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From: Ari (Israel)> I hear some SLP'S that talk about acceptance, some talk about tools to speak more fluently,and a few of them talk about both aspects as separate aspects. I wonder why almost nobody talk about changing the stuttering as a bridge between the two aspects,that's mean in order to change your stuttering you need to desensitize it,and when you change your stuttering in some cases you can use better speech tools. So the question is did changing the stuttering is include in the accepting side,or that the most professionals don't find this method useful?
From: J Scott Yaruss, Univ of Pittsburgh
Hi Ari! So nice to see you in this format! You've raised a superb question... I think it's fair to say that many (though definitely not enough) clinicians do include work on changing the moment of stuttering in their comprehensive therapy approaches. Certainly not the fluency-shaping therapies - but anything based on the work of Van Riper, Williams, Breitenfeld, and others, would include work on using desensitization as a means of changing the moment of stuttering. When I do my trainings, one of the analogies I use is that of a coconut: a coconut is comprised of a tough outer husk and a the inner meat and milk that everybody wants. The inner part is likened to the fluency... the outer husk is the tension and struggle that characterizes the moment of stuttering. If you try to just get straight to the meat and milk, you'll have trouble getting there because it's encased in the tough outer husk, but if you take the time to strip away the husk, you'll have an easier time getting to the insides. Likewise, if you take the time to strip away (through desensitization, awareness, understanding, acceptance) the tension, the struggle, the avoidance, and all the rest of the reactions to the moment of stuttering, then you'll have a much easier time of getting to the increases in fluency. As a clinician (or a speaker), you can't do just one or the other - you need to do both (to varying degrees). Moreover, you need to do both in the right order and in the right amounts for each individual speaker. Then, if my audience is with me on the analogy that far, I'll add in the kicker... if you think carefully about the husk of the coconut and view it in another light...not just as a nuisance that must be stripped away but as a useful part of the coconut, then all of a sudden, you have two useful things to work with... shells (for building your houses, bowls, utensils, clothing, etc.) and food (for sustenance). Likewise, if you view the moment of stuttering as not just something to run from or something to be avoided, but rather as an expression of the underlying block, then you can see other ways of using the moment of stuttering as a way of improving communication... Stuttering more easily, pseudostuttering / voluntary stuttering helps to prevent the tension from building, and that, in turn, makes it easier to improve fluency (even if through the use of fluency enhancing techniques). Perhaps a bit complicated, but it highlights the exact point I think you're trying to make -- you get improvements in fluency when you work on the stuttering and accept the stuttering and allow the stuttering rather than denying the stuttering, and optimal outcomes follow from working on the entire disorder from all perspectives... Looking forward to the dialogue! Take care, Scott
From: Ari (Israel)
Scott! I am very glad that i know you ,you are so nice person! I loved so much your answer, and i will study it more. One point that inspired me was that you see stuttering as one problem. I heard so much SLP'S saying "we are not psychologists, we don't know what to do with the fear," for my opinion they don't understand what is stuttering. Thank you for your long answer!
From: J Scott Yaruss, Univ of Pittsburgh
Thanks much Ari! I'll add one point, too - while it's true that we are not psychologists, treating the adverse impact of stuttering (including negative emotional reactions) is definitely within the scope of practice of speech-language pathologists. Therefore, we MUST address these if we are to be consistent with our purpose in the field. Surprisingly, this is a point of contention amongst some of our colleagues, but, to put it simply, I feel that you can't treat stuttering effectively if you don't address the entire condition. I think the research supports that. And, that means that we must use some of the same tools as psychologists. That doesn't make us psychologists any more than my using a hammer makes me a carpenter. But, if I want to put some nails in a piece of wood, I'll be much more effective if I use a hammer. Often, when I put it that way, clinicians see that we can do this (provided we're adequately trained, though as one of the other posts pointed out, we're not always adequately trained). So much to do...but understanding the true nature of the condition is the first step... Nice to correspond with you, as always. Take care, Scott
From: Ari (Israel)
Such great point: I don't know how it's possible to separate the physical side and the emotion side. For example "holding the sound" can be very desensitize tool and can be a physical tool to reduce tension and to control the stuttering. Voluntary stuttering also can serve more than one purpose. That is the reason that i think that the people that separate the two sides, don't really get the difference between stuttering easy and stuttering with tension, for them this is all stuttering. So if you think this way, you really don't find any connection between the two sides, cause your main goal is fluency but you accept that sometime you will stutter, but you don't change your stuttering cause your goal is fluency. Today my goal is not fluency(nobody is 100% fluent) but normal speech process, without fear without planning my sentences, the fluency is just something that maybe will improve "by product". Thanks for your wonderful reply! Ari
From: Keith Boss (ISA Director BSA Trustee)
I thank all of you for offering to spend time helping answer our questions. It is much appreciated. I attended an Open Day at the University of East Anglia (UK) yesterday (1st October 2011). My partner's granddaughter is interested in an SLT degree. We enjoyed our time in their vibrant problem solving based teaching environment. On the way home I reflected on their figures that there might be 400 applicants for the degree course, 200 interviews, and only around 30 to 35 offers of placement. A number of questions. 1. In your combined experiences does the smaller number of newly qualified SLTs/ SLPs specialising in stuttering meet the demand of PWS wanting help? From what I hear around the world the answer is no in many if not all countries. 2. How can we help those who qualify to achieve their maximum potential? 3. How can we increase the numbers qualifying? 4. How can we reach countries where little or no professional help exists? Answers to these three "How... " questions may be included in future work of the International Stuttering Association. Thank you for your time.
From: J Scott Yaruss, Univ of Pittsburgh
Hi Keith - Thanks for your post and the thoughtful questions you've raised. I'll offer my input here and look forward to notes from others on the panel: 1. In your combined experiences does the smaller number of newly qualified SLTs/ SLPs specialising in stuttering meet the demand of PWS wanting help? From what I hear around the world the answer is no in many if not all countries. >>> That's an easy one for me to answer. No. Simply, no. We need more people who are not only specialized in stuttering, but even just adequately prepared to begin to help people who stutter. (Specialization is actually a lot to ask when so many of our clinicians are graduating with minimal experience and comfort with stuttering to begin with...) 2. How can we help those who qualify to achieve their maximum potential? >>>>Oh, that's a harder one. We need to give people the opportunity to interact with people who stutter! I think in the US, the self-help groups such as the NSA and Friends have been doing an excellent job of outreach, and of course the SFA has wonderful materials targeting education of clinicians. But, there are so many pressures on the training programs and on the students...it's hard to teach them everything they need to know. So, while I absolutely acknowledge the need, I'm at a bit of a loss about how to overcome it. One thing that does help is having adequate continuing education opportunities available - and having the clinicians get the time and funding they need to attend them. I have given many workshops on stuttering treatment, but in recent years, it's gotten harder to do because the clinicians in the schools in the US don't get the time or support in order to go take them. They can benefit from training, but they have to do it on their own time and their own dollar, and they're already spending quite a bit of their own time and money just to do their daily jobs. So, it's a problem... the solutions involve increasing support for schools and teachers and clinicians, but this is not the mood of at least our country right now. 3. How can we increase the numbers qualifying? (see #2 ;-) Too many demands on the training programs and students. 4. How can we reach countries where little or no professional help exists? >>> Well, many of the outreach programs of the Stuttering Foundation, the ISAD concept and conference, the IFA/ICA/Oxford conferences make a difference. Some of those tend to attract specialists, of course, and they tend to attract those who can travel, which is understandable. Increasing outreach to under-served countries will again require funding and support. I don't think you'll find a shortage of specialists eager to do the training - there are many of us who would be thrilled to be involved in this type of program...I know I would...but the logistics of making it happen, including finding available time and funding, make it much tougher. Man, that was a depressing set of responses, wasn't it?!? I don't think it's all hopeless, not by a long shot...but I do think that it will require a concerted effort to make changes in some of these issues... Fortunately, we have a wonderful set of colleagues around the world - dedicated clinicians and researchers and support organizations - that I believe are up to the task in many ways. We just need more of us, and more time to tackle the issue. Thanks again for the excellent questions. I'm looking forward to the dialogue! S
From: Keith Boss (ISA Director BSA Trustee)
Scott, Thank you for your very thoughtful answer. I hope more of your friends will be able to contribute. More effort is needed to help around the world. Keith
From: Florence Myers
I also want to thank Scott for his thoughtful responses. Yes, with the current world economy, finding the resources to support means to train clinicians to specialize in fluency disorders is a tall order. Even in the States, graduate programs are hard pressed to provide sufficient training for graduates to consider themselves as specialists in even one specific disorders. We are by and large training generalists. This is where organizations such as the Stuttering Foundation and Friends play such a critical role, as well as of course associations providing seminars and workshops at conventions. Progress can be made at the grassroots level as well, especially if cost of travel (especially abroad) is prohibitive. I will be giving the third of four live seminars on cluttering through Skype tomorrow to a fluency class in Buenos Aires. Even this type of endeavor, however, takes time and coordination--especially when an interpreter is needed. Progress is made one step at a time, whether using a top-down or a bottom-up model. As evidenced by the various contributions at this ISAD online conference, however, there are so many empassioned by the spirit of sharing their knowledge, insights, and skills related to fluency disorders. Finally, a deep note of gratitude to Judy for spearheading this conference! You make a different in the world of fluency.
From: lbc> Hi How important do you think voluntary stuttering and avoidance reduction is in controlling a stutter / stammer ?
From: Dick Mallard
A comprehensive therapy program will include both properly administered fluency shaping procedures as well as desensitization and avoidance reduction. Which therapy approach comes first depends on many factors such as age, severity of problem, and attitude of the client toward communication. A forty-five year professional career and a lifetime of dealing with my own stuttering leads me to believe that an open, positive attitude coupled with a willingness to communicate (lack of fear) provides an excellent foundation for controlling stuttering whether you use fluency shaping or symptom modification.
From: Gary J. Rentschler
I think its significance to a treatment program really depends upon the individual who stutters. While I'm a strong proponent of voluntary stuttering, I see that many who stutter really find it difficult to do. To some degree, the greater the resistance to doing it, the greater is the person's need to reduce their avoidance behaviors. In my personal experience stuttering, it has helped me of "get over" how terrible I felt is was to stutter. Voluntary stuttering need not be big, exaggerated blocks (although that's the real test), but it can consist of simple, easy repetitions like almost everyone has in their speech. The core ingredient is reducing the importance PWS often place on avoiding stuttering moments.
From: Ken Logan
I wanted to "second" the comment that Gary and Dick made. In my days as a client, I also found voluntary stuttering difficult to do (and many of people who stutter that I've met do not seem very eager to do it either). If it is introduced to a client, it's helpful to set up the rationale for its use, i.e., it's role in desensitization. After introducing the rationale, I've found that it is helpful to ask clients where or when they might be willing to use the technique. For example, some may find it relatively easy to use during a telephone call to a stranger. In that setting, it can be used as a precursor to modification of speech disfluencies.
From: Ellen-Marie Silverman
Taking a more playful, experimental approach to stuttering deliberately can be useful. By analytically trying out different ways to stutter, say on the same word, we can discover we know how to stutter with greater ease than we often may, that the capacity to do so is available to us. And by approaching stuttering with interest rather than dread or disgust, we may more readily discover that we can change how we speak. >>> This variant on "voluntary stuttering" has helped people I have known to speak and live more as they wish. Ellen-Marie Silverman
From: Walt Manning
ibc, When experimenting with voluntary stuttering I have heard many people express that they didn't realize they had a choice about how to stutter. When speakers are given "permission to stutter" rather than spending nearly all of their effort struggling to be fluent and trying NOT to stutter the understanding of their options begins to change. As others have said, desensitization and a decrease of avoidance behavior are central aspects of the process. I think one of the first principles of dealing with a problem is going at it rather than denying it or doing all you can to avoid it. Rather than avoiding and hiding, voluntary stuttering as described in the earlier posts provides a way to cope with the problem in a new way and vary and experiment the old, automatic responses to stuttering. By increasing the degrees of freedom about how you stutter, you are able to experiment and even "have fun" with your stuttering. It's also important to realize that voluntary stuttering can result not only in easier forms of stuttering (less struggle and effort)but - along with other activities and techniques - it can lead to spontanious fluency.
From: J Scott Yaruss, Univ of Pittsburgh
Hi all - Terrific question and wonderful discussion by my colleagues. I just want to maybe add one thought...a couple of people mentioned how uncomfortable this can be for speakers, and how hard it is to do at times. This is certainly true. I also want to point out, though, that if the clinician is careful to set up the therapy so the client moves toward desensitization and acceptance gradually, then many people can make improvements in their ability to tolerate moments of stuttering. (Remember, acceptance doesn't mean you have to like it - it just means you have to be able to tolerate it.) And, the more progress a person makes in this process of desensitizing to stuttering, the closer they will get to acceptance. Every step in along that hierarchy is a step in the right direction. For some people, it is extremely hard - and as somebody pointed out, those are the ones who need it the most - but each step helps...little by little, people can move toward that goal (and the closer they get, the faster they progress). Thanks again to all for the lovely discussion! S
From: Ken St. Louis
I agree with Scott here absolutely. I tell my clients that our goal is to move the feelings about voluntary stuttering from "dread" to "unpleasantness." But here's another angle...Van Riper cautioned us about the masochistic stutterer who rather seems to enjoy punishing his or her listener. I've really only seen one or two such stutterers in my many years of practice, and in those cases quickly abandoned the voluntary stuttering assignments. But I have often had stutterers tell me something like, "I couldn't believe it, but I really began to have a strange but good feeling as I was stuttering (voluntarily) to people." This is NOT a dangerous thing and, in my experience, is temporary. It's just the pendulum swinging a bit too far the other way, that is from dread to, "Dang it, I'm going to stutter and I'm proud of it!" Eventually, if things work out well, the feeling settles to, "This isn't fun, but it's a necessary chore." One client regarded doing voluntary stuttering as hitting her "reset" button.
From: Vivian Sisskin
Great discussion! I find that voluntary stuttering can be very helpful in a comprehensive treatment program and understanding the rationale for using it can often make the difference in ease/willingness to use it and in outcome. For those who struggle more when they are trying not to, voluntary stuttering can be used to "show yourself as a person who stutters when you don't have to", kind of like letting the cat out of the bag, or doing the thing you fear the most. The paradoxical nature of this assignment makes it effective in reducing fear of stuttering.
From: Michael
Dear Stuttering Professors: I need some expert advice and a question. Has past research shown stuttering to be a hinderance when it comes to dating and how unattractive is stuttering? What can a person who stutters do, more therapy focusing on fluency and trying to be as fluent as possible? I have been through many years of therapy, but still stutters significantly at times, stuttering is situational. When I meet someone new, I always wonder if I should disclose (advertise) right away or not mention it because most people consider stuttering to be negative. In a way, stuttering is just one part of me and not all of me. What would be your advice for people who stutter like me, regarding how to improve the quality of my life and living with stuttering? Why not do more research on improving the quality of life for stutterers. Stuttering genes are cool, but that is not going to help the millions of stutterers currently living with stuttering everyday? And I am not sure dating and possibly marrying another person who stutters is the way to go, given that there is no cure for stuttering and I don't want children who stutters. Is it true that a female who stutters has a stronger chance of having a male child who stutters? Thank you. Michael
From: Dale Williams
Interesting topic, Michael, and one in need of some research. Here's my take. While I don't generally advocate hiding stuttering, it is understandable that people do so when dating. If one views his or her stuttering as unattractive, the tendency will be to avoid, given that we rarely make ourselves less appealing voluntarily. But is there a responsibility to own up to it? Some would say there is no reason to 'own up to' anything, no cause to assume that anyone would have a problem with stuttering. Others argue that, while discussion may not be necessary, somehow the stuttering should be displayed. For one thing, avoidance behaviors hurt recovery. And even if avoidance is not the issue, the health of the potential relationship may require more honesty & less hiding. As with most issues pertaining to dating, it depends on the people involved. Sorry I can't offer anything definitive.
From: Ken
Dear Michael, You ask a number of tough (but important) questions about living with a stutter. Yes, it probably would not matter much in the the daily life of an adult like you (I assume) who stutters if a hot shot researcher had just identified 75 different genetic defects that could lead to stuttering. Your quality of life would not likely change very much. What would affect your quality of life would be the amount and kind of stuttering you do and what you and those around you think, say, and do about it. I'm just guessing here, but I have a sense that you have reached a point in your life where you are not searching quite so much for fluency as you may have in the past. But it still would be nice to not be burdened so much by the stuttering you do have. Maybe you have grown used to the burden, but you still regard it as a burden. And, maybe, if your comment about not wanting to have a child who stutters is from the gut, I'm guessing that you still are a ways from completely accepting stuttering. Or maybe the memories are painful, and you don't want your child to go through what you have been through. I would completely agree with Ken Logan's answer about the effect of stuttering on dating and marriage. The same rules don't apply equally to everyone. I might add that, especially since, therapy has helped you in the past, it might be good to continue or take another shot at GOOD THERAPY. Finishing the job might be just what you need. Whether or not you reach 0% syllables stuttered or nothing checked on a self-appraisal questionnaire, I'm again guessing that you could get to the point where you don't think or concern yourself much about stuttering. It could reach the point that you might decide that disclosing that you stutter, say at a reception of VIPs, would be a useful thing to do for yourself. But at another similar event, you might decide to just go ahead and speak fluently or stutter, whichever one happens, with no explanation at all. Maybe your stuttering could become as important as dandelions in my lawn are to me...I don't care. Sure, I admire a lawn that is as finished as a golf green, but it's not worth it to me to strive for that in my own lawn. For what it's worth, there is a lot of research going on that deals with quality of life of people who stutter. It is also probably true that females who do not recover from stuttering on their own have more genetic influence for stuttering than males. Stutter on... Ken
From: Kevin Eldridge
Michael, You ask a question that many of us asked ourselves when we were your age. As Dale Williams, said, the answer varies. I know one PWS who told me that he would have never married his wife if he didn't stutter. He felt he better take what he could. I know other people who stutter who married beautiful, smart women who they are crazy about. I think that stuttering is as unattractive as you make it to be. If you can honestly believe that stuttering is just a part of who you are (and maybe a rather insignificant part at that) I'm guessing it will not look unattractive to anyone you want to date. However, if you say it is only part of you, but still feel it is a big negative part of you, I bet it will be unattractive. Good luck seeing stuttering for what it is, and what it isn't.
From: Dale Williams
FWIW, there are 2 regular support group attendees here who married "out of their league" (their words, not mine). According to them, their stuttering made them seem more vulnerable or unique or something else--whatever it was, it worked.
