequently meet children who stutter with mild articulation issues which minimally effect their overall intelligibility. In these cases where we can understand the vast majority of what the child says, I typically refrain from addressing the coexisting articulation. concerns. However, for a child who is struggling with significantly impaired intelligibility, I will address the articulation issues at the same time as the stuttering. For me, it is a matter of focussing our effort on the most significant concern in an effort to make the greatest gain.
From: Pam
I know this is the last day, but I had a good question on one of my papers from a student and wanted to see what "the profs" think of my answer. A student asked, based on my paper about what I have learned in therapy, if I thought it would make sense for clinicians to spend a couple sessions early on in treatment on attitudes and feelings rather than immediately assessing stuttering severity. I said yes!! I base this on my thought, that others may share, that exploring attitudes and feelings makes sense so that the client and clinician are on the same page and that the clincian is "treating the right thing". Like, if a client has a deep sense of shame about her stuttering, it might make more sesne to validate and support that and discuss desensitization ideas instead of measuring severity and going right into speech mechanics. Does that make sense? I think it speaks to acceptance on mnay levels, by both the client and clinician. Many thanks to all of you who so kindly and patiently answered many of my questions.
From: Lynne Shields
Pam, When an adult visits me for the first time for therapy, I don't automatically collect a speech sample to analyze for frequency or severity of the overt stuttering. As you suggest, I think it is important to find out the issues and concerns that are important to the client. If it turns out that reduction of overt stuttering is one of the person's goals, then obtaining samples to evaluate stuttering severity and frequency at some point can be helpful, but I don't see it as essential, or even necessarily beneficial, at the beginning of treatment. In your own case, were you not covert when you began attending therapy? In that case, I'm not sure what a clinician would be measuring early on! Thanks for all of your good questions.
From: Ken St. Louis
Pam, I completely agree with Lynne's reply. I always have my students ask first in an evaluation, "What do you hope we can do for you?"
From: Vivian Sisskin
Pam, Great question and I'd like to add something to what Lynne and Ken have said. I find that it helps to work simultaneously on attitudes, emotions, and speech motor change, and that includes assessment as well. I find that these aspects don't exist in isolation in PWS. Changing the stuttering pattern often involves doing something different, and that may require courage (both desensitization and cognitive work can help here). Once a person achieves some success in motor areas, his/her confidence (that he/she can stutter more comfortably) increases, which leads to positive attitudes about showing oneself as a PWS (important to acceptance).
From: Betsy Runner
I am very interested in learning more about bilingual individuals that stutter in their native language but do not stutter as they are learning a second language until they become fluent in the second language. Could you list some articles I could read. My friend is marrying a man from Spain who exhibits these characteristics.
From: Ken St. Louis
Dear Betsy, I would suggest you locate and read the chapter by Patricia Roberts and Rosalee Shenker intitled "Assessment and Treatment of Stuttering in Bilingual Speakers" in the book by Edward Conture and Richard Curlee, "Stuttering and Related Disorders of Fluency" (Thieme, 2007). Personally, I stutter much more in a second language I learned after I was 21 years old, even though I was pretty fluent in the early stages of learning it. That, however, is often not the typical pattern. Many people stutter LESS in their second or subsequent languages.
From: James
Is there any connection between bilingualism and stuttering? Can you stutter in a new language that you are not proficient in yet? Or is this the case: as you learn the 2nd language better, you start to stutter more in the 2nd language? (Can't stutter if you don't know the language). Kind of like: when you are fluent in a second language, you starting becoming dysfluent in that second language.
From: Ken St. Louis
Hi James, Good questions. I am not an expert in bilingualism and stuttering, but there are numerous articles and chapters available on the subject. Please see my previous reply to Betsy Runner's similar question. Ken
From: Frank Monitello (NYU)
Dear Panel, I am in the process of taking a fluency disoders course, and the subject of stuttering and its counseling component fascinates me. How would you, personally, go about approaching a parent of a child who stutters? How would you address the diagnosis for the first time with the parent.
From: Lynne Shields
Frank, You asked a great question. I think that training to begin to develop counseling skills is important for all SLPs. How would I talk to parents during an initial evaluation for stuttering? Probably the most important thing to do is to listen to the parents carefully, to identify their concerns and to find out what they need to know. In my younger years as a professional, I know that I spent way too much time focusing on giving the parents all sorts of data at the initial evaluation and overloading them with information about stuttering. I'm not entirely sure that it was all that helpful. Presently, I'm more inclined to engage them throughout the evaluation, asking them to tell me what they see in their child's speech, what has helped their child, and what questions they have for me. There are some really very nice resources on counseling. If you haven't viewed the Stuttering Foundation DVD, "Sharpening counseling skills", with David Luterman, you might enjoy watching that to gain some basic counseling skills. Hope this answer is helpful to you. Regards, Lynne
From: Concerned Mom in MA
I have a 14 year old son whose stuttering has morphed into blocks with fluctuating severity - at it's worst he has complete stop of airflow and relys on many motor-based secondary behaviors (hitting his hands against each other, head jerking) to get through the block. I wonder what the causes of these types of blocks are and what happens to the speech mechanism when this happens
From: Greg Snyder
Hi Concerned Mom' This may or may not be a mainstream view of the stuttering phenomenon, but I'll offer my two cents on this. It's my belief that the "act" of stuttering isn't stuttering at all. "Stuttering" (i.e., the phenomenon) occurs at the neural level. It's a phenomenon of the central nervous system. The act of stuttering is actually the body trying to jump-start (or initiate) the system back into action. Now--the body has an amazing skill of compensating and adjusting in order to preserve functioning. However, when it's left only a few alternatives, the body tends to try to use "more force" to fix the problem. We see this all the time in other pathologies (such as vocal pathologies)--or even when you're remote control is running out of batteries. What do you do? Push the button harder. So let's take this back to stuttering. During our teenage years, we often lose a lot of control over stuttering. So the body, in an attempt to compensate (or regain control) does whatever it can--which usually results in muscular hyperfunction. And rather than relaxing, we end up adding tension onto tension onto tension. So much so that it's entirely counterproductive. So as far as "what types" of blocks--I can't answer that. I don't believe there are different types of "blocks" per-se, but rather as a function of the different speech sounds being stuttered upon and the normal dynamics and evolution of stuttering. However, severity can most definitely ebb and flow--and in our most severe, muscular force and tension can be both exceedingly strong and seemingly global (relative to speech production). And (again), it's my view that this is the body trying to kick-start the system or overcome the stuttering block (at the neural level). Unfortunately, it's not a very efficient response. Fortunately, stuttering modification tools (such as volitional stuttering, bouncing, stretching, etc) can be very effective to combat these counterproductive responses to stuttering. (Sorry for the stream of consciousness; hope this helps')
From: Michael Retzinger
To the concerned Mom - Regarding Stuttering Modification Techniques...As a person who stutters, I would disagree with Greg. I found Stuttering Modification techniques to increase the severity of my stuttering and contribute significantly to my decreasing verbal output. They made my stuttering worse and I consequently talked much less. This has been my experience.