From: Walt Manning
Here is another aspect of stuttering and dating - When the students in my class are asked to initiate some moderate levels of stuttering in order to get some sense of the stuttering experience I suggest that they try to inject some stuttering when they are on a date. Most of the students are female, of course, and they find that it is a way to quickly find out if the date will be emparassed or supportive. Finding out how another person response to less than ideal circumstances often reveals the real nature of the person. Some of my students have even experimenting with stuttering with guys are bothering them in a bar. That also works most of the time, and again, it reveals the basic nature of the beast.
From: David Shapiro
Hi Michael, You've raised some excellent questions and addressed some sensitive issues. I see that others have given good advice, shared relevant data, and left you with questions to ponder. I won't repeat any of this. Your post resonates with me, however, more on a personal than a professional basis. Not at all minimizing the realities of stuttering, I recommend that you keep in the dating scene until you find the right girl. That girl will see you for who you are and will see that your stuttering is a part of who you are, even when you are tempted to define yourself on the basis of stuttering alone. She might even puzzle over why you have chosen to 'advertise' that one aspect of yourself. It is said that love can conquer all. I'm a believer. When it happens, you'll know it. Let me tell you a little story. Many years ago, I was where you are. I wondered if someone, anyone, could see through my stuttering, because I couldn't. Then I found an amazing girl who didn't seem to notice that I stuttered. Truly I couldn't believe that such a talented, beautiful girl with the bluest eyes would be interested in me. She's been my girlfriend for nearly 30 years, and we're married too. We have two amazing kids, now young adults. Challenges have come and gone, but the joy is that we get to face them together. Every burden becomes lightened when it is shared. Why not share them with the one you love? One of the respondents suggested 'stutter on.' I'd suggest keep looking so that you find the right one. She's out there. Good luck. David
From: Scott Palasik PhD,CCC-SLP
Michael! Nice to meet you. Great questions and the responses are wonderful. I wanted to echo everyone and agree with David. The laws of attraction are as variable as each of us. What one person finds attractive another may not. Like anyone, you want to be with a person who wants to be with you, you as a person which includes many parts, like stuttering for one. Taking a different angle on this topic, I know a few friends who stutter (both men and women) who actually date more than non stuttering friends of mine. Again, like previously mentioned, attraction is a personal perspective. Thanks for asking this great question! With compassion and kindness, Scott
From: Mark (non-expert)
I found a study here. http://libres.uncg.edu/ir/uncg/f/R_Mayo_Would_2010.pdf The results aren't terrible, but not exactly good either. I can't judge the validity because I don't work in the field.
From: Paul Goldstein
I don't know if it's all right for me to post a response to this question, even though I'm not on the panel. But I would like to mention that I met my wife Liv BECAUSE I stutter! Liv is a fluent speaker (of many languages), but has had a mysterious fascination with the disorder of stuttering and people who stutter since early childhood. I was a 45-year-old bachelor when Liv found me at a stuttering-related website close to 12 years ago. We fell in love very quickly. We met each other in cyberspace in January 2000; we first met in person in April of that year; we were engaged in May, and married in September. For decades I had similar concerns as you have, and was wondering if stuttering would be a hindrance in finding a life mate. I dated many women, but nothing became really serious. But finally I struck gold! Keep on trying - you just never know!
From: Thomas
Tom Weidig at the Stuttering Brain Blog http://thestutteringbrain.blogspot.com/ is a well known Stuttering Blogger. Many PWS and many parents of children who stutter read his blog and he said his blog is popular and well read. His blog shows up when you search for stuttering information on the internet??? Dr. Weidig is famous for attacking Mark Onslow, his research team, and the Lidcombe Programme results.....and even challenging people to public debates. Recently, he has stopped blogging because he found a new job. My question is: Given the extreme popularity of his blog. Is the blog good or bad for the field of stuttering, for consumers who need reliable information, and how to prevent inaccuracies from disseminated?
From: J Scott Yaruss, Univ of Pittsburgh
Hi Thomas - I'll take a stab at this one... My opinion is that with 60 million people who stutter in the world (give or take), there is room for a whole lot of different opinions about the condition. I know that many people follow Tom's blog and benefit from it. That's great. There are other people who follow and benefit from input from other people. I think there's room for all. For some of these issues (many?), where the answers are not clear-cut, I hate to say that one source might be correct and another incorrect... Of course, sometimes that's true, but so much of our field (and any scientific or clinical field) involves shades of grey. That means that there must be room for more than one opinion. So, bottom line? The more (reasonable) sources of information, the better, because different people will benefit from different sources. We have much to learn, and the more we can all work together to share ideas in a collaborative fashion, the more we will all learn. Just my $.02. - S
From: Frank Stechel
It seems that therapeutic techniques in the area of stuttering, be it fluency shaping or stuttering modification, are at least three decades old or longer. Is that because these techniques have proven to be effective or because new research is more medically oriented (e.g., genetics and medication). Thanks
From: J Scott Yaruss, Univ of Pittsburgh
Hi Frank - interesting question. I think that it's fair to say that we'd all like to see more treatment research in stuttering. One major problem that we face is that there are just fewer researchers in the field today than there were once upon a time. There are many excellent researchers working on issues like genetics and medications, as you said, as well as neuroimaging and other important areas. There are also excellent researchers focusing on treatment, but the work is complicated and slow, funding is limited, and the field just plain needs more people doing the work. I think - though this is just because our knowledge is limited at this point - that we may someday find that there are only so many different things that one might try in order to enhance fluency. Perhaps the majority of those have already been explored; perhaps not. Another thing to keep in mind, though, is that treatment involves far more than just working on speech (whether that be in terms of speech fluency enhancement or stuttering modification). Another key component of therapy addresses the affective and cognitive reactions to stuttering, and this can be addressed through a variety of means. There are also issues related to improving functional communication, quality of life, social interaction, etc... There are advances there, but again, there is much work to be done. I hope this helps to answer your question...I'll look forward to input from others! Take care, Scott
From: Walt Manning
It is true that many of the basic aspect of treatment protocols that were developed decades ago are still being used. But the protocols are being refined and these methods are used in combination with other approaches from fields such as counsling. For example, information and ideas about the common factors that are effective across many treatments and ways to predict changes in cognitive and coping aspects of stuttering are resulting in long term success following treatment. Quality of life issues broaden the scope and impact of therapy. Progress is slow, for as Scott commented, the process is reasonably complex and takes effort and time, both on the part of speaker and the clinician. The field of psychology is still using many "older" approaches but is developing somewhat faster than our area of speech-language pathology. But there are MANY more people working on many more problems in psychology than there are in fluency disorders. That's why using concepts and ideas that have been researched and found to be effective in areas of psychology is a good ieda.
From: Rodney Gabel
I would like to reiterate pretty much everything Scott and Walt shared. I think that much more research is needed exploring treatment programs, because though these programs may be quite similar to those done decades ago, we still need to gain a deeper understanding of many issues related to treatment. There has been refinement and a deeper understanding of why and how treatment works (if it does). I think the publication of papers dealing with more realistic designs, such as single case reports, would really help the discipline move forward in exploring traditional therapy methods. As Scott shared, doing treatment research is so difficult, we really need to find ways to report our data that is more realistic.
From: People who stutter and desperate for better treatment
How come the federal government does not fund research for better stuttering treatment research. Must we occupy NIDCD to make our poiint. Please give one of the stuttering professors millions of dollars for stuttering clinical research, not brain imaging research comparing PWS to normal subjects .....there is too much variability and too small of sample size anyway.
From: Lisa LaSalle
I too appreciate the other answers here to an intriguing question. I think the answer lies in augmentations and more than one "track" to the treatment initiatives. For some individuals who stutter, it is true that age-old "techniques have proven to be effective," as you say, and I would add that the techniques need to be satisfying or accepting to the person who stutters him or herself. Walt added the importance of the developments in the field of psychology, and I would underscore how important that side of the equation seems to be for treatment outcomes and initiatives. I was struck by King's Speech producer David Seidler's at the NSA Friends conference. Seidler said that for him, a period of teenage rebellion and other history of Tx (some good, some not so good), and acceptance basically, is what brought about more fluent speech for him. Then again, there are cases of individuals who do spontaneously recover in their teenage years, and they don't really credit any one reason. The individuals who stutter on Phil Schneider's Transcending Stuttering DVD series also brings out this need for self-acceptance before any real treatment can come about. It seems the "medically oriented research (e.g., genetics and medication)" is also a really important track of, as you say, new Tx initiatives. I heard Gerry Maguire speak on this topic a couple weeks ago. He stutters, he is an MD psychiatrist, and he has research funding to study medications and stuttering. Yet he credited both the stuttering modification therapy he had as a kid, *plus* the medication he is currently on (asenapine) for being able to keep his lecture within its allotted time limits. (He commented on the time limit part, jokingly, of course). So it seems to me that the new treatment initiatives need not throw out the need for treatment efficacy research on the old treatments, as they are also effective for many, and can serve as good augmentations for newer Tx and Rx.
From: Afton Gillis
Currently, I am completing my last semester of graduate coursework and will begin my educational internship in January. One of my greatest concerns is feeling that I have sufficient knowledge about stuttering in general and how to treat stuttering in order to serve as a resource for educators and other professionals. I am confident that I know where to find the information that I need to provide effective fluency therapy, but what are your suggestions for me in regards to communicating and collaborating with educators and other professionals in terms of working with children who stutter within the classroom? What do you believe are valuable strategies that they can implement in order to assist with the carryover of the beneficial techniques acquired in therapy? Are there specific resources that I can direct them to? Thank you in advance for your responses!
From: J Scott Yaruss, Univ of Pittsburgh
Hi Afton - That's a superb question. Unfortunately, it has a loooooong answer ;-) There are many excellent resources for educating teachers, parents, and others in order to foster generalization. I'd recommend some of the current textbooks, as well as materials from the Stuttering Foundation, Friends, and National Stuttering Association in the USA, as well as the British Stammering Association and many other international associations. (A great place for a list is the Stuttering Home Page!) I do know that there are some articles in the 2002/2003 and 2010 Issues of Seminars in Speech and Language that address issues of working with school clinicians, etc. You can find those on a pubmed search, or email me offline and I'll see if I can help you track them down. Good luck! - S
From: Educating Educators and Others
Afton, Great question, and Scott gave you some really fine places to find information. The most important thing to do, once you have some basic information, is to talk to the teachers, the office staff, the custodial staff, the cafeteria workers, and anyone else who might be an ally for the children who stutter at your school. You may want to consider engaging the children in educating their teachers and other adults and children at their school. Starting to learn self-advocacy skills early is one of the best gifts you can give to the kids who stutter on your caseload. Regards, Lynne
From: Vince Vawter
Has there been in linkage between stuttering and attention deficit disorder? While there may no proven causative effect between the two behaviors, does it stand to reason that a person with ADD would have a more difficult time dealing with a stutter?
From: John Tetnowski
Vince, One of the things that we do know is that ADD/ADHD and many (actually most) other conditions run concomitant with stuttering. These figures range between 40 and 68%, depending on which data sets we are considering. I think that almost any extra concomitant disorder makes stuttering therapy more difficult...especially when we want our clients to be better communicators (not just less stuttering). The issue that often comes up is, "How do I treat a person who stutters who also is diagnosed with ADD/ADHD?". My answer is to begin with techniques that have been documented to be effective. In addition, make adaptations based upon the individual needs and skills of the individual. The bottom line is this, there is not one documented approach that works for ALL PWS that also carry a diagnosis of ADD/ADHD, just as there is NOT one treatment for all PWS. Our role as SLPs is to make wise clinical decisions when considering a) the condition of the client, b) the needs of the client, c) the motivation of the client, d) the skills of the clinician, and e) what has been documented in the research. Thank you for the question. John Tetnowski
From: Judy Kuster
Vince, you might be interested in reading a past conference paper "The Link Between ADHD and Stuttering: A Closer Look" by E. Charles Healey and Robert Reid http://www.mnsu.edu/comdis/ISAD3/papers/healey3.html and also a tutorial they published in 2003 in the Journal of Fluency Disorders. It is online at http://www.unl.edu/fluency/pdfs/adhdstutter.pdf Using the search engine on the Stuttering Home Page (http://www.stutteringhomepage.com with the key word ADHD will uncover some more interesting information to explore on this topic.
From: Retz
Vince - Dr. Joe Donaher at Childrens Hospital in Philadelphia is also an excellent resource professional regarding the relationship between stuttering and ADD/ADHD.
From: Vince Vawter
Thanks for all the replies. Exactly what I was looking for.
From: bc
Morning everyone - having experimented with voluntary stuttering, it has forced me to evaluate my speech and my fears. I used to dread stuttering and would spend all day worrying about how bad the day would be speech-wise - as I am sure some of you have also done in the past or even still do to this opresent day. With voluntary stuttering, I am probably stuttering on MORE occasions each day, but I am controlling it a hell of a lot more and I am becoming more and more comfortable with it. As a result of this, my INVOLUNTARY stuttering is becomg LESS frequent. So, this has made me ask myself the question : is the problem stuttering itself or losing control of my speech ? I stutter more now (maybe!) but it is nowhere near as big of an issue. I am confronting it. Not hiding away from it. Take it on ! Over to you...........
From: Charley Adams
Hi lbc, First, congratulations on taking an active role in recovery from stuttering. I think the answer to your question is in your subject line; the problem isn't stuttering, or loss of control - it's the FEAR. And you're winning, my friend...
From: lbc
Thank you. For the past 2 months, I have been making on average 40 phone calls / face to face questions per day. This has contributed to a less fearful existence and my confidence is growing. Some calls / face to face contacts are good, some not so. This was difficult at first to accept - now I move onto the next one and dont worry about it so much. I am trying to release 20 years of negativity and fear - so I realise this will not be fixed overnight. Fear is still there and sometimes I forget my techniques etc, but this is a work in progress and I can slowly see progress being made. My favourite technique's / methods are ssssliding into words and also dropping voluntary sta-stammers into conversation. If you havent tried voluntary stammering - i wholeheartedly recommend it. It completely changed my outlook on stammering and helped me gain more control in my speech - with more control on its way. I could carry on writing but you may have fallen asleep by now so I shall stop !
From: Ellen-Marie Silverman
You are discovering that acceptance is a preliminary step toward healing and that resistance contributes to suffering. That is no less true for stuttering problems than anything else we feel plagues us. Good Work!!!
From: Ken St. Louis
Great thread. I just posted the following in a previous thread but should have read further. It fits better here. Ibc, your experience is a great testimony to the value of voluntary stuttering. EARLIER, I WROTE: I tell my clients that our goal is to move the feelings about voluntary stuttering from "dread" to "unpleasantness." But here's another angle...Van Riper cautioned us about the masochistic stutterer who rather seems to enjoy punishing his or her listener. I've really only seen one or two such stutterers in my many years of practice, and in those cases quickly abandoned the voluntary stuttering assignments. But I have often had stutterers tell me something like, "I couldn't believe it, but I really began to have a strange but good feeling as I was stuttering (voluntarily) to people." This is NOT a dangerous thing and, in my experience, is temporary. It's just the pendulum swinging a bit too far the other way, that is from dread to, "Dang it, I'm going to stutter and I'm proud of it!" Eventually, if things work out well, the feeling settles to, "This isn't fun, but it's a necessary chore." One client regarded doing voluntary stuttering as hitting her "reset" button. KEEP UP THE GOOD WORK! Ken
From: Walt Manning
Yes, giving yourself permission to stutter opens up great possibilities. You are free to experiment and even have fun with your stuttering. You may be stuttering more but you are stuttering lots better. Which leads to less avoidance a greater fluency in the long run.
From: Jon
Is Bilingualism a risk factor for stuttering? What about the benefits of learning multiple languages? There was an article from http://www.sciencedaily.com/releases/2008/09/080908215938.htm Study done in the UK, by Peter Howell? On a more practical level, how should one counsel parents of children who stutter regarding exposure to second language learning? And should bilingual speech therapy be given to a bilingual child (for example, find a bilingual Spanish-English Speech therapist if stuttering occurs in both English and Spanish). Thank you for your help and answers. Jon
From: Jean Sawyer
Hi Jon, There have not been very many carefully designed studies of bilingualism and stuttering. Your question is intriguing, as quite probably, more people are bilingual than monolingual, so there are more bilinguals than monolinguals who stutter. The Howell, Davis, and Williams study you mention, as well as other studies on bilingualism, have some methodological and reporting deficiencies, so we do not have a clear picture about whether bilingualism is a risk factor for stuttering. Patricia Robers and Rosalee Shenker have written a nice chapter about assessment and treatment of bilingual speakers in Stuttering and Related Disorders of Fluency, edited by Curlee and Conture (2007). In this chapter, they cite research that points to no increased risk of stuttering for bilingual speakers. There is little good research on whether continuing to speak a second language to a child will tax fluency, so it is not known whether parents should be counseled to speak to the child in only one language. The authors recommend treatment in the language that the clinician and client have in common, so it is probably not necessary to have a bilingual clinician or two clinicians. All in all, we don't have many definitive answers about bilingualism and stuttering.
From: Ari (Israel)
I just couldn't stop myself to quote Dr Murray in his book:He tell about Van Riper therapy "He spent several months in therapy ,often under Dr.Bryngelson,who had him work through voluntary stuttering to gain control over his involuntary blocks" And after it he tell about Dr .Johnson: "He saw Charles Van Riper's stuttering fading away,and he was so impressed that he put himself on a similar program. Immediately ,his stuttering became so much worse that he was told to stop speaking altogether and to go off on a week-long fishing trip,during which he was to continue his silence" So voluntary stuttering that help to some stutterers (including me)can be disaster to other .
From: Tricia Zebrowski
I have heard from a number of PWS that the disfluency characteristic they would most like to change is sound prolongation (with or without airflow and/or voicing). Many have noted that this type of disfluency feels like a "blockage" and this inability to move forward in speech causes them a great deal of discomfort and anxiety (some report a feeling of panic). Naturally, they experience a strong physiological reaction that seems to be best described as "fight or flight", perhaps what we (slps) see as "struggle". I think that voluntary stuttering or replicating the behavior of stutering purposefully is both desensitizing and increases behavioral awareness. It helps the individual to feel what they are doing when they stutter in a context that is relatively devoid of negative emotion and physiological reactivity. Paying attention to what you do so that you know when and how you might change it is an old theme in stuttering therapy (thanks to Wendell Johnson and Dean Williams), and continues to hold true in attempts to change any behavior. As a side note, even if the PWS wants to focus on learning ways to produce controlled and ultimately automatic fluency, I typically introduce purposeful stuttering as a method for decreasing emotionality in the moment of stuttering and for helping the person to pay attention to what he does during speech, both fluent and stuttered. That being said, I don't teach stuttering modification unless the person wants to focus on changing those moments once he experiences a level of awareness and reduced arousal.
From: Ari (Israel)
For years i felt in most situations that i cant speak at all, so i didn't. On few situations i felt that i can speak but some sounds i can't produce. When i tried speaking in such situations, i couldn't say a sound or the specific sound. I passed more than 12 SLP'S in Israel and nobody, understand this, they wouldn't imagine how i felt outside the clinic, cause in the clinic i didn't felt this feeling so i was quite fluent, but in most situations i couldnt talk at all. I almost gave up of my life, cause i knew it is impossible to do anything when you feel that you cant talk. I want to ask: did you met clients that seem very fluent, but couldnt talk at all in the real life, and how you brought back to them the feeling that they can talk, even if they would stutter! Thanks Ari
From: Lynne Shields
Ari, Your experience is fairly common, I think. I find that many clients are much more fluent, if not entirely fluent, in the therapy room than they may be outside of therapy and more willing to talk in therapy. There isn't just one way to address the goal of increasing comfort in talking in the person's 'real world'--different people may choose different approaches that are a 'best fit' for them. Regardless of whether the client chooses to just try talking (as opposed to avoiding talking), to use voluntary stuttering (as you mentioned in your previous post), or some speech modification tool of some kind, I think it helps to first spend time helping the client identify their 'fear hierarchies' for speaking partners and situations. It is much less stressful, and therefore probably more do-able, for a client to try talking to the least feared speaking partner on their hierarchy, or in the least feared situation. Once they have worked at this level, they can decide when they are ready to challenge themselves to a person or situation slightly higher on their hierarchy. Best regards, Lynne
From: From: Ari (Israel)
Thanks Lynne for your reply! I think that "hierarchic" is easier in cases that the stutterer have situations that he have more fear and situations that he have less fear. It is more difficult when the stutterer have very little fear in one situations,and panic feeling in most situations. (I solved it by feeling the fear in my comfort zones,and only when i started to stutter more in situations i never felt the fear,i started to believe that it is possible to speak when i feel that fear)
From: Lynne Shields
Ari, I agree with you. Each person has to figure out the way that he or she can best approach 'getting out there' and talking. I think doing a lot of talking at a level that you can tolerate is a great way to prepare for those fearful situations, especially if you don't have many 'in between' situations or speaking partners. Thanks for sharing how you figured out the best way for you to manage getting more involved in speaking out. Regards, Lynne
From: Ari (Israel)
Thanks again Lynne! I needed to do a lot of changes in order to see the light, in the dark tunnel i was. ari
From: vin Eldridge
Ari, Nice to see you are still around. I enjoyed your posts last year, so I'm glad you didn't give up on your life (seriously!). My question for you is... Did any of the 12 SLPs you worked with in Isreal treat you "in your real life" (at work or a coffee shop, cafe, bar, or in a park, synagogue, etc.) instead of a therapy room?
From: Ari (Israel)
Hey Kevin! Until i was 19 years old i never went out with the SLP. Then i had one day that i went out as a group to practice "Fluency shaping" targets,but i knew that it is impossible for me so i avoided it, by doing some things that i wont feel the fear. 6 years ago i passed another "Fluency shaping" treatment but without SLP'S,and then we went out a lot. But they spoke with me before very slowly and i was in control,so sometimes it helped me to avoid the fear,but to try doing it alone was another story. Someday i was half an hour in the street trying to ask somebody something,but i couldn't, i felt that i cant breath,i felt panic. The feeling that nobody understand my feeling ,even the most experts SLP'S that i met , didn't left me all the years. Thank you for your kind words! Ari
From: Kevin Eldridge
Ari, The fear of stuttering. The fear of talking. This really is the core of the problem for so many of us that stutter! The fear of stuttering is so great that we no longer try not to talk, we try not to stutter... which leads to what.... STUTTERING! What good is learning all the fluency shaping techniques in the world if your fear (which is very real I am sure) is so great that you can not access those techniques. Some people say that the fear will go away when the PWS realizes he has new tools to speak. But I say, FEAR is way to strong... and yours sounds stronger than most. As a PWS and an SLP it really upsets me to hear stories like yours. I don't want to make any assumptions, so before I go on, I want to ask you a question. If you are comfortable answering it, online, please do. How did you feel when you were standing on the road for 30 minutes trying to do something that you were able to do quite well in therapy room?
From: Ari (Israel)
Kevin,i feel that i need to add some background of my experience. When i was 30 years old, I knew that i cant live my life trying to ignore my "black hole" -my stuttering. The problem was that in Israel, the most SLP's work only about acceptance, and that stuttering is OK. But i almost never stuttered, and when i didn't have a choice but to stutter, I had silent blocks that i tried to break with a lot of struggle, and i couldn't accept talking with such effort . So i tried again Fluency Shaping, and indeed it was better, they took me to stores and with them i could ask questions very slowly, very controlled, very fluently, and i thought that i could deal with my "black hole". After it i wanted to go to the next level, to succeed talking to people by myself, and i thought that if i will do it day by day, someday i will feel better without such fear. And some days i felt that i don't have such a fear and it was easier (of-course i used a lot of tricks),but someday it was very frighten like in the past. When i was in the street half an hour afraid to even try asking someone, and feeling panic ,i felt that i am starting again from zero, I didn't achieve anything, I steal talking very good in my "safe zones" and feel panic in most situations. When i told this story to an slp in FS reunion, she told me to consider taking drugs to deal my anxiety, but i couldn't agree cause my anxiety didn't start by itself it came from my stuttering, so i knew that the answer is where the problem began. So again answering to your question: for me it was natural, obvious that in the real world i cant talk at all, the real problem was that i thought that i couldn't do anything with my life if i couldn't talk with new people, and i didn't know how to change it? Thanks Ari!
From: Jane
Dear Professors, I was wondering what is a good definition of covert stuttering? Is Covert Stuttering a disorder that is established and can be found in future textbooks and DSM-V. Most importantly, how do you treat a client who says he or she is a covert stutterer (closet stutterer), with very little or no stuttering behavior (no prolongations, a couple easy quick repetitions, and appears to be a fluent speaker). I do not see how fluency shaping therapy would help?? Thanks! Jane
From: Kevin Eldridge
Jane, Great question. Covert stutterers are by definition, probably not going to stutter much when they first see you. They have spent their life using elaborate techniques to avoid stuttering. The first thing you need to do with a Covert stutterer is to get them to stutter more! Why... because this means they are actually starting to be honest with themselves and are facing their worst fears... that they will stutter. Often times a Covert stutterer may begin therapy before they are really ready to do the hard work. If this is the case you are correct fluency shaping is definitely not going to do any good (whether it ever does any good is a question in itself). But it sure won't help here. They would use the technique in the therapy room and then continue to avoid and use their tricks in the real world. An interesting side. When I first began my doctoral studies my advisor told me of a covert artic case she had. This college student came to her for help with his speech. After the first 10 minutes she had no idea why he was there. His speech sounded perfectly normal. The he told her he couldn't pronounce the /r/ sound. When she reviewed his speech sample video, she realized that he had talked 10 minutes without using a word with the letter /r/. Talk about working hard to avoid a problem. It is amazing what some people will do to avoid showing that they have a communication disorder.
From: Barbara Amster
Jane in addition to Kevin's great response please also look at the article about Covert Stuttering by Gary Rentschler in this conference at http://www.mnsu.edu/comdis/isad15/papers/rentschler15.html It's really terrific! Barbara
From: Gary J. Rentschler
Thanks for the compliment Barb! Treating covert stuttering is all about "the head game".. counseling the client to overcome his/her fears of stuttering and helping them work through their avoidances. I appreciate that this is sometimes more difficult than traditional speech therapy where we work to modify actual speaking behaviors. But what the covert stuttering client often needs are reliable means of speaking so that the can trust their speech will "come out" when they want to talk. It makes little sense to the causal observer that someone with no visible signs of disfluency could be so absorbed and fearful of stuttering... Experience finds that the person who stutters covertly goes to astonishing lengths not to show their stuttering. As a result, the handicapping effects of their problem are equally as strong as those who stutter openly.
From: Klaas Bakker, Missouri State University
I am personally fascinated by this problem as well. If there is nearly no overt stuttering, then stuttering behavior (in an overt sense) is obviously not the problem, but it seems that we have a new problem now: strong concerns and incredible internal efforts to avoid what may (but we don't know for sure!) lead to stuttering. It seems to me the straighforward choice for treatment would be to work on reducing the concerns. I do believe that allowing the stuttering to come out could be one way to deal with with concerns, but there may be other ways that are simply directly aimed at finding out how to overcome concerns and fears.
From: Ken Logan
Good topic! It seems to me that some of the ideas that have been discussed under the "voluntary stuttering" thread would be a good way to help a person who frequently uses word substitution, circumlocution, etc., to cope with the expectation of disfluency. In such cases, it seems critical to help the person increase his or her comfort level with having repetitions, prolongations, blocks, etc., "leak out" into the open for all to see. Voluntary stuttering and, as others have called it "playing with stuttering" are a step in this direction.
From: Lindsey
Dear Professionals, Sometimes it seems impossible to get a teenager to be motivated enough to be an active participant in therapy both inside and outside of the therapy room. I know that most motivation must come from within, but I was curious as to what sorts of motivators have worked for you, especially with your teenage/young adult population?
From: Dale Williams
This is a really good question Lindsey. I'm always looking for new ideas myself. Some of the things that have worked in the past: playing music during sessions, making tasks competitive, using sports or fashion magazines as stimuli, & calling athletes on the phone (I work with a lot of sports-crazed teens). One young woman I worked with just needed someone to listen to her, so I did a lot of that before she got motivated. Having said all that, however, your point about internal motivation still holds. Sometimes a kid isn't ready for therapy & all these efforts fail.
From: John Tetnowski
Lindsey, Great question. Early in my career, I made a decision that I was not going to work with teens because of their lack of motivation.....now it is my favorite group to work with in therapy. First, I think that we have to let them know that therapy and change is their responsibility, not their parent's responsibility. The teens that I see are responsible for their tasks, homework, etc. I have found that treating them like adults, gives them confidence and pride in what they are doing. Another thing that I have learned is that "if they do not want to be in therapy right now" there is little we can do about it. Often, the parents want them to be in therapy, but they do not want to be there themselves. In those cases, I make a deal with the teen and the family. The deal is this, "you do not have to come to therapy right now, as long as you come to our self-help/support group once a month". This keeps them engaged until they are ready. Speaking of groups, the accountability to the group is very important for teens. Getting them into groups is important. Recently, we also added another level to our group that helps. It is difficult to get kids/teens to the group for the first time, so we started doing a parent group that breaks off of the main group during our time. We ask parents to come even if their kids/teens do not attend. Within a short time the kids/teens start coming with their parents. I have also found that parents begin to understand the commitment much better.....it is not the old medical model of "I'll drop off my kid and pick him up when you have fixed him". Even though the teens are resposnible for their own work, it is the parent's responsibility to get them to therapy/ group. Kids don't miss soccer games. if the parent can't get them to a game, they arrange for a ride some other way. I like to set the same expectations for therapy. I also must add that it is our resposnibility to the parents to explain therapy goals and expectations. It is the teen's responisbility, but the parents need to know the overall plan and should be invited to watch and participate on a regular basis. But tehy need to know that it is their kid's responsibility to complete tasks, etc. It is like the middle school and high school science projects that we see. If the parents build the project, it looks great, but the teen learned very little. Let the parents watch and help, but the teen needs to build the project themselves in order to learn. This is the same with stuttering therapy. I feel like I am rambling now, so I will stop. Any of the professors could probably write hundreds of pages on this topic. Feel free to contact me off-line for more ideas. Great question!
From: Ken Logan
As John and Dale said, this is a complex issue. The approaches that John and Dale noted sound like excellent ways to engage teens. I see many college-age people who stutter. Many of these folks did not wish to participate in therapy during high school and are either just engaging in speech therapy for the first time or are doing so after not working at their speech in a therapy context since childhood. They typically will say that although stuttering was not something they enjoyed during high school, they did not perceive it as necessarily being a critical problem to address, either. In college, however, they suddenly seem to care much much more. Sometimes the level of concern perks up in freshman year, but more often it is during the sophomore or junior years. often this is precipitated by their desire to participate more in class discussions, social settings, and (the big one) their desire to perform well in interview situations for jobs or internships. So, in these cases it seems to be a matter of hitting a low point and wanting to do something about it.
From: David Shapiro
Hi Lindsey, You're asking a great question. I see that others have given you some excellent advice. Here's another idea. I have found with people who stutter, and particularly with teens, that nothing is as motivating as success itself. In fact, success begets success. I believe it is the clinician's responsibility to construct opportunities for (and later with, and eventually by) the client so that the client experiences fluency success. No words from a clinician can be as motivating as what the client experiences for him/herself. Many clients have had years of treatment and have become skeptical if not jaded. You might want to take a look at my paper on this forum (Stories of People who Stutter), and particularly the experiences of George. In order to maintain that motivation, I focus my treatment around achieving collaboration (doing with, where the client is a partner in all aspects of treatment), success (defined individually; not only using fluency controls but experiencing communication freedom as well), and fun (having a genuinely good time in the process of interacting with another person and learning and growing together). Good luck. David
From: Rodney Gabel
What a great question. Like John and others mentioned, I really like working with teenagers too, though teens can be very tough. One piece of advice is to let them know that "the door to therapy swings both ways." They can leave or stop therapy, but they can also come back when they are ready. Like Ken said, many people will make the decision to do therapy later, in early adulthood, and I think that teens need to know that their decision to attend therapy or not is their decision alone. Feeling forced into therapy never a good thing and may lead to them never coming back to therapy later. Treating them like an adult with autonomy is so important. Also, I think letting them do a bit of teaching, about their stuttering and what they experience is helpful. Often, they take an orientation that "adults know everything" so they enter therapy with "this adult thinks they know everything but I still stutter so how much do they really know?" I usually engage clients in this age group in assignments or activities where they get a chance to teach me about what they know about stuttering and their own stuttering. Allowing them to generate the discussion points and tell their story is a very helpful approach. I will make one last point. It is important to share stories, videos, or other examples. We also need to let them know that these are just examples. We have to be careful that they realize that their change, their progress, may very well be unlike others. Often, perfect models or other types of models can be discouraging. We need to help them understand that there are reasonable outcomes to therapy and that their outcome will be their own.
From: Pamela Mertz
Hi all - I know there are many camps on this issue, but I have a variation on the theme. I know many people who stutter do not consider themselves disabled bu their stuttering, myself included. I felt most disabled when I DID NOT speak due to fear of stuttering and negative judgement. Then, there are many who rightly so do consider their stuttering disabling. They may have severe blocks or secondaries which makes every effort at speech a struggle. Here's my question though: ready? I had a boss recently who insisted on referring to my stuttering as a disability, even though I do not. I found it quite offensive actually. He would go as far as to mention to other colleagues that I might be the best one for a particular task since I have a disability and experience with disability issues.Because the relationship with this authority figure was power-based, I found it hard to tell him how offended I felt when he was running around telling people I have a disability. Shouldn't that be my choice? How would you advise someone coming to you looking for guidance with an "insensitive" (putting it nicely) person?
From: Kevin Eldridge
Pamela, I think you answered your question. Yes... you are correct... It should be your choice. I think the advice is simple to determine, but hard for some to carry out. The employee needs to explain to their boss, that although the boss views stuttering as a disability they do not feel disabled by their own communication impairment, and therefore are requesting that he stop telling others that they are disabled. Even though I felt quite disabled myself, I would never have wanted my boss saying I was disabled. Another thing.... I would first tell the boss in person, but if it happens again, I would send an email and request that he respond to my email. Then if he continues to mention I was disabled, I'd have information his superior to look at.
From: Lynne Shields
Hi, Pam! I agree with you and Kevin--it really isn't up to anyone but you to decide whether or not your stuttering is a disability. I know it has to be a bit sticky to deal with this coming from higher in the chain at work, but figuring out how to gracefully-yet-firmly advocate for yourself, letting this person know that you don't care to be referred to as having a disability seems to be important to you and is therefore a worthy goal. If he keeps hearing your preference from you I would hope that the message will sink in eventually. Or, as Kevin suggests, you may need to go up a level, if it continues. Let us know how it goes! Best, Lynne
From: Rodney Gabel
I am a clinician (obviously since I am on the panel) and I am also a person who stutters. I think stuttering, in itself, can create a stigma. Disability, as a label, can also create a stigma. I have found it helpful, for myself and my clients, to think about disability at its very base. If someone is struggling with something, be it a vision impairment, obesity, stuttering, etc., then the condition is disabling. By the same token, a person can have all of these same problems but have absolutely no difficulties coping and thus have no disability. So, that is the way I think about disability. We can stutter and have a disability, or we might stutter and not (with no limitation). The practical issue is one of service. Often, I find people who stutter have difficulties with accepting that they have limitations, a disability if you will, thus they really do not have services provided to them. This is particularly glaring with school therapy. If the child or family do not use the "D" word (or the "S" word), then services might not be available. Unfortunately, that is how many school districts have to operate. There must be a documented limitation or disability secondary to stuttering. This is so easy to document, once the family and speech language pathologist know how to talk about the POTENTIAL DISABILITY that can come with stuttering. It is heartbreaking to see people not get help, simply out of fear of admitting the disability/limitations that are present.
From: lbc
Any thoughts on this?
From: Gary J. Rentschler
That's actually a complicated question. I look at it this way... people who stutter are more prone to have disfluencies in their speech -- as a consequence, fluency is more sensitive to disruption in stressful conditions. That's the part that I would say "happens to us". But we can contribute to occurrences of stuttering by our behaviors -- being anxious (some would argue that "happens to us" too) usually results in more muscle tension, trying to speak too rapidly, using more effort to talk... those are conditions we are responsible for and we can control. So, I guess my response to your question is "both"!!! An interesting thought.. if stuttering happens to us, why doesn't it happen to us when you sing, or whisper, or when you are alone talking to yourself? or talking to a pet?
From: Ken Logan
I'd agree with Gary, who said it is some of "both." There is pretty good evidence now from research in the areas of genetics, neuro-imaging, speech motor control, and so forth that there are physical/physiological differences between people who do and do no stutter. What "happens" as a result of these differences is not fully understood yet, but the parts of the problem that stem directly from an underlying impairment may not always be controllable, and thus perhaps something that happens to us. There are plenty of things that a person can do to aggravate the situation however...some of the these things have discussed on other threads here(e.g., avoiding speech, expecting negative evaluations from listeners, etc.). This is the part that is very open to change.