From: David Shapiro
You're asking such a good question. I relate to your question as a parent, as a person who stutters, and as a speech-language pathologist. Often what we do reflects our knowledge or strategies that we have available to us. From what you have described, it looks like your son is doing what he can and what he knows in order to get through the blocks. I am wondering if you have consulted with a speech-language pathologist who is in a position to enable your son to develop fluency facilitating strategies that would be more successful and conducive to ongoing communication. For example, usually a combination of fluency shaping (which primarily addresses fluency behaviors) and stuttering modification (which addresses stuttering-related thoughts, feelings, and attitudes, in addition to behaviors) enables people who stutter to increase their speech fluency and to feel more positive about themselves, thereby gaining confidence that comes with achieving success. A related suggestion would be to attend to what your son is doing differently (thoughts, feelings, and behaviors) when he is fluent than when he is disfluent. Often fluency is characterized by evenness in rate, gentleness in onset, and natural-sounding inflection. Although disfluency and secondary behaviors tend to get more attention, it is not uncommon for people who stutter to have more fluent speech than disfluent speech (i.e. more words spoken fluently than disfluently). In any case, a speech-language pathologist could help by creating opportunities for studying and understanding what your son does when he is fluent and thereby learning how to do it even more often. I know how worrisome such behaviors can be for the parents, particularly when we feel as if an aspect of our child's experience is outside of our control or influence. Help and understanding are available from speech-language pathologists and from self-help groups. You can see from this conference that your concern is shared by people who stutter, families, speech-language pathologists, and allied professionals, among others all over the world. I think this shows us that we're not alone. There is no better support than that of a mother. Good luck. David Shapiro
From: Vivian Sisskin
An interesting feature of stuttering is that the symptoms change over time. Stuttering in older children and adults looks very different from stuttering in very young children. The compensating and adjusting that Greg is referring to can end up being helpful or harmful to forward moving speech. Unfortunately young children do not consult anyone when they try these strategies on their own (using 'uh', pushing harder, repeating the previous phrase, hand tapping, etc). These behaviors generally work to help release the block initially (perhaps due to distraction and escape from the block), and they often become tied or conditioned to the stuttering pattern. So the next time the person gets blocked, they try some of the compensatory strategies that have worked in the past. Sometimes they work and sometimes they don't. Eventually, they become part of the presenting pattern (someone who taps, losses eye contact, and restarts sentences in order to get out of the block). Learning some helpful compensatory strategies to replace the maladaptive ones can be helpful and can reduce the struggle. Sometimes therapy strategies can help. However, good old common sense can be surprisingly effective. Instead of hitting hands or head jerking, for example he might chose to go ahead and stutter directly on the intended word. That word will be quite bumpy at first, but after some desensitization, more comfort will be a byproduct of not interfering with forward moving speech. These choices are not easy to make initially, and may require the help of a speech language pathologist. But just understanding why the struggle behaviors develop can be enough to help someone make some good choices.
From: Mark Irwin
In keeping with the theme of this year's conference, "More Than a Tangled Tongue", does anyone disagree that stuttering discussions, diagnosis, therapy, research and public awareness could be greatly assisted by the use of clearer definitions to separate the Tangled Tongue (overt stuttering) from the More (social anxiety disorder and covert stuttering.)? What definitions would you regard as appropriate? Kind regards to all, Mark PS. No doubt you are all aware that stuttering is listed as a symptom of Social Anxiety Disorder (SAD), not all pws have SAD, and that all conscious human activity has affective, behavioural and cognitive components.
From: Lynne Shields
Mark, While I agree that all people who stutter are unique and not all have fear or anxiety about stuttering, I'm not sure exactly what you are looking for when you say that there is a need for clearer definitions to "separate the Tangled Tongue (overt stuttering) from the More". A number of researchers have attempted to develop ways to look at the various components. If you haven't already, you might take a look at the CALMS model, for example, which can be accessed at the University of Nebraska-Lincoln Fluency Center website. Best wishes, Lynne
From: Judy Kuster
Date: 22 Oct 2009
The live, threaded discussion part of the 2009 ISAD online conference is now closed. The responses made here during the conference will remain online. Thank you for stopping by. Judy Kuster