From: Ed Feuer
Does anyone, these days, do the full regimen of Van Riper therapy as described in his classic, "The Treatment of Stuttering"? And if not, why not? edfeuer@mts.net
From: Gary J. Rentschler
It's hard to speak for every speech pathologist, but I am not aware of anyone who uses Van Riper's "Traditional Approach" solely on its own. However, many clinicians, including me, integrate parts of Van's program into the stuttering therapy program for individuals we treat. Among the specific components I find valuable are Identification, Desensitization, and several of the stuttering modification techniques credited to the Traditional Approach. The Van Riper approach was utilized with me when I was a client... and I turned out alright! I infer from your question that you see merit in his approach and wonder if its being utilized by the profession???
From: Walt Manning
Like Gary, I use many components of the Van Riper "stuttering modification" approach. One of the key components is Variation where the speaker begins to break up the many overt and covert components of the habitual manner of coping with his or her stuttering. There are, however, components of other treatment and counseling approaches that are often used in therapy depending on the needs of the speaker.
From: Ed Feuer
Gary, yes, I do see a great deal of merit in Van Riper's approach as described in "The Treatment of Stuttering." It makes eminent good sense. But why, in your view, do practitioners not do the full regimen of stuttering therapy as described in the book? Why do those who do anything from the book only pick and choose, cafeteria-style? edfeuer@mts.net
From: Dick Mallard
Ed, like Gary, I was taken through the Van Riper program as it was designed at age 22 which was my first therapy experience. That is exactly what I needed. However, I find that many clinicians do not understand the importance of following the Van Riper (or any therapy for that matter) sequence as it is laid out. There are too many of us who try to use a procedure designed for the last part of Van Riper's program at the beginning of treatment and then wonder why things are not working out. You can't expect a client to use cancellation, for example, without first having been through Motivation, Identification, Desensitization, Variation, and THEN Cancellation, followed by Pull-outs and Preparatory Set and finally Stabilization. There seems to be a lack of understanding of the foundations of this therapy and then the procedures are misapplied. One of the best experiences of my overall clinical training was being taught to do Precision Fluency Shaping at Hollins College. One must follow the steps in the fluency shaping sequence or proper learning does not take place. We all know that there is a lack of adequate instruction in therapies for stuttering during our formal education. That speaks to the importance of specialty training. I could go on and on here but the bottom line is clinical programs should not be initiated unless they are administered as designed by appropriately experienced professionals.
From: Ed Feuer
Dick, Van Riper therapy as described in The Treatment of Stuttering, would require a highly structured, labour-intensive, time-intensive, expertise-intensive regimen of identification, in vivo systematic desensitization, modification and stabilization. It involves unlearning, learning, relearning, genuine and thorough desensitization, healing and strengthening. The book, as such, was a compendium of Van Riper's best ideas gleaned from his experience over the course of decades ' his description of the ideal therapy situation. But the regimen prescribed there is woefully impractical as a template for therapy delivered by sole practitioners. SLPs very quickly discovered that and at best, picked-and-chose ideas cafeteria-style. That's why these days nobody does the full-regimen Van Riper therapy as described in the book which is out of print. And quite frankly, I don't think Van Riper ever did so either. The full regimen certainly wasn't done when I was at Western Michigan in 1974-75 when he was in semi-retirement. But I still think the book offers a valid model, still the best around for what is needed ' but it would take a team ' a coordinated multidisciplinary team. The realization of that goal would first require that SLP finally acknowledge that their profession, alone, cannot deliver effective stuttering therapy ' still a pretty tall order, unfortunately. But they would still play a central role as facilitators in such teams which would utilize the speech therapy model provided by Van Riper. edfeuer@mts.net
From: Dick Mallard
Ed, your response to my is interesting. I never thought that Van Riper's program had to be administered by the sort of multidisciplinary team you describe. That was not my experience as a client with that model and I have used that model in a private practice when applicable. I would appreciate you elaborating further on why you believe the Van Riper model has to be conducted as your describe. I look forward to hearing back from you. Thanks in advance.
From: Ed Feuer
Dick, To me Van Riper's central idea as he stated in The Treatment of Stuttering is this: 'We feel that stuttering needs a global therapy, a total push, if it is to yield to clinical intervention and that it must be attacked from every quarter and with every available weapon.' Can it be honestly claimed that anyone anywhere is doing that today? What exists out there now for the treatment of stuttering in adults? Everywhere, we see too much clinic-room fraud, token therapy, short-term quickie fixes that focus only on one element of a multi-faceted problem, distractor devices, the false hope of the pink pill; and many SLPs not qualified to treat stuttering but who claim otherwise. As I stated earlier, SLPs realized that that they couldn't do the full regimen of Van Riper therapy, that they lacked both the necessary knowledge and necessary time. My view is that if any sort of successful long-term outcome is the goal, then Van Riper's prescription finally needs to be taken seriously in practice as well as theory. And that would take a coordinated multidisciplinary treatment team. I elaborate on this in a presentation I did at the International Stuttering Association conference in Buenos Aires earlier this year. I would be very happy to e-mail you or anyone else interested a copy. edfeuer@mts.net
From: Dick Mallard
Ed, I would love to have a copy. Thanks. You can send it to amallard@satx.rr.com.
From: Alana Mantie-Kozlowski CCC-SLP
I have used DAF with an individual with Parkinson's disease (PD)(moderate hypokinetic dysarthria and palilalia) with some success. When I ordered the device, the manufacturer was insistent that I needed FAF because the patient had PD. Is there support for that recommendation? Also, could anyone explain why this was deemed so important for an individual with PD? I thank you in advance for any input.
From: Richard
If the general consensus is that 1% of the general population stutters. Of that 1% (1 out of 100), how do you think stuttering severity is distributed? For example, how about 5-10% severe stutterers, 50-70% mild stuttering, 30-40% moderate stutterers as measured by the Stuttering Severity Instrument. In other words.....most stutterers are really "mild stutterers"? And how accurate is the 1%estimation, didn't some people estiimate the true prevalence to be 0.1% to 1%. Thanks! Richard (interested in stuttering)
From: Ken St. Louis
Richard, These are good questions. Let me take a stab at them. As for the distribution of severity, it all depends on the group of stutterers you look at. Most studies have looked at clinical and research populations, that is individuals who come for evaluations and therapy or are recruited to participate in research projects. These are included in--but are not the same as--those in the 1% prevalence figure you cite. Only a tiny fraction of those ever see the inside of a clinic or a laboratory. So, if we take the clinical/research population, Soderberg (1962) summarized stuttering frequency in oral reading of 105 adult stutterers from four master's theses at Western Michigan University and Ohio State University. I wish I could paste in his histogram, but I can't. Here are the figures. With 200-word passages and therefore 200 possible stutters per individual, 51 (or about half) had 0-16 stutters, 18 had 16-32 stutters, 13 had 32-48 stutters, 13 had 48-64 stutters, 3 had 64-80 stutters, 3 had 80-96 stutters, 3 had 96-112 stutters, 0 had 112-128 stutters, 0 had 128-144 stutters, and 1 had 144-160 stutters. What this set of numbers virtually screams out is that, during reading, adults who stutter don't stutter very much. The histogram is highly negatively skewed toward the mild side. In the clinical/research population, the large majority of stutterers are likely mild, moderates account maybe for the majority of the rest of them, while severe stutterers are rare. In a different vein, I have been having my students interview people who stutter (or used to stutter) for years, and I have kept a summary impression sheet for each of them. These individuals were usually found through queries from family and close friends "back home." As such, they are mixture of clinical/research AND the "other" population of stutterers. Here's a "quick and dirty" snapshot of those (nonverified!) impressions of severity for 256 adults who stuttered at some time in their lives: No stuttering--14%, very mild--37%, mild/moderate--9%, moderate--9%, moderate/severe--7%, severe--4%, very severe--1%. It gives the same impression as Soderberg's report, but even showing much less moderate and severe stuttering. As for prevalence, probably the best study around was the National Speech and Hearing Survey done in 1968-69 by Colorado State University. I worked on that study as an examiner for one year. Six teams went to 100 randomly selected school districts around the country testing 39,000 randomly selected children from grades 1-12. There were no questions about whether or not one stuttered. Subjects were scored as stuttering if they actually stuttered during a 10-minute speech/voice/language sample. There were many more stutterers in the early grades than in later grades, but the overall prevalence rate was 0.8%. Since we did not ask about stuttering, and since many stutterers can speak in a screening situation like that without stuttering, it is likely that the estimate is lower than the actual prevalence rate. The conventional wisdom is that, of the TOTAL population of stutterers (clinical/research/other), 5% will stutter sometime in their lives (known as "lifetime incidence'), usually during preschool years and early elementary years. About 80% of them will recover spontaneously, leaving about 1% who will stutter chronically. That is the figure that most prevalence studies will approximate. I hope this figure-filled answer deals with what you wanted to know. Best, Ken
From: Ken St. Louis
In the long previous post, I omitted the Mild category from my own list of stutterers. It accounted for 18% of the total group. Two percent were not included in this listing. Ken
From: Ari (Israel)
I was introduce to Technic, of separating the sounds, the purpose of this technic was to avoid stuttering, but i found that it is very useful for me for: stutter more easy and to reduce tension. That's mean that instead holding the all syllable i am stuck in ,i only prolong or repeat the first sound until i can move on to the next sound (with gentle onset) . For example if i am stuck with "mo" i only prolong the m until i release the tension and i can say the "o" sound. I must say that it helped me a lot to reduce the tension quickly and to feel "moving forward" feeling. I want to ask: what you think about this concept? Did one of the pioneers of the "Stuttering Modification" talked about this concept?
From: Vivian Sisskin
Ari, Getting on the first sound of a word is a good way to reduce silent blocks and helps to begin the desensitization process. That said, holding on to the first sound until the "fear dies down" often keep you in a locked position and can sometimes reduce the ability to move forward. I find that anything one does to "wait out the fear" will allow the next sound to release more easily. That is why some PWS wait or postpone initiation of the first sound creating inappropriate pauses in their speech pattern. Others do this by repeating the previous phrase a few times. These sometimes add to the struggle over time. Moving ahead to the vowel, and desensitizing to the fear of making "vowel noise", which often occurs when tension is high, might be helpful in the long term.
From: Ari (Israel)
Thanks for your answer! Yes what you described is exactly what happened to me.Holding the first sound was the only way i succeed to start conversation instead silent blocks. And like you wrote: after it i felt that i prolong the sound too much,without moving to anywhere. So now i try to "be in the block" just to release my tongue tension,and then despite the fear i try to move to the next sound. What i tried to say is: that also when i am stuck,i concentrate only on the first sound,and it helps to release the tension more quickly in order to move to the vowel,with gentle onset. For me it is a game of timing,to know when to move to the next sound,not too quickly cause it can cause me a silent block,but not waiting until the tongue will be completely relax ,but stable without interrupting me moving to the vowel. ari
From: Jack M.
Hi everyone, I wanted to share some news and pose a more theoretical question on this discussion board. After undergoing speech therapy myself for over 13 years, I have recently developed a new speech therapy app for iPhone, iPad and iPod touch. I truly believe that technology has the power to transform how we communicate and access our speech therapy. So, here's my BIG question: where do you see speech therapy heading in terms of innovative technology? Telepractices have become common and mobile apps are being developed, but where do we go from here? Would love to hear your thoughts! Jack McDermott Founder, Balbus Speech http://Speech4Good.com jack@balbusspeech.com
From: Judy Butler
I have been looking forward to a response to this question. I hope someone from the panel will provide a positive, constructive reply before the conference is over.
From: Katie Dauer
I am a board recognized SLP in stuttering. I have a question about recovery in the younger children. During the course of treatment of these children, I often see the severe dysfluencies go away (like tension and secondaries), put part word repetitions remain along with nonstuttering like dysfluencies. If the tension is gone, when and how do we decide that they can discontinue therapy. Sometimes I start doing therapy less often and if the stuttering doesn't change, work towards discharge. Are there any guidelines regarding this? Thank you in advance.
From: Lynne Shields
Katie, I don't know of any set of guidelines for discontinuing therapy for young children in the case where they continue to show some stuttering-like disfluencies. My preference is to talk to the parents, and the child if they are aware of their stuttering, to see how they feel about the level of fluency achieved. If they are comfortable with the child having some easy disfluencies, then I see no reason to continue therapy. I typically do as you suggest, seeing the child and parents on a reduced schedule, and then eventually keeping in touch by phone or email for a period of up to a year to be sure that tension and struggle behaviors are not returning. I am careful to let the family know that they can always return for additional treatment if the stuttering worsens, or if the child indicates an interest in reducing the easy stuttering. So, I see this as a decision for the family and not me. It is the child's speech and the parents' child, so they are the 'authorities' in knowing when it's time to manage on their own. When the parents are not in agreement, all I do is engage with them in discussing the options and their fears or concerns and let them make the decision. Hope this is helpful. Regards, Lynne
From: Charlie Osborne
Katie An excellent question! I agree with Lynne about following the child and his/her family (I typically follow for 5 years after therapy). To me, knowing when to end therapy with younger children has become less about frequency of stuttering and more about the child and family demonstrating a 'sense of control' when it comes to talking. By this I mean that the child is aware of how s/he talks, does not experience any angst if s/he continues using easy repetitions, and knows s/he can choose to talk the way s/he wants to. I have had some children who prefer to not use many repetitions by therapy's end and then there are those who are not that concerned. In either case, the child is typically demonstrating a strong self-concept when it comes to communication. Regarding parents, again, when they feel that their child is talking the way s/he prefers (and is able to talk with or without easy repetitions by choice), they are usually comfortable with easing out of therapy. I guess I keep Yaruss and Quesal's (2004) interpretation of the WHO Model in mind. If the problem of stuttering has resolved and the way a child talks and feels about talking isn't limiting his/her ability to interact in activities of daily living, there isn't anything else to work on.
From: Vivian Sisskin
Katie, I would add one more thing. Before I feel comfortable discharging from therapy, I like to know that the child is comfortable problem solving on his/her own about speech and stuttering. I include things like knowing what behaviors are harmful and helpful to comfortable communication, knowing what specific strategies to use when they might experience fear of stuttering, or avoidance behavior, making sure that channels of communication are open between parents and child, and arming them with resources that are age-appropriate.
From: Katie Dauer
I have a second question. Sometimes with the younger child, I also see another change during the course of therapy. As the tension goes away a mild prolongation remains that has no tension and could almost sound like an easy onset that is a bit longer than necessary. Have you seen this and what can or should be done to help them. Sometimes, I talk about "let's keep our easy onsets short." and I model what I mean. Any other suggestions?
From: Dale Williams
Katie--as you suggest, those lingering disfluencies can be frustrating, for client, family, & SLP alike. It's difficult to answer your question accurately without seeing the kid, but in general (and I'm sure you already know this), decreased tension is a good thing & this might just be part of the recovery process (i.e., a decrease in quality, as opposed to quantity, of disfluency). It could also be a learned behavior or a sign of overall discoordination. What happens when you ask him to voluntarily shorten them?
From: Ken Logan
Hi Katie, This is a good question, and illustrates nicely the difficulties that we sometimes have in distinguishing between "unmanaged stuttering" and "managed stuttering." Van Riper discussed managed stuttering at length under the concept of stuttering modification therapy, and the speech pattern you describe could be consistent with the stuttering management techniques he described (e.g., preparatory set) if it is being done deliberately. If so, the "disfluency" could be considered positive (i.e., an instance of managed stuttering). The notion of gentle onset (or more precisely "slow, gentle onset") is usually associated with fluency shaping approaches, where the overarching goal is to eliminate, or at least substantially reduce, stuttering breaks in speech. I've always thought that the two approaches are not really not as different as they are sometimes made out to be. In your example, we may be seeing a case of managed stuttering, but it's tough to tell whether it is that or unmanaged stuttering. It might be worth a discussing it with the client. (I'm forgetting the age of your client, but s/he might be a bit young for this). If it is something that the client has actively done to manage stuttering, and it results in less severe stuttering compared to previous patterns, than the child is to be congratulated and decisions can be made about whether to go for even finer management. If the child is not aware of it or is aware but has not or cannot do anything to change it(unmanaged stuttering) then it might be worth working at further (I say might because the disfluency may not impact communication very much and may not be of concern to the child.). Good luck!
From: Damon
What is the prevalence of the disorder of cluttering behavior in people who stutter? 35%? Does Insurance pay for cluttering treatment, and what is cluttering treatment for kids, teens, young adults, and seniors. Is Cluttering more cognitive, and language based (not related to speech motor aspects)? I am not sure if I am a person who stutter or a person who stutters and also clutters (the relationship is interdependent). I am really curious about stuttering and cluttering, how do I know whether I am a clutter or not. Who is the #1 cluttering expert I can go to? Really appreciate your help. Thank you!!!! Damon
From: Ken St. Louis
Damon, I'm writing this message after my reply to your later message about person-first labeling. I am definitely not the "#1 expert" on cluttering, but some people think I know something about the disorder. You may know that an "expert" is a "has been" ("ex") and a "drip under high pressure" "spurt."
From: Klaas Bakker, Missouri State University, Springfield MO
Damon, Like Dr. St Louis, I have spent a lot of time learning more about cluttering and participating in a number of studies on the subject. I too don't know if that makes me an expert but I like your question and will try to relate my thoughts. It seems Dr. St Louis already came out with the numbers which were close to yours. But I think you were also between the lines asking about the relationship between stuttering and cluttering, and how they may relate within yourself. Of course the best answer would come following an evaluation by an SLP who is knowledgeable both about cluttering and stuttering. Reading some of the documents online available on the website of the International Cluttering Association (http://associations.missouristate.edu/ICA no doubt would help you better understand how much you have of each. I personally think someone may have signs of both but not necessarily happening together at the same time something like slipping into a cluttering mode of speaking and later getting hung up in a stuttering mode. To some extent the problems have opposite characteristics which why it is so fascinating that it apparently is quite comment to find both within the same person. Not sure if this helped any, but I think someone working with you one on one and who has a demonstrated interest in fluency disorders may bring out a lot of helpful information, even though not all of it has a lot of science behind it. Research in cluttering is only in the beginning stage and depends a lot on people like you who are interested in sharing their experiencing. The International Cluttering Association makes a point to work close together with people who clutter. Hopefully we can connect sometime through that channel....
From: Florence Myers
Hello Damon - Katrina deHirsch, a contemporary of Deso Weiss (who might be considered 'the father of cluttering' in the modern era), once wrote that the question of the relationship between cluttering and stuttering is one of the most important questions in our field. The major constructs associated with stuttering is that there is often physiological tension, effortfulness and fragmentation (especially fragmentation at the sound/syllable level) in speech. Clients often tell me that they know what they want to say but the difficulty is transitioning or blending successive sounds and syllables. I still consider myself a 'student' when it comes to cluttering, though I have spent the past nearly 30 years studying and thinking about it. I learn a lot from my clients. This is what people who clutter have shared with me: a) multiple thoughts come to mind and the PWC cannot or does not 'choose' to take the time to sequence the thoughts into language and speech; b) a tendency to be on overdrive most of the time (in fact, one client said that he's not in his comfort zone UNLESS he multitasked and at a fast rate at that) due to what may be an inherent disposition to want to do everything fast or in a disinhibited mode; c) some degree of difficulty in imposing self-monitoring and self-correction when talking. We also classically differentiate the disfluencies associated with cluttering by noticing that these disfluencies are not as fragmented or physiologically tense as in stuttering. The disfluencies in cluttering include interjections, incomplete utterance, and revisions. These disfluencies are also associated with typical speakers and has come to be known as (linguistic) maze behaviors. It is as if the PWC has difficulty encoding the ideas of a message in a completely focussed, well-organized, and efficient manner. I personally have advocated the notion that these disfluencies may reflect certain disruptions in the thought-to-language formulation process. Another distinctive feature about cluttering is that sounds and syllables are often dropped, rendering portions of the speech unintelligible. The listener thinks the PWC is talking fast or in a spurty manner perhaps in part because the listener has difficulty 'keeping up' with the processing of the message as it is not consistently easy to understand cluttered speech. Many individuals have elements of both stuttering and cluttering. One client told me that as he slows down to focus on his cluttering, stuttering-like behaviors emerge. You have raised a very important question for the profession, as well as of course for yourself. I would follow some of the leads provided by the others to seek someone who is knowledgeable about fluency disorders (both stuttering and cluttering). As a field, we know much more about stuttering than cluttering. Thank you for your contribution. Florence Myers
From: Damon
Since some past research studies has shown that using the term stutterer may have a slightly more negative connotation than the term PWS.......Are there any benefits to using the term stutterer rather than PWS? If using the term PWS (or person who stutters) is always better than the term stutterer, then let's hope no one ever use the term stutterer again. Some of the old folks still use stutterer. Damon
From: Vince Vawter
I understand why "PWS" is more appropriate than "stutterer," and I try to use it in discussing the subject, but I have no problem in referring to myself as "a stutterer." I recall in a Q&A after one of my speeches, a member of the audience was nice enough to say that she didn't think I was a "stutterer" because she couldn't hear it. I told her that while she might not hear it, I could certainly feel it and if she wanted to follow me around for the rest of the day, I would show her some stuttering doozies. So, for my part, I'm a guitar picker, I'm a golfer and I'm a stutterer. I do the first two somewhat crudely. I do the latter beautifully.
From: Charlie Osborne
I am not a person who stutters, but as a clinician, if I did stutter, I'm not sure would rather be referred to as an acronym, 'PWS,' or by 'stutterer.' I think Vince hit on the reason for PWS vs. stutterer. Using the term 'stutterer' implies that the characteristic of stuttering encompasses all that a person is. By using 'person who stutters' it includes the many other characteristics of what constitutes a person. When I went to school, back in the old days, I learned about 'stutterers.' I now use either term when talking about stuttering and the people who do so. The problem isn't so much the term 'stutterer,' but the words 'is' or 'am' which are all inclusive. For me, I am a SLP. This leaves out all other characteristics of who I am (husband, father, sibling, son, wanna-be home brewer, etc.). As an instructor, I make every attempt to help students recognize that in our field we work with people who happen to stutter and that person A who stutters is not person B who stutters, etc.
From: Ora McCreary
You write "Using the term 'stutterer' implies that the characteristic of stuttering encompasses all that a person is. By using 'person who stutters' it includes the many other characteristics of what constitutes a person." I've never found this argument convincing. We use nouns all the time to refer to people, and ourselves, without implying that this is all we are. A person might describe himself/herself as an opera-lover, a cook, a writer, a therapist, a pianist, and a singer. None of those descriptions imply that that's the totality of the person. Should we say person who plays piano? Person who cooks? Person who writes? Person who performs psychotherapy? Everyone understands this type of wording, and no one is confused by it. Similarly, no one thinks that a stutterer is ONLY a stutterer. Why then should we invent the awkward phrase "person who stutters"?
From: Ken St. Louis
Damon, Good questions, but ones that strike a chord (or a nerve) with me. I had a paper on this topic a few years back. Maybe you'd like to take a look at the paper and the threaded discussion.
From: Kevin Eldridge
Ed, You are right on target. Kristin Chmela was the person who pointed out that it is not CWS, but children who stutter some of the time. This is so important (for children especially) to realized. It is the term I always use with the clients of all ages that I work with. Do you have an idea for an abbreviation?
From: Ed Feuer
Kevin, that's a tough one. PWSSOTT is definitely unwieldy. Such is the problem of stuttering that there's difficulty even coming up with a good but accurate abbreviation or acronym. We are sometime stutterers but the initials for that formulation have a ring to them that is horrific. A great rock group where I live once solved a name conundrum by calling itself The Guess Who. But we can't use that because it's obviously taken. So I guess at least for now, we're ' accurately ' PWS (some of the time). edfeuer@mts.net
From: J Scott Yaruss, Univ of Pittsburgh
Hi all - interesting discussion on person-first language. Of course, there's research on this conducted by Ken St. Louis showing that many people who stutter don't mind being called a stutterer... I'll let him and others comment on that. For my part, though, I want to pick up on the use of the acronym. I have to tell you that personally I hate the use of the acronym to refer to people. I know I'm probably alone on this, given the widespread use of the acronym in both informal and formal writing in our field. It seems to me, however, that if we're using person-first language so as not to dehumanize somebody, then when we switch to an acronym, we've actually moved in the wrong direction. Personally, I never use the acronyms "PWS" or "CWS" in written or spoken language. If I'm going to go to the trouble to refer to somebody with person-first language, I will actually say "person" or "individual" who stutters... Or, as Michael Sugarman and I put it in an ISAD paper a few years ago, "a person living with stuttering." This refers to the condition of stuttering rather than the behavior of stuttering because, as pointed out elsewhere in this thread, people who stutter only stutter sometimes. FURTHERMORE, if the point of using the acronym is to save time or to be more efficient, then I must reflect on the fact that saying "person who stutters" requires 6 syllables and saying "PWS" also requires 6 syllables. So, there's no benefit! Yes, this is sort of a pet peeve for me (I have several)... but I would personally love to never read the acronym PWS or CWS again (and I'd love to never hear somebody say "I have 3 CWSses on my caseload") and instead say "I am working with 3 children who stutter..." (Note that doing that actually saves you a syllable because CWSses costs you an extra one.) To me, it comes down to the purpose of person-first language - to maintain the dignity and humanity of the individual experiencing a problem. If saying "person who stutters" helps to do that, then we should do so. (Of course, many people who stutter feel perfectly comfortable with "stutterer," too, so it's fine to call them that if they are fine with it...) Either of those options seems better to me than the acronym. Again, I know I'm kind of odd about this... ask my students... but there it is. End of rant. OH YES: for some reason, it doesn't bother me as much to refer to speech-language pathologists as SLPs, so go figure... (I actually prefer clinicians or, dare I say it, therapists because that keeps the focus on the clinical interaction rather than the pathology... But that's a point for another rant...) G'day all! Thanks for letting me emote. S
From: Scott Palasik PhD, CCC-SLP
Damon! Nice to meet you (so to speak) and thanks for question. Being a person who CAN stutter I use both terms. Charlie brings up a great point about the words 'is' and 'am'. These simple words can 'fuse' people to a thought and build constructs that are not entirely accurate. For example if you say. 'I am a sad person' is that accurate? Probably not, you might be sad sometimes, you might be happy sometimes, you might be neutral sometimes. The point is language is a power tool to constructing perceptions of ourselves and others and when we use 'Prison words' (Kelly Wilson's term, a contextual psychologist at Ole Miss) like 'always, never, am', these words allow not options or flexibility in thought and can perpetuate a construct of ourselves that is not true, all the time. We can teach this concept by inserting a simple word like 'can', which allows flexibility in behaviors (both thoughts and physical actions). That all being said, we give meaning to words and language of which we choose. The word 'Stutterer' doesn't have to be negative, if choose it not to be negative. These are just my thoughts and some perceptions from contextual behavior psychology. Thanks for asking the question Damon and feel free to keep asking questions!
From: Florence Myers
This has been an interesting discussion. The original intent of PWS is laudable. However, I feel that many use PWS or PWC mostly to be politically correct, rather than consciously 'emoting' (to use Scott's word) the regard and toward a given individual or group of individuals. But somehow 'PWS' loses the essence of its original intent when we put it as an acronym. Someone earlier said that words are powerful. I agree. In the end, however, it's the intent and action behind those words that are even more important--whether one uses 'PWS' or 'stutterer.' When we interact with clients, we should ask which term that particular individual prefers.
From: Jean Sawyer
I agree with you, Florence, that we should ask the individual which term he or she prefers, if we need to use a term at all. Our clients are people first. I always tell my students to use people-first language, as disorders don't define a person. I also tell them that some people who stutter may call themselves "stutterers," but that is their choice to make, not my students' choice. I agree with Scott and many others that PWS is no better than "stutterer" as a label.
From: Ed Feuer
Professors, what are you doing to encourage your students to challenge orthodoxies and to think outside the box before they become well invested in the not-so-glorious status quo? edfeuer@mts.net
From: Tricia Zebrowski
Hi Ed....this is a big question and we could answer it in many ways. What do you think we should help students to question? I think we strive to teach students how to think critically, and that may be what you are asking...but I'm not sure. Can you clarify your question?
From: Ed Feuer
Tricia, yes this is certainly a big question. What do I think students should question? Well, for starters there's clinic-room fraud, token therapy; short-term quickie fixes that focus only on one element of a multi-faceted problem; distractor devices; the false hope of the pink pill; and many SLPs not qualified to treat stuttering but who claim otherwise, flawed research where we're not differentiated according to age, severity, gender, over, covert and before and after intensive programs; ASHA's failure to establish a dedicated ombudsman for stuttering; lack of independent third-party assessment of outcomes over time; and failure by SLPs to give "multidisciplinary interaction" (it's on ASHA's SID4 page under "professional issues") anything more than lip service. Many large issues about stuttering still lie unresolved but within the profession, there appears to be a surprising and disappointing lack of ferment, dispute and debate ' the time honoured ways advances are made in science. Fluency disorders students should be front and centre in challenging the status quo. But if their profs have convinced them things are just peachy, they won't be a force for change. Teaching them how to think critically and speaking out accordingly rather than going along to get along is certainly needed. I know that I have been talking about these problems for years but so far I've seen little indication of students picking up on these ideas. Of course, who stutter (some of the time) have also been remiss. I quote Jim McClure, NSA board member and consumer representative on the ASHA specialty board of fluency disorders, who stated the following on Stutt-L on Dec. 20, 2010: 'Consumers generally get what they demand if significant numbers of them are organized and persistent enough to make their presence felt in the marketplace and legal arena. So far, unfortunately, people who stutter have been less than demanding.' Indeed. ' Ed. edfeuer@mts.net.
From: NAEd FeuerME
Well, I've waited patiently for an answer after my clarification and it seems that not only are the professors not "in" for this question, they've left the building. I have a friend who tells me that I'm wasting my time in expecting progressive, idealistic students will be drivers for meaningful change. "Ed, these are not arts students," the friend says, meaning that they don't question, debate, challenge and protest. Maybe the penalties for the above are just too severe. It could be that because stuttering is only one of many speech disorders, they don't give it the focus many of us who stutter (some of the time) would like. Perhaps only those SLPs who have a stuttering problem themselves care enough to be real generators of advances. (At least those in that category who don't feel they have to be more royalist than the king to garner acceptance from their fluent peers.) Sooooo, because I continue to live in hope and since PWS (some of the time) do it repeatedly, I will repeat my question: Professors, what are you doing to encourage your students to challenge orthodoxies and to think outside the box before they become well invested in the not-so-glorious status quo? And yes, sadly, no answer is an answer in this case. ' Ed edfeuer@mts.net
From: Jean Sawyer
Dear Ed, I like to teach my students to be good thinkers and problem solvers. I tell them that I sometimes hear from people at conferences that some SLPs feel "afraid" to treat stuttering. I tell my students that that is something I don't ever want to hear about them, even if they haven't had much experience treating stuttering. I have 4 goals for my students 1) to become more personally involved with stuttering and people who stutter 2) to assess stuttering effectively (and that means the entire disorder, not the behavioral features), 3) to treat stuttering effectively, and 4) to know where to go for answers to their questions. I invite people who stutter and SLPs who stutter to my classroom, and have the student work on a stuttering awareness project, which has included some of the "outside the box" issues you speak of. I try to help the students build critical thinking skills and help them feel comfortable treating people who stutter across the lifespan.
From: Lisa LaSalle
Jean put it well, what we try to do for students in the profession. I always bring clinical cases into lectures, to impress upon students the individual variability. But, Ed, when you quote Jim McClure as saying, "'Consumers generally get what they demand if significant numbers of them are organized and persistent enough to make their presence felt in the marketplace and legal arena. So far, unfortunately, people who stutter have been less than demanding.' It makes me wonder if you've disovered www.stuttertalk.com podcasts? They're awesome.
From: Kelly Brummel
Dear Professionals, I'm a graduate student in speech-language pathology and am currently finishing my last semester of classes. I have a 10 year old boy on my caseload this semester who experiences mild disfluency (determined both subjectively and through the SSI-4). I recently gave him the OASES-S in which he scored an overall impact score of mild. Through assessments and discussion, he has mentioned how his stuttering does not affect him or his quality of life. He is overall effective in using his tools (easy onsets and stretching; his "superheroes" as we call them), however he experiences disfluency when excited during conversation and more "unstructured" activities. Because his stuttering is mild and (according to him) it doesn't seem to bother him, I've noticed an overall indifference to therapy recently. Although he enjoys the activities done in therapy, I would love to see more motivation from him. I recognize that his stuttering doesn't affect him greatly right now and think that's wonderful, but how can I get him more motivated in therapy? And motivate him to generalize use of his tools in the "real world"? Thanks in advance!
From: Lynne Shields
Kelly, The age-old issue of motivation! It is a great topic for you to consider as someone just starting in the field. This 10-year-old has some good things to teach you, so why not talk to him about this? For example, ask him why he doesn't use his easy onsets and stretching outside of therapy. It could be that it takes too much effort or concentration at this point in his life, or it could be, as you suggest, that he really is not finding a negative impact from stuttering at this time in his life. If that is truly the case, and you and your supervisor believe that stuttering is not really impacting him at present, then perhaps focusing on being more fluent isn't high on his top 10 list of 'things to achieve'. Exploring stuttering, how he stutters when he gets stuck, what struggle behaviors he uses, etc. may be more profitable. If he shows tension and struggle, then perhaps he would be motivated to find ways to reduce the struggle, rather than stop stuttering--stutter more easily rather than less. Or, he might be more interested in learning interesting facts about stuttering. Perhaps talking about good communication skills--eye contact, making sure the listener knows the background information, letting others have a turn in conversations, etc.--is a good focus for therapy, if he does not have a good feel for his use or failure to use these skills. It may also be time for a break from therapy. So, in the next few weeks or months, you might refocus by talking with him and his parents about things they can do at home, right now and in the future: having a stutter-friendly household, where it's O.K. to talk and stutter, and the parents focusing on their son's message rather than on his stuttering; how to handle teasing if it happens; and, discussion about what signals he thinks will tell him that he may be ready (in time to come) to return for more therapy. Not knowing the details of this child, I can't tell you the best way to go about this, but you and your supervisor, the child and his family can certainly work together to decide what is in his best interest now. Best wishes, Lynne
From: Charlie Healey
Hi Kelly, You asked a great question about your client's stage of treatment and how he could achieve more success than what he has apparently achieved thus far. Lynne has given excellent advice and insights for you and I would agree with everything she has said. I would add though that maybe the child is comfortable and accepts his mild stuttering. I think to push him to higher levels of fluency and to convey to him that he must use his techniques more often gets away from the central message that we like to instill in therapy, which is it is okay to have some stuttering and feel like he is successful. I don't advocate measuring success by how frequently a child stutters. Has he changed is feelings, attitudes, and reactions to stuttering? Can he tell a long complex story without lots of stuttering? If not, then work at that level. Story telling is key and that is part of the effective communication skill that Lynne was talking about. I also think that you need to sit with the child, the parents, and your supervisor and discuss where you are in therapy and what other things can be accomplished, if anything. Is it really motivation issue? Maybe the child will say that he is fine with his speech and the parents are too. It's amazing sometimes how everyone is not on the same page. Try not to let your own bias or perceptions lead him to think that he is not motivated to improve his speech. I think through more discussion with the child and the parents, you will get a much better picture of what additional things you need to do in therapy. Or, as Lynn suggests, maybe this is a good time to cut back on the number of times he is being seen for therapy. That's a decision for everyone involved to make.
From: Ken St. Louis
Kelly, You have some wonderful insights from Lynn and Charlie. Print those out and put them in your files to refer to in the future when you have a client who seems not to share your enthusiasm for making changes in his/her speech. I would add one simple point. In my book, motivation isn't something that someone "has," or motivated is not something that someone "is." Motivation is the end product of two dynamics, COST versus BENEFIT. If something "costs" you more in time, effort, money, status, etc. than the "benefit" you believe you will get out of it, you will not be "motivated" to pursue it. And of course, to the extent that the "benefit" outweighs the "cost," you'll be, probably to that precise degree, "motivated." My $.02 worth. Ken
From: Kelly Brummel
Great, thank you so much for all of the advice! I appreciate it! We plan on having a discussion with the parents and students around mid-term to see what direction we will take the therapy in next, what else the student himself would like to accomplish, etc. I'm thankful for all the wonderful advice!
From: Heather Grossman, Phd, CCC-SLP
I began working with a young man who speaks Mandarin as his first language and mentioned that he stutters differently in the two languages, but hadn't considered aspects of tone. Does anybody have any information about stuttering in languages where tone/inflection dominates meaning?
From: Tricia Zebrowski
Hi Heather! Yes, in fact. One of my students has just finished a study in which she looked at the relationship between stuttering loci and tone in Mandarin. She found that stuttering is more likely to occur on syllables produced with tones 3 and 4, and compared Mandarin tone to linguistic stress in English (which we know has a relationship to stuttering). I will ask her to post her findings more specifically.
From: Heather Grossman
Thanks Tricia, I will ask my client if this is his experience as well.
From: [no name]
A few years ago I worked with a young man who spoke Mandarin (primarily at home with his family) and English. He shared that he experienced much more tension when speaking Mandarin and experienced more severe stuttering in that language. It is good that Tricia and her student are conducting this research. We need a lot more information about how stuttering behaviors differ across languages.
From: Judy Kuster
I think the 3rd and 4th tones in Mandarin are rising pitches, aren't they? And wouldn't producing them require/indicate at least some amount of increased laryngeal tension? Could this be why stuttering occurs more often on those tones? Same question with stressed syllables in English. I was once told that in Icelandic, the stress is always on the first syllable. I'm not sure I remember that correctly, but it is interesting if it is true.
From: Rick
Dear Heather, I would be interested in how you treated this client (first language is Chinese)? Did you work on attitudes and how to use pull-outs or easy onsets in the Chinese language? I think there are over 2 million Chinese speakers living in the United States. Thank you! Sincerely, Rick
From: Fang-Chi Chou
Hi Heather, I am a doctoral student of Dr. Zebrowski. I summaried the results of my research. Hope the information will be helpful for you! My research examined the influence of Mandarin tones on stuttering loci in preschoolers. In English, stuttering occurs more on stressed words, which have high variability in speech production (longer duration, louder intensity, and more varied pitch movement). Individuals who stutter are vulnerable to increased variability, resulting in more speech disruptions in connected speech. In Mandarin, tone is one of the paramount characteristics. Every Mandarin syllable carries a tone. Changing the tone of a syllable can alter its meaning. There are five tones in Mandarin: four lexical tones (Tones 1, 2, 3, 4) and a neutral tone (Tone 5). The results of my research showed that stuttering occurred more on four lexical tones instead of on the neutral tone. The reason may be: the four lexical tones all have a distinctive pitch contour, while the neutral tone doesn't have one. The pitch of the neutral tone depends on what the preceding tone is. Therefore, the syllables carry the neutral tone are generally defined as 'toneless.' Second, compared to four lexical tones, the neutral tone is shorter and softer. The Mandarin neutral tone is somewhat comparable to English unstressed words. Thus, less stuttering instances were found in syllables carrying the neutral tone. Compared to the neutral tone, the four lexical tones have longer duration, louder intensity, and distinctive pitch contours. Mandarin lexical tones are somewhat comparable to English stressed words. Thus, stuttering instances were found more frequently on syllables on syllables with carrying four lexical tones. Among the four lexical tones, the research results showed that stuttering instances occurred more frequently on syllables carrying Tones 3 and 4. Compared to Tones 1 and 2, Tones 3 and 4 have higher production variability. The variability may come from production difficulty of the tone itself and the influence from the tonal context. (For example, the pitch contour of a tone can be changed in terms of what the preceding and following tones are). Tone 3 is a falling-rising tone. That is, when producing Tone 3, we lower the F0 first, and then raise the F0 at the second part. Tone 3 is the latest required because of having more variations in distinctive contours. That is, it can be produced as Tone 2 or half-Tone 3 (only the first falling part) depending on what the following tone is. The varied alternation in pitch target can contribute to high processing load, leading to more production variation. On the other hand, when producing Tone 4, we drop the F0 rapidly from the highest level of the pitch register to the lowest level of the pitch register. This dramatic pitch change can pose a challenge in speech motor system, causing more speech disruption. This study focused on investigating the relation between Mandarin tones and stuttering loci. However, linguistic factors that can influence stuttering loci are interdependent. We still have to consider other linguistic factors such as content vs. function words and word position. Like English, stuttering events are more likely to be found on: 1) content words for adults; 2) function words for preschoolers; 3) the initial position of a word, sentence, and utterance (Based on Yang's research in 2002). The aforementioned research results are what we have known about stuttering loci in Mandarin. Definitely, more studies are needed! Fang-Chi
From: Heather Grossman
Thank you so much Fang-Chi for that very interesting summary of your findings. I have just started to discuss some of these issues with my Mandarin-speaking client. He told me that while Mandarin Chinese is his first language, that since he tends to speak English more now, he finds the actual pronunciations of many words to be more challenging in Chinese. We are working now on using easy prolongations to gain control on words he anticipates tension, and using pull-outs when he finds himself in a block. He seems to be transferring the skills well between the 2 languages.
From: Curious question
Why do children who stutter stutter more frequently on function words, while adults who stutter stutter more on content words. For example, many stutter on their own name and address (city, and street name), and stutter on their children's names.
From: Ken St. Louis
Dear Curious, One reason is that young children start so many of their sentences with monosyllabic words like "I," "me," and "you" which are pronouns, and hence function words. I'm sure there are other reasons. Nan Ratner and her colleagues have researched this extensively. Ken
From: Gerald
Why don't more Speech therapists in stuttering teach clients to improve their overall communication skills? It seems some SLPs are afraid to go beyond stuttering reduction and is only comfortable with telling clients to practice and "use your techniques", why is that? Because........ If the stuttering is already mild, and less than 1-2%. Shouldn't the focus be on improving overall communication skills? And how about helping the client improve her/his quality of life, rather than focusing on learning techniques and reducing Thank you. Gerald
From: Lynne Shields
Gerald, You make a great point. Addressing communication skills is quite important in therapy, for any type of communication disorder, including stuttering. I think that there are quite a few of us in the field who do consider this an important part of treatment, and sometimes the most important part. Your point is well taken, though, in that I suspect that quite a few SLPs focus more on the fluency skills than on the big picture--helping the person feel comfortable communicating, whether or not they happen to stutter. You also mentioned quality of life. Bob Quesal and Scott Yaruss are on this list and may want to comment on their assessment tool, the OASES, which rates the impact that stuttering has on the speaker's life. Some of us use this tool to help identify where the person is relative to quality of life, and work with the person to figure out how to begin to make positive changes. I would guess that SLPs may not address these important aspects of therapy relate to the nature of their training (focusing on techniques) or lack of training in the area of fluency disorders. Thanks for posting your question and bringing this issue up for discussion! Regards, Lynne
From: Ed Feuer
Lynne, I think you've hit the nail on the head when you say that "SLPs may not address these important aspects of therapy relate to the nature of their training (focusing on techniques) or lack of training in the area of fluency disorders." That being the case, it is high time they put professional jealousies aside and recruit experts from outside experts in such areas as interpersonal communication, assertive training, and acting and drama to work together as needed with the stuttering client as part of a multidisciplinary team within the parameters of the speech therapy model. That would help acknowledge in practice as well as theory that stuttering is not only a speech impediment but a life impediment and must be treated accordingly. By the way, I will know that my advocacy of a multidisciplinary team approach for treatment is gaining traction when SLPs start claiming it was their idea all along. ' Ed edfeuer@mts.net
From: Charlie Healey
Traditionally, most students learn in their courses on stuttering treatment to work on speech mechanics as a way to help the person who stutters manage stuttering. However, there is a growing trend to look at stuttering treatment outcome as more than just how much someone stutters and consider it a multidimensional problem. Unfortunately, not many clinicians feel comfortable working on communication skills because they are not sure what to do. I think you raise a great point and trust me, there are many of us who teach our students to think more about stuttering than just reduce stuttering or use techniques. Clearly, an effective communicator is one who can still exhibit stuttering but is not afraid to talk about any topic to anyone at anytime. That's what good communication is all about and is an important goal for therapy for kids and adults who stutter. Many of us are doing our best to get that message out to as many SLPs as possible.
From: Walt Manning
Great discussion topic. I know there are some clinicians like Kristin Chemla and others on this "list of professors"(but not enough) how go beyond focusing on the frequency of stuttering. Like Charlie Healey commented, I don't spend much time on the frequency of stuttering but more on the form and effort associated with the stuttering. The overt behavior associated with stuttering is, of course, the most obvious aspect of the problem and the feature(s) the person is often most interested in changing. At least when they first come to therapy. But improving their ability to comunicate is also critical, especially for continued success and many begin to realize that once they begin to achieve greater fluency. Jane Fry and her colleagues have incorporated this into their treatment at the Michael Palin Center in London. The last I heard a manuscript was in press Fry, J., Millard, S., & Botterill, W. (in press). The effectiveness of intensive, group therapy for teenagers who stutter. Journal of Fluency Disorders.) However, an even more basic goal of therapy, and one that underlies a basic aspect of change is the development of an agentic lifestyle (and is closely related the the earlier on this thread on quality of life. I think it is best desribed as the ability of a person to 'achieve a voice in a literal as well as a metaphorical sense' and where they can act and speak for themselves (see Monk, G., Winslade, J., Crocket, K, & Epston, D. (1997). Narrative therapy in practice. San Francisco, CA: Jossey-Bass Publishers. This is why the line in the King's Speech "Because I have a voice." went through my chest like a spear - and I suspect that it did for many others who have a history of stuttering. So, as others have commented, I think the best clinicians take a broad, multifactorial approach and not only attend to the goals and abilities of the speaker but also focus on aspects of change such as communication ability and recognizing and developing agentic behavior in a variety of forms.
From: Scott Palasik PhD, CCC-SLP
Gerald. Thank you for asking a wonderful question and bringing up this vital point about teaching clients to be better overall communicators. This is not only pertinent to stuttering, it can also be applied to all communication disorders. Since we are talking about stuttering, I'll address that one here. One thing I have started introducing into therapy with all of our clients is learning how to create and produced public speaking skills. We have had clients from age nine through adulthood practice speeches that are taken directly from the Competent Communicator Manual that members of Toastmasters International Organization use. We use this manual and discuss the different learning points for each speech, allow the client to brain storm ideas, and then present these speeches which could be 4-7 minutes in length to the clinician or small groups of people (depending on the client's wishes of course). We also try to teach clients that they can talk about any topic (even those they know nothing about) for a few minutes while still organizing a good speech with an opening, body, and conclusion (again, an important component of a Toastmaster's meeting, Table Topic speeches). Lastly, we teach somatic (body movements) as related to communication. We encourage clients to be aware of their posture and how they move in space in order to convey a message (not only verbally but also a sense of confidence). Gerald, your question is a great one and I thank you so much for posing it to this group.
From: Pam - not a professor but interested in this topic
Gerald, I was very happy to see all this discussion here about communication skills for people who stutter. And particularly pleased to see the last professor who responded, Scott, reference Toastmasters. I am an adult who stutters. I was covert (or tried to be, or thought I was) for many years, until I reached a crossroads 5 years ago, and gradually moved towards acceptance. Very gradually. In my first year in therapy (ever, as an adult, I did not allow myself to stutter publicly for that WHOLE year.)Eventually, I did allow myself to stutter, and now I do overtly. Along the way, I found Toastmasters, which has had a profound impact on my life. I have been involved with Toastmasters since April 2006, and have completed the Competent Communicator track, as well as three other advanced tracks, in all delivering more than 50 "official" Toastmasters speeches over the years, to small and large groups, to familiar members of my club and to total strangers. And I have stuttered in EVERY single speech - sometimes very little, sometimes quite noticeably. I gave a speech to over 200 youth and parents 2 years ago (that I did not know) called "Don't Be Like Me", and I actually got a standing ovation. They admired the fact that I could give a speech about public speaking AND stutter, and be OK with it. Toastmasters is a great resource, and beneficial supplement to traditional or self therapy. Several of the professors here mention that communication is not about stutter-free speech. It's about being able to confidently convey our message and connect with our listener, without fear of stuttering or fear of judgement. Feel free to check out my own paper on this conference titled, "I Stutter! How In The World Can I Join Toastmasters?" Hope no one objects to me chiming in here. ~Pam
From: Vivian Sisskin
Gerald, Thanks for posing this question. I sometimes wonder about that too! I think that more recently, communication skills ARE included in the treatment plan. I tend to individualize those goals based on the client's needs, some would like to improve the ability to engage in small talk, others would like to be more expressive as a speaker, others want to be more spontaneous in the way they approach conversational interaction. I have no doubt that some clinicians do not include these goals, but I wonder if we are seeing an effect of the client's perception? I have had an opportunity to talk with clients who had been treated by clinicians who I know DO address communication skills. But when the client is asked what he/she worked on, they inevitably tell me the specific motor or desensitization strategies they learned! I think that reduced struggle and reduced fear/avoidance are more likely to be on the radar of PWS. Improved communication is perhaps a less dramatic change in their lives??
From: Rodney Gabel
Great question and great responses! I always put the use of whatever modification, shaping, or other approaches to managing stuttering in the context of improving (and increasing) communication. I agree that this is often lost in therapy. My clients have the belief of simply overcoming the presence of their stuttering, without thinking about the lost "practice" or practical experience they have with communicating. We often have discussion (usually very much based on the person) about how to approach people, initiate conversation, turn taking, etc. A lot of times, this comes up based on specific experiences like job interviewing or public speaking tasks.
From: Irene Bullard
I have written an article for this conference on coping with the dual diagnosis of stuttering and spasmodic dysphonia. One of the persons who commented on my article asked me what is the incidence having both at the same time. I imagine it would be quite low but was wondering if any of you have heard of anyone having both speech difficulties concurrently, I doubt that there in much information on the frequency of this happening.
From: Lynne
Irene, I have not seen any reference to the two disorders co-occurring, so I suspect you are correct about the incidence being low. You are the only person I know presenting with both disorders. I did a bit of searching, and the references that mention both disorders are typically likening spastic dysphonia to 'laryngeal stuttering'. Most of those references are relatively dated--1970's and before. Someone else may know of some references to the dual diagnosis, but since no one is responding to this question, I'd guess that if there is a reference out there, it may be obscure. Good question--wish I had an answer for you. Regards, Lynne
From: Irene Bullard
Lynne, thanks for your response. I got similar results when researching the question.
From: Klaas Bakker, Missouri State University, Springfield MO
Irene, I have to admit that I have not yet read paper, but was intrigued by your question. I agree with Lynne that pure and clearly identifiable cases of spasmodic dysphonia are quite uncommon (let's assume 1 out of 1000 in the population), and also stuttering being a relatively low incidence problem (1 out of 100 prevalence, 1 out of 20 incidence) and assuming there aren't reasons for having one condition affecting the incidence of the other, you would have 1 out of 20,000. Of course this may be wrong for various reasons. Spasmodic dysphonia may be by itself or be part of a larger neurogenic picture. Also, the prevalence of stuttering at young ages is greater than older, while spasmodic dysphonia usually starts later in life...... Now comes another question, what if one does have an effect on the other, or presents itself as a coexisting sign of the other? I believe the current interpretation of spasmodic dysphonia is that it involves a "focal dystonia" specific to the larynx. This would be very different than stuttering and suggest that typically they aren't related. On the other hand there is the appealing notion of similarity with uncontrollable spasms at the laryngeal level blocking you in the flow of speech. Fascinating. I am rambling, and after reading your paper I may have other thoughts about your questions.
From: Irene Bullard
Thanks for responding to this question. I assumed the incidence would be very low as you suggested. As far as I know there are no other neurological problems that I have, I have had consultations with two different neurologists. They also described spasmodic dysphonia as a dystonia.
From: Ari (Israel)
Do people that are dis-fluent, could be stutterers if they would try to speak with perfect fluency? Do stutterers could be just dis-fluent if they wouldn't try to avoid their dis-fluency? Is it any relation between people that are very dis-fluent and people who stutter? Ari
From: Gary J. Rentschler
Ari, there are a couple ways I look at your question. I start from the premise that most people have disfluencies in their speech from time to time. People who stutter (in general) have a constitutional predisposition to stutter and are therefore different that people who are disfluent, but don't stutter. Stuttering is different than the disfluencies others have. For people who stutter, trying not to stutter or trying to hide their stuttering can result in a greater likelihood of actually being disfluent... it seems that what we do trying not to be disfluent or stutter is exactly the wrong thing! My basic point is that people who stutter have regular disfluencies too. But people who stutter are different than people who don't. Hope that addresses your question.
From: Rick
I am a native Chinese language Speaker currently living in the United States. Stuttering can be situatonal and variable, although I can stutter severely in both Chinese and English. I was wondering what we know about stuttering in different cultures (Asian countries, Africa) and if there are any published studies available on the prevalence of stuttering and societal attitudes toward stuttering? In particular, I wonder if stuttering is viewed more negatively in other cultures (by doctors, teachers, parents, general public). As evidence by this video here: http://www.youtube.com/watch?v=vGZGLbNE9FY&feature=player_embedded Part of the problem related to stuttering severity is the fear of listener reactions. Negative reactions rom the listener make the stuttering worse in children and adults. I always suspected that the prevalence of stuttering in Chinese speakers might be lower than 1%. This is because changes in prosody might affect stuttering. For example, when I raise my voice or change my pitch, I am able to improve my stuttering (get out of a silent block). Nevertheless, there must be tons (millions) of Chinese speakers in China who stutter and I am not sure how they live with stuttering. Finally, does the Lidcombe Program, Fluency Shaping techniques, and Stuttering Modification program "work" in languages besides English, which are the specific changes/tweaks that need to be made to adapt classic stuttering therapy to other languages? I do not see any published studies on pubmed? Thanks a lot for your time! Sincerely, Rick
From: Judy Kuster
Do any of your training programs have a required course where suicide ideation, threats or attempts in clients is discussed? I always included it the Counseling and CDis course I taught, but the course was dropped when I retired. I'm old enough I guess to have experienced dealing with threats - eight times that I can remember. None were completed, but 5 of those involved people living with stuttering - two were children, two were young adults, and 1 an adult). Is suicide discussed in stuttering courses? Probably the least we all could do is guide our students to some of the resources listed on http://www.mnsu.edu/comdis/kuster/suicide.html
From: Scott Palasik PhD,CCC-SLP
This is a great question and an important to the psychology of stuttering as a disorder. The construct of suicide ideation (thoughts) maybe a more common part of this disorder than we think, however we don't know because it is challenging to study this. In the stuttering course I teach, I do share with the students that some client in their teens and adulthood may express thoughts of suicide which they relate to stuttering. We discuss that as much as this can be a part of treating people who stutter, clinicians need to be aware of their comfort level with this depth of counseling. I would love to do a study on this phenomena someday and there are many challenges to getting approval for this type of research. This I know, as a person who stutters and clinician, I would not be here today if there weren't speech-language pathologists out there who were patient enough to just listen to my thoughts, without judgment or advice. Just listen...
From: Jean Sawyer
Thanks, Judy, for reminding us that we can do more for our students and their clients by talking about suicide. I do that in my counseling class, but have not done that in my stuttering class. Your post has inspired me to attend a workshop next week addressing suicide.
From: Vince Vawter
The "C" word referred to here is "cure." As an SLP, if a teen client were to ask "can you cure me?" what would your answer be? Would it be the same answer for an adult client? There seems to be a fine living between offering hope to the person who stutters and being totally candid. A young person might not understand the subtle difference between "cure" and "overcome." However, an adult who has struggled with therapy for years might appreciate the reality of the word "overcome." I'm curious how today's training for SLPs addresses this subject.
From: Vivian Sisskin
Vince, I do have this discussion with my adult and teen clients and also with the parents of older children who stutter. (for the parents of young children, I talk about the nature of spontaneous recovery). I don't present it as a "fact of therapy', but part of the process of therapy as they grow in understanding of the difference between "stuttering" and struggling". In the early stages of therapy, my clients tend to view fluency (and being cured) as a success because the alternative is struggle. As they begin to see that disfluency can be comfortable and it does not have to interfere with communication or thinking, the value of "cure" diminishes.
From: Vince Vawter
Thanks, Vivian. I like the idea of "cure" becoming a non-issue. (CORRECTION: In my question "fine line" should replace "fine living." I don't know if that was Freudian or not?)
From: Scott Palasik PhD,CCC-SLP
Good question and feedback so far. I agree, the word "Cure" can be a delicate word to address with clients and families. We as therapist can guide clients and families away from it and instead guide them toward "living a valued life", which is more important than chasing "fluency." To comment really quick on Joe Biden, I saw him speak in person before the 2008 election and on a few television spots and he still has disfluencies. In closing, whenever a parent or client asks me for a "cure" I rely on being honest with them, letting them know our focus isn't "fluency", it is developing comfort with speech both psychologically and physically. With compassion and kindness, Scott
From: Ken Logan
Just to put another twist on this, there's an article by Eugene Cooper in the Journal of Fluency Disorders, written I believe in the mid 1980's that I always think of when this issue comes up. He was not by any means advocating a "cure first" mentality, but he did say (and I'm paraphrasing here) something like this, "When a person asks 'will it go away', 'will I make a lot of progress' etc., I say "I don't know...why don't we get started and find out..." (I'll see if I can round up the exact quote when I'm back in my office tomorrow). With teens, I've found that it is usually not too productive to have lengthy conversations about precisely what will or won't happen in the future..., the important thing is to focus energy on is creating change now. With preschoolers, as others have suggested, one can discuss with parents information about outcomes, recovery, etc., but even in those cases we're talking about group average. When it comes right down to it, at an individual level, it's still a case of, "I'm not really sure, let's find out." (and then, perhaps, to remind the interested parties that even it doesn't "go away" there is still plenty that can be done!!)
From: Walt Manning
Hello Vince, I was going to make may of the same that Scott made about Gene Cooper's handeling of the "C" word: Essentially, let's find out how fluent you can be. But more importantly, let's find out how you can successfully manage your stuttering so that it becomes a minor (rather than a major) theme of your story; a theme that is valued and that informs you about your ability to handle problems. With young children (especially pre-school age)the word cure would seem to apply more often. With adolescents and adults, successful management - including the attainment of spontanious fluency in some cases, seems to be a better concept.
From: Audrey Maurer
Hi, I am in my last semester of graduate classes for Speech Language Pathology. I am taking a Stuttering course this semester and we have been discussing effective therapy tools with children who stutter. I am curious as to which therapy tools you find most effective and why?
From: Gary J. Rentschler
I don't know that there's one therapy tool (technique) that's best for all children; its often hard to generalize. One interaction style that I've found to be particularly valuable is modelling... showing the child what to do (in addition to telling him).
From: Klaas Bakker, Missouri State University, Springfield MO
Audrey, I was intrigued by your question but also I am not exactly sure what you meant by tools, clinical materials/procedures or technologies. Could you clarify this a little? Thanks.
From: Audrey Maurer
Thank you for taking interest in my question. I was referring to any tool you find effective in therapy such as techniques, a certain therapy approach, games, workbooks, or others. We have been talking about a variety of tools in class so I thought it would be interesting to see what other professionals recommend or have found most useful to them in there intervention.
From: Retz
Audrey - You ask a terrific question to the Professors; I am not on the expert professor's panel, but I am moved to answer your question. In my most truly humble opinion - In all of my 31 years of working with children who stutter and their parents, I have found the single most effective "technique" is the profound - and acquired - attitude of IDGAS regarding stuttering. It "flies in the face" of what are considered by many to be traditional "techniques". This attitude is extremely difficult for CWS/TWS and their parents to acquire; as well, it is extremely difficult for professionals to assist CWS/TWS and their parents in acquiring. yet when it is mastered by a child/teen who stutters and is embraced by their parents, true IDGAS regarding stuttering offers tremendous freedom to speak and interact...even if you do stutter! Best regards to you in your future as an SLP!
From: Heather Grossman
Like any other technique, therapy approach, or mind-set, while IDGAS is unbelievably freeing and empowering to many PWS, I would be reluctant to say this is true for all. I worry about people who really believe that they really don't care or have concerns, when clearly their behavior (including their stuttering behaviors) would suggest otherwise. Perhaps some are afraid to care, because that could mean change, and change is scary.
From: Ken Logan
I'd be hard pressed to list one thing that is most helpful/effect, but just to respond to IDGAS idea...Caring (attending?) less is probably helpful for some (though we might ask...caring less about what? Listener reactions?, one's speech production?). Just to play devil's advocate, it seems that opposite approach is helpful too. That is, techniques such as "time out," "regulated breathing," "prolonged speech" (which ultimately ends up as "monitored articulation rate") all are supported to some extent by research. How do they help people speak more fluently? It's not clear, but one thing that do seem to have in common is that they promote attention to the "how" of talking. So, in a sense "I attend more"...(IAM??). Of course, whether one can keep that heightened attention up for long periods of time and whether it feels natural to talk like that is another matter...
From: Katie Bergschneider
I am currently in my last semester of graduate school, studying speech-language pathology. In the future, I hope to work in an educational setting. I am excited and nervous, especially for my first fluency client. What kind of advice would you give to someone working with a fluency client for the first time? Also, I know that teasing and bullying is an issue faced by many children who stutter. If you're working with a client who is being bullied, how do you help them cope and respond to bullying?
From: Scott Palasik PhD, CCC-SLP
Katie! Congratulations on going to graduate school, getting closer to the end, and having the ambition to see your dream working in an educational setting come true! The first thing I would say to a new therapist working with stuttering clients is you don't have to be afraid of these clients. They are like any other kids. They have hobbies, dreams, personalities, passions, friends, things that make them unique and things that make them upset. Take home message, they are like every other child with the exception that you have the opportunity (the honor) to help them become comfortable with their speech and themselves. Your second question about bullying is great one too. Teasing comes down to ego (at any age). Basic psychology is that the person teasing perceives their thoughts (judgments) as right and thus categorize other's because it is easier than getting to know them. To quote Rita Mae Brown 'people aren't grapes --- you can't weigh them in a bunch, but I guess it's easier than dealing with people as individuals.' You may have some of your clients who stutter express anger, sadness, guilt, blame (all kinds of feelings) about being teased or bullied. Some strategies to address teasing and bullying with your clients is to first listen to them express their thoughts regarding teasing with open compassionate ears. When they are open to new thoughts you can give them some strategies for dealing with bullying peers like saying 'Yup I stutter. It makes me unique', 'That is pretty good. That sounds kind of like me' or just walk away (these are just a few ideas). Counseling can be a great part of therapy and a wonderful asset to your speech-language pathology career. Thanks for asking your questions Katie and best of luck with the rest of your graduate school career! With compassion and kindness, Scott
From: Rick
I was wondering what is a clinician to do when faced with a new stuttering client? What is the current best evidence based practice in stuttering therapy? Is it fluency shaping techniques or stuttering modification? I guess also to avoid law suits.....Thank you. Rick.... Preschoolers: Lidcombe Program or Demands and capacity...... School Age: ?? Teens who stutter: ?? Adults who stutter: Fluency Shaping or Stuttering modification or Integrated Approach?
From: Kevin Eldridge
Rick, There are whole courses taught on the question you asked. I wouldn't even begin to attempt to answer your question in this format. As a PWS (and SLP) I get nervous when I hear an SLP ask a question like yours. If you are a student, take the course in stuttering and keep your questions in mind. It will help you get the most out of it.
From: Ed Feuer
Query for the professors: The best answer to Rick's question, in the view of this PWS (some of the time), to the question would come through independent third-party assessment of treatment outcomes over time: one year, three years and five years. And this independent third-party assessment would involve not only assessment of the client but eliciting input on outcome from the client's family, friends and co-workers. Do not the basic rules of scientific inquiry demand such independent third-party assessment in order to claim validity? Why should consumers accept the "too-expensive" response?
From: Jen
Is it possible for a person or an event to cause someone to stutter? I didn't start to stutter until I was nearly 8 years old and I've always blamed it on a specific person with whom I had a traumatic encounter just before onset. But now that I've been reading about some of the research on genetics and fMRI, I'm trying to figure out how this new information fits into the picture. I have a grandparent who stutters so there's a genetic link but I'm confused at how stuttering could suddenly appear in a child who had already been speaking for several years. And the question that keeps me up at night is would I have started to stutter even if the traumatic event hadn't occurred.
From: Charley Adams
Hi Jen, Great question! I believe the conventional wisdom is that a traumatic event can trigger the ONSET of stuttering, but does not CAUSE it. There must be an underlying predisposition in order for stuttering to 'hang on'. Is there any history of stuttering at all in your family? I understand your desire to ascribe blame somewhere, but I think that you need to let this individual off of the hook... Best, Charley
From: Ken St. Louis
Jen, Good question about whether or not your stuttering can be attributed to a traumatic event at the age of 8. Honestly, I don't think anyone can tell you with 100% certainty that your stuttering would have emerged at some point if that traumatic event had not occurred. But I'll go out on a limb and speculate that there is about a 95% chance that you would have stuttered at some point, regardless. I would also not be surprised if you had stuttered some when you were very young, but simply "outgrew" it (spontaneously recovered). Stuttering does typically begin during the preschool years, but a fair number of cases start in the early elementary years as well. At least that's when many became aware that they stuttered. Can stuttering start after a psychologically traumatic event? Absolutely. Van Riper described so-called Track III stutterers whose onsets are often (though not always late), who often have silent or laryngeal blocks, who are typically highly aware of the stuttering right from the start, and who often have elaborate accessory behaviors. Aside from the post-traumatic onset, do any of these other symptoms fit you? Hope this helps a little. Ken
From: Jen
This helps a lot! I don't remember a lot about that time of my life so it seemed like a deep, dark secret but you've helped me make sense of the pieces. What you describe for Van Riper's Track III stuttering seems to fit well. My parents told me that after that event, I could barely get a word out. That sounds like lots of blocking to me. I don't know what accessory behaviors are though. Are they like secondaries? I don't have very many secondaries but I was able to hide my stuttering well enough by age 10 that no one knew I still stuttered. If avoidance behaviors count then mine certainly are elaborate. Thanks!
From: Scott Palasik PhD,CCC-SLP
HI Jen! Great question and you have some great responses which I will not waste time repeating here. I just wanted to share an experience I had with a client I was fortunate enough to talk with for a year. I was an SLP in a school system outside of Chicago and teachers of a ten year old student came to me at the start of the school year and asked if I could assess a student whom was stuttering. Upon request, I observed the student in class, outside of class, and then received consent to do an evaluation. His mother was very concerned and informed me (along with his past teachers) that he had not history of stuttering and that he started stuttering over the summer, when he returned home from his father's house in Florida (where he spent the summer). It turns out his new step-mother was abusing him that summer. Now, can I say the abuse caused the stuttering 100%? No, I cannot. However, I think we can safely assume that if this child had a predisposition to stuttering, the abuse may have triggered that stuttering to come to the surface. Again, I just wanted to share one experience of mine related to your questions. Keep asking questions! With compassion and kindness, Scott
From: Ellen-Marie Silverman
Hello, Jen. You know, it may take some time to fully know what contribution the traumatic event you experienced had to the development of your stuttering problem, so concentrating so hard on that matter that "it keeps you up at night" may not be a good use of your time right now. A better use of your time and energy, in my opinion, might be to implement constructive ways for you to speak and live more as you wish. Whatever caused your stuttering problem, caused your stuttering problem. What you really want to do, I believe is satisfactorily resolve it. My best wishes to you as you engage yourself in that task, Ellen-Marie Silverman
From: Ken Logan
The others have made some great to your question. A few additional thoughts... as you noted, it is likely that one must be predisposed to stutter if one is to one day express the symptoms of stuttering. It seems that it is possible also to be predisposed to stuttering (or some other heritable conditions) and not show the symptoms (studies of stuttering in identical twins suggest that this is the case, i.e., one member of the pair can shows signs of stuttering, while the other does not). For many children, it may be that something as seemingly benign as grammar acquisition can lead to the expression of the symptoms, (grammar lets a person build long sentences, long sentences place a certain amount of stress on the speech production system, if the system is "weak" in some way, then that weakness becomes apparent). As the others suggested, though, at some point it almost doesn't matter what triggered it - the more important thing to expend energy upon is this: what can I do about it now? Also, it is worth considering the possibility that subtle signs of stuttering may have been apparent in your speech before you first became aware of it. So, it might be that the encounter you described triggered your awareness of stuttering, but not necessarily the symptoms.
From: Rike (from Ireland)
I have a 6 year old daughter, who recently developed a stutter and it is getting worse and she is noticing it too. We moved house in the summer so we changed her school, so would that have anything to do with it? I am panicking here, so every bit of information is appreciated.
From: Charlie Healey
Hi Rike, As a parent, I'm sure you are very concerned about your daughter beginning to stutter. It is difficult to know what to suggest given the brief information you have given. When you say she is "stuttering" what is she doing when she stutters? She notices her speech but I would need to know what she is focusing on...her speech, her reactions to what people are saying to her, how others are reacting, etc.? Moving to a new location can be very stressful to anyone and that might have increased the anxiety your daughter feels right now. However, there are many aspects of her fluency disorder that need to be evaluated so I would suggest that you find someone who specializes in stuttering and see what that person recommends. You can also check out my website to see what speech-language pathologists look for when parents ask, Is my child beginning to stutter? Go to www.unl.edu/fluency and then select "for parents" and that will take you to information you might find helpful.
From: Lynne Shields
Rike, Charlie Healey gave you a good website to visit. Another that is closer to home is the British Stammering Association at: http://www.stammering.org/ They have quite a lot of really fine information for parents. There is also an Irish Stammering Association with a website at: http://www.stammeringireland.ie/ That website doesn't seem to update as often, but I think you may find some local contacts through them for support and information. I think you may have found some great information through reading some of the papers on this conference. I agree with Charlie that seeking help for your daughter is a good idea, particularly since both of you are concerned about her speech. Best wishes, Lynne
From: J Scott Yaruss, Univ of Pittsburgh
Hi Rike - So sorry to hear of your daughter's speaking difficulties. My colleagues have offered you some excellent resources to consider, and I absolutely agree. If I might point you to a few more...The Stuttering Foundation (www.StutteringHelp.org) has wonderful materials for parents of children who stutter to help you figure out if this is something you need to worry about at this point or if this is just a stage that your daughter is going through. The National Stuttering Association here in the US also has helpful information (www.WeStutter.org). I'm not suggesting that you need to read everything ever written on stuttering - that would be overwhelming - but it can be helpful to have some background so you'll know what factors are likely to contribute to stuttering and what factors are just part of a child reacting to the situations around her. Finally, there are many excellent professionals all around the world who care deeply about people who stutter and their families, and I know that as you reach out to them, they will be very eager to offer what input and support they can. There is hope and help for young children who stutter, and many organizations and individuals who will be there for you and your daughter as you go through this process. Please keep us posted and let us know your thoughts! -Scott
From: Dick Mallard
Rike, I work with families of children who stutter. Perhaps I might be of assistance to you. You can go to www.familystutteringprogram.com. I hope to hear from you.
From: Retz
Rike - I strongly encourage you to obtain and read a recent book that has been published titled "VOICE UNEARTHED: Hope, Help and a Wake-Up-Call for the Parents of Children Who Stutter" written by Doreen Lenz Holte. She is a parent of a CWS and wrote the book for Parents of CWS; the book holds excellent information for parents of CWS regarding making therapy decisions. Details for obtaining the book? http://voiceunearthed.blogspot.com/
From: James
Hello Professors and Stuttering Experts! I graduated from college in May with a bachelors degree in Psychology and I am still looking for a job. I sent out hundreds of resumes and emails and still no interviews. I used up all my savings. I had just completed an intensive fluency shaping program a few months ago. Hoping to improve my stuttering when I telephone potential employers, my parents helped me and paid for an intensive stuttering treatment program. I was promised that I would be stutter free by the end of the program. I was so excited! Now I am very depressed, money spent, I worked hard, but still no job. I was stutter free and able to talk in the clinic with my clinician, she was very nice although she didn't stutter. However, I am having a lot of trouble making the transfer to daily life, I practice easy onsets, light contacts, prolong my syllables, and use slow rate, stretching. My speech sounds highly unnatural and people have trouble understanding me on the telephone. I wonder after searching on the Internet: Do Fluency Shaping Techniques work in "Real Life" Situations? Should I advertise to people that I am using my fluency shaping techniques when I go out and talk to people and doing my transfer activities. Some people can be impatient with me when I speak slow and they cut in. I am supposed to make phone calls. I am desperately looking for a job. I am not sure how my employer will like the "way I talk"?? It is very slow and deliberate, and I feel people are impatient. Need your help and advice? Thank you for your help. James
From: Gary J. Rentschler
James... its a very difficult job market out there (you didn't say what type of job you are looking for) and its easy to look inward at your stuttering as being the reason for not yet getting a job. But your question was about transferring your fluency skills in clinic into the real world. This is a challenge for all clients in stuttering therapy, not just for you. One issue I picked out of your post was that you aren't yet comfortable with your controlled fluent speech. Over time two things will happen; your will become more accustomed to your new speech and you will become more confident as a fluent speaker. With more confidence (which comes from the knowledge that stuttering will no longer control you, but you can control it), more natural fluency emerges. As you become more naturally fluent you will be happier and more accepting of your speech. But it takes a great deal of time and practice to get to this point.. it's a process. It sounds like you learned the basic tools to be fluent from the fluency shaping program. Speaking in a controlled manner to earn fluency requires a great deal of discipline and practice... don't take it out on yourself by beating yourself up over this; perhaps thinking about it as people do about a youngster learning how to walk.. the first steps are very awkward and there are usually plenty of falls. But with time and practice they develop the skill... its not always a "pretty process", but you too will get there. I take my clients out and practice in real world settings with them. I use the speech targets that I ask them to use to demonstrate them and show them how to manage people's reactions to controlled fluency too. Sometimes you need to 'buddy up' with someone else to provide you feedback and see things that you yourself cannot see. Go Nike... just do it. Don't give up, don't beat yourself up.. be persistent and determined... you'll find that those are qualities that employers are looking for too. Best of luck.
From: Pam
Hi Gary, hope you don't mind me commenting on your suggestions to James. You mentioned the long journey it can be, and the patience and focus needed to work on techniques and targets. I know there has been endless discussion on various sites about the use of the word "target." I wonder if that could be the reason why some folks like James struggle with maintaining a satisfactory level of fluent speech outside the clinic setting. They work so hard on "hitting the target" that if they miss, perhaps he/she feels like they failed. If we are already worrying about being judged for not talking like everyone else, wouldn't the feeling of failing that comes from "missing the target" sort of compound the problem? For me, when I was doing fluency shaping therapy, I came to despise the concept of a target. I actually rebelled and would not say each week, "Hi, my name is Pam and the target I am working on tonight is . . . " (That did not endear me to the clinic staff, I know! Sometimes, other clients would jump in and say, "Pam, you forgot to tell us your target." I hated that too!) I felt like I was throwing darts each week in therapy - if I missed and didn't hit the target or the "bulls-eye" then somehow I had failed. For me, that feeling of failing or not understanding why I couldn't "get" full breath or easy onset, just added to the feelings of shame I had already had. Wonder how you deal with that at all, or does it not come up? ~Pam
From: Lisa LaSalle
James, Thanks for sharing your story and your struggles. My dad went through an intensive program in attempts to cure his stuttering (Precision Fluency Shaping at Hollins College VA) in the early 1970s. It helped for a short while, but the fluency he gained did not last. It is possible that the problem is the unnaturalness of the "targets" that Pam on here. Also it takes a high level of vigilance to use targets all the time. Those of us who are normally fluent speakers (as you said you clinician did not stutter) can only imagine that degree of vigilance needed. Does using targets 80% - 100% of the time ever become automatic? In my experience since those years working with people who stutter, it seems like blending Fluency Shaping and Stuttering Modification approaches is the best way to go for many. So, you have already begun with a great background knowledge of Fluency Shaping (speaker more fluently) tools. Now, what about learning some Stuttering Modification tools (including techniques like self-disclosure, that Scott suggests)? Ever heard of www.stuttertalk.com? That's an amazing resource from Peter Reitzes, of over 300 episodes of adults who stutter podcasted, talking to one another. I know there're more than a handful of topics/episodes about job interviewing. Best of luck in your job hunting and on finding your own way with more fluent speaking and easier, more open stuttering.
From: J Scott Yaruss, Univ of Pittsburgh
Hi James — I'm sorry to hear of your struggles, but as Gary noted, it does take a lot of determination and patience and practice. It sounds like you've down tremendous determination in getting this far - and that will help you carry yourself further. You had asked whether you should let people know that you're using your strategies when you're talking to them. I have known many people who have used this strategy ("purposeful self-disclosure") with great success. Letting people know about your stuttering - and the fact that you're working on in - helps them understand your speech patterns while you are developing more comfort with them and shows people that you have the determination and grit to face and work through your problems. It can be hard to do this at first, so maybe try some easy situation - talking to somebody where you really don't mind if you stutter and they really don't mind if you use a speech management strategy. It can help to go out to a mall or someplace else for your practice, and see what it's like to let people know that you stutter and that you're using your strategies to make it easier for you to say what you want to say. Many people I've done this with find that it's a very freeing experience to "let it out." As you have success in the easy situations, then you'll have an easier time moving into the harder situations like phone calls and job interviews. It's a tough process, as Gary mentioned, but with determination, you can do it! (Consider going out with a friend to do this practice...ideally, another person who stutters who can offer you encouragement even as you offer encouragement back!) It is worth facing your fears - the more you face them, the more you overcome them. You've taken several important steps to help prepare yourself for success... You can do it! Good luck! -Scott
From: Ken Logan
Just wanted to add a little to the thoughtful that Gary and Scott offered .... Interview-related phone calls are difficult for lots of people, and I've always thought that it is a particularly tall order to suddenly go from having little or no fluency management success on phone calls to having excellent fluency management. It just doesn't happen that way very often, even after one has completed intensive therapy and all the techniques, etc., that go along with it. My suggestion - and this is nothing particularly novel :-) - is to set relatively small goals for yourself. If you're like most people, you want to do really really well in each of those situations (which is understandable, but perhaps not too realistic at this point). So, rather than trying to "hit the home run" (which in this case may be something like, "I'll talk so fluently that the interviewer won't know that I stutter." go for a more specific and attainable goal. The latter might be something speech related (like using a stuttering management technique for some small segment of the phone call) or it might be something related to the attitudes or feelings that accompany stuttering during these phone calls). Change takes time, and with regard to changes in stuttering, time can sometimes seem to pass to very slowly, or at least not a pace we'd like it to. But the important thing to remember is that change does happen - and the surest way for it to happen is to keep on plugging away. Good luck!
From: Kevin Eldridge
James, Let me start by telling you that I am an SLP and a PWS. I went through a fluency shaping program when I was entering college, and then again when I was just out of college. It was similar to your intensive in that I learned a new way to speak and recall being told that if I used my newly learned skills it would be physically impossible for me to stutter. Did my therapist really say that, or is that what I wanted to hear.. I don't know. All I know is that I practice quite a bit and kept waiting for my techniques to become natural. When I was younger, I was waiting until I would turn 15 because that was the age my dad quit stuttering. Well... I turned 15, 16, 17... still stuttered. So waiting for that was a waste of time. Similarly waiting for the "targets" to become natural was a waste of time (for me). My techniques gave me confidence to enter some speaking situations, but they never became natural. Funny thing though, once I was able to actually look at how much progress I had made, rather than how much further I still had to go, my speech began to get more fluent, more natural. Did my strategies help, probably, but that was not the key. I had to change how I though about my stuttering and my self. So... not sure I agree that the thing to do is practice and practice and hope it will become natural. For me... and many other I have met... that is not the case. For me that's ok....
From: Retz
James - I am not one of the expert professors on the ISAD panel, but your plight and questions moved me to respond. Your question regarding "Do Fluency Shaping Techniques work in 'Real Life' Situation?" Dr. William Perkins (recipient of the Honors of the Association (ASHA) and Distinguished Emeritus Award at USC for his 50 years of Stuttering Research.) was one of the original researchers, developers and promoters of fluency shaping therapy with PWS; he is considered a GIANT in the field of stuttering by many professionals. After he retired and formed relationships with a number of individuals in the NSA, he authored a number of articles published in the NSA's publication "Letting Go". Some of his published observations of Fluency Training therapy are as follows: "I assumed...that if we could keep our people fluent long enough, eventually their fluency skills would become habitual. Not once did that ever happen. --- Failure to maintain fluency was the clearest evidence of dissatisfaction as speakers gave up hope that this therapy would ever lead to natural speech free of stuttering. --- The blame for failed therapy lay in the professional's failure to recognize that fluency is not the proper objective of therapy. --- The speaker is helpless to prevent involuntary blockage. --- Neural mechanisms of naturally fluent speech cannot be brought under voluntary control no matter how long you try. --- Expecting to speak naturally with voluntarily controlled fluency is like pasting feathers to your arms and expecting to fly. --- Fluency is simply a natural by-product of the speaking system functioning automatically. --- My colleagues and I have been to blame for the fluency failures. --- Voluntarily controlled fluency is the wrong scientific objective, to say nothing of the wrong treatment objective. --- The very existence of self help groups speaks to the failure of professional therapy to address the needs of those who stutter which is not about making speech acceptable to the listener. It's about coping with the feelings that create stuttering and understanding how they offer a path to full recovery."
From: Christina Ryan
Hello everyone! I am a Speech Language Pathology graduate student and I am working my first school age stuttering client this semester. This is her first semester in therapy as she has become more comfortable discussing her stuttering, it has become more and more apparent to me that she is sometimes teased about her stuttering in school. She has told me that this teasing bothers her, and therefore, I would like to give her some tools to help her cope with the negative effects of bullying. My question is, what techniques have experienced SLPs found to be most effective for empowering and building self confidence among school age children who stutter?
From: Lynne Shields
Christina, First let me congratulate you on developing a relationship with your client that allowed her to reveal her concerns about teasing. That's wonderful! There are many ways for a child to deal with teasing, and no one way is the best. As her clinician, you are in a position to have conversations with her about teasing, what it is, why it happens, and who owns what in a teasing situation. What I mean by the latter comment is that someone who teases and bullies is usually trying to make the person being teased feel badly about themselves in order to show off to friends or to make themselves feel higher on the food chain. I want children to begin to understand that it isn't their fault when someone teases or bullies them--it is really a negative reflection on the bully, that person is being unkind or downright mean. Your client feels bad--right now, she is 'owning' the negative feeling, maybe even blaming herself that the teasing occurred. However, if she can begin to see that her stuttering really isn't the issue at all when someone is teasing her. It's simply the vehicle the teaser chose to try to make her feel badly, she is in a position to walk away in a better frame of mind. Your client can decide that she no longer wishes to accept the bad feelings; that she is going to figure out a way to turn things right back to the person who teased or bullied her. That involves learning to self-advocate, working out what I refer to as 'snappy comebacks' to use as a way to verbally put the ball back in the teaser's court. On the Stuttering Homepage, under the Just for Kids section, there are posts from children concerning how they feel when they are teased and what they do to deal with teasing. This might be a place to begin exploring your client's feelings as well as to give her some ideas of different ways to respond to teasing. I like children to come up with several different kinds of responses, since teasing happens in different ways. So, in some cases, it might be most appropriate for her to decide to simply walk away, ignoring the teaser. This can work fine, as long as she can walk away and not feel bad about herself. In others, a comment such as, "that hurt my feelings. I don't want to play with you right now." might feel right. If someone mimics her stuttering, she may decide to respond by telling the other person that they really don't stutter all that well, or by offering to give them some tips. Role playing the chosen responses can empower a child by giving them sufficient practice that they will eventually feel able to try them out when teasing happens. Best wishes as you continue to work with this child, Lynne
From: NAJ Scott Yaruss, Univ of PittsburghME
Another great question and discussion topic. I'll second everything Lynne offered. I'd also like to suggest a couple of resources (though I hope you'll forgive me for suggesting writing that I've been involved in). The National Stuttering Association has a booklet written by Bill Murphy, Bob Quesal, Nina Reeves, and me that includes details about how to help kids practice some of these types of responses. It's called "Bullying and Teasing: Helping Children Who Stutter." We also have a couple of articles in JFD from 2007 that give an example of how these techniques might be applied with a school-age child who stutters. I'll be happy to send you links if you want to drop me an email - jsyaruss@pitt.edu. Thx, S
From: Charlton Knowles
Dear SLP, Stutterers often report that as they have grown older, their stuttering generally has diminished in both severity and frequency. If you agree that generally speaking, this is the case, what can you attribute this change too?
From: Barbara Amster
Charlton, very interesting question. My guess is that as we age, we hopefully become more self-accepting and self-acceptance may lead to less tension, effort, and struggle. With less struggle, the stuttering may seem like less of a problem.
From: Charlton
Barbara, that was my thinking too. but has there been any research done on this age group to solidify your view?
From: Barbara Amster
Charlton Unfortunately, I cannot find any current research on this. This may be a good area to study.
From: Justin Rafferty
Hello professors and professionals! It seems there is little information available considering cluttering. So, I have a quick question that may set some of you thinking, or it may be painfully obvious. It is commonly stated that cluttering often includes a difficulty in monitoring one's speech output. Have you seen any cases in which a recovered mild clutterer developed a mild stutter? Thanks! justin rafferty Kean University
From: Lynne Shields
Justin, I have worked with a number of people of all ages who clutter and I have never had one of them develop stuttering as an outcome of treating cluttering. What I have seen on several occasions is a client who has been diagnosed and treated for stuttering and their cluttering has been missed (not diagnosed). I suspect that often, the stuttering is so pronounced initially, or of such concern to the person and/or their family, that the cluttering symptoms were overlooked. Or, it could also have been that the SLP didn't look further once the stuttering was diagnosed. I'll be interested to see if any others on this panel have had a different experience with the dual diagnosis. Regards, Lynne
From: Ken Logan
Hi Justin, My experience has been similar to Lynne's. Most people who I've treated for cluttering had no appreciable stuttering and none that I can think of developed stuttering symptoms in conjunction with or after cluttering therapy. Several of the people who I've seen for cluttering really struggled with self-monitoring / self-regulation, even after extensive practice. (But I suppose the same can be said for some of the folks who stutter that I've seen, as well!) And then there have been some cases with both stuttering and cluttering symptoms. It would be interesting to know the developmental pathways of both symptom sets within such individuals (which came first, etc.) I'm not if the average patient would know that or not, but it would be worth asking about. Anyway, that's my two cents worth. Best regards, Ken
From: Lisa LaSalle
Hi Justin, You asked "are there cases in which a recovered mild clutterer developed a mild stutter?" Chiming in with my colleagues, I can't think of a case where this this happened either. It is true however that monitoring is a key feature that needs to be improved in most individuals who clutter in order to improve their fluency. It would be important to think of what you mean by "mild stutter." If you are referring to only the surface behavior and the person reports that they experience control of the sound or syllable or word production, then yes, all speakers have these within-word disfluencies from time to time (0-2 on average per 100 words). Don't know if that helps what you're getting at but I really think it's helpful to bring back into our profession Bill Perkins' comment in 1990 that one important aspect of the definition of stuttering is "loss of control."
From: C. Baerg
I have trouble with the plosive sounds at the beginning of words like the 'b' in blizzard. It seems like the plosive sounds in blends with an 'l' too. I tense up and cannot move past it. I have developed a secondary symptom of releasing it that I don't like. I was wondering how I can get rid of the tension and get through the block? How does a person deal with those kinds of blocks?
From: Vince Vawter
Plosive blocks are my nemesis also. I love banana milkshakes, but rarely order one because of the bad "b." Years ago I tried visualization of letters to help me get through blocks. I would imagine a giant B and then see it get smaller and smaller and then try to "gentle onset" my way through the sound. Sometimes it worked and sometimes it didn't. Hang in there.
From: C. Baerg
Thanks Vince for the reply. I will try it the next time I order my favorite food at Dairy Queen which is a "blizzard". When I can face the fear of stuttering it is easier. I've just taken a huge step of just accepting that I have a stutter by going to a stuttering conference this summer. It has changed my whole view of stuttering. Thanks a lot!
From: Scott Palasik PhD,CCC-SLP
Hi! You ask an important question. Many people who stutter have a sound or several sounds they "fear". I say "fear" because I would bet you anticipate plosive sounds coming up and then have thoughts that relate to "stuttering" on those sounds (most likely negative thoughts). I do the same thing with a few sounds like /st/ clusters, /s/, and velum sounds like /k/ and /g/. That being said, what we can do is play with the sounds in order to deconstruct and/or deflate the meaning we place on them. This starts with doing some vocal play with these sounds and words. During therapy, with any age client, we can allow the client to stutter on a word and when they finish their thought, go back and say that sound and word in a funny voice, a different accent or dialect, and even varying the pitch and volume. This "playing with sounds and words" cognitively takes us way from some of the mental fusion we have with words and negative thoughts that we created! The next step could be to address those thoughts as we approach those "feared" sounds. Asking questions like "what reasons do I have to fear this sound?" can help make us aware of some events and past times that we maybe hold on to that continue to influence our present behaviors. These are just a few thoughts on the subject of feared sounds and words. Such a great question to ask, really wonderful. Keep asking questions! With compassion and kindness, Scott
From: C. Baerg
Thanks Scott for those suggestions. When I anticipate those stuttering blocks, yes, most often there are negative thoughts along with it. I will definitely explore my stuttering in those ways you suggested with playing with those hard sounds and asking myself questions why I would have to fear. I have another question to ask. I sometimes wonder why it takes many years for a person to accept the stuttering. I'm in my forties' and am just beginning to be able to accept it. Would that be a norm in general? I would avoid speaking to an audience at ALL costs. That kind of stress has taken a toll on me. This summer was the first time I ever went to a stuttering conference, (I've wanted to for years already.) that changed my whole perspective of stuttering. I found out I WASN'T alone and there was NOT anything to be ashamed of. The support that I felt there left me standing in AWE! Now it seems like I have the tools in which to deal with those situational fears although it be baby steps right now. Before I just didn't have them. One thing that helped now too is just being open to anyone that is interested. Before I rarely spoke to my family about it and now I've been able to open up to them which was hard. I was amazed at the support I felt from them. I read your paper from this online conference from last year. It was very inspiring to me too. It led me to a deeper insight on my life. Thanks again very much!!
From: Ken St. Louis
Dear C. Scott and Vince gave you some great suggestions to weaken the anticipation and thereby hard blocks on plosives. I agree with both of them and won't try to add to their cognitive/behavioral strategies. But here's another one that you might just try and then maybe even write back and let us know if it works. Get out your dictionary and start saying /b/ words and let the stuttering happen as you start down the list. If you don't stutter or it quickly fades out, FAKE your hard blocks. If they turn real, so much the better. In any case pay attention to what the faked or real blocks feel like. Do this on your own for about 10 minutes without stopping while stuttering on every word. Then go say something to someone using a feared /b/ word. Again, if you like let us know what, if anything, was different. Ken
From: C. Baerg
Thanks Ken for that suggestion. Last night I did get the dictionary and read the /b/ words and faked the stutter. I did this when I was alone and of course I don't stutter when I'm alone. When I faked them I caught myself thinking how I would feel if this was real and someone listening to me. I phoned my friend but she wasn't home so I just left a message. Almost without thinking I did some fake stuttering on some /b/ words which really didn't bother me. I figured it was a friend that I have confided in about stuttering and she probably wouldn't think twice about it. It felt quite good just to go ahead and stutter. Thanks again. I will explore my stutter like this further.
From: Ken St. Louis
Dear C., Thanks for the report. I believe the strategy had the desired effect. It was developed a long time ago by Knight Dunlap and is called "negative practice." By CONSCIOUSLY practicing something wrong, one can become aware of the the subtle tactile (touch) and kinesthetic (position sense) cues associated with it. Then, when it happens for real, the person is able to intercept it very quickly and learn to modify the response. It also is a powerful desensitizer. That is, by doing "massed practice" of a feared response, one experiences an immediate reduction in the fear. That reduction might not last too long, but with repeated mass practice, the fear reduction lasts longer and longer. Good luck on your journey.
From: Ora McCreary
Some therapy programs advertise their programs with a claim to "stop stuttering" - we all can recognize the style: colorful text, long inspiring stories or helping a child reach his potential, promises to teach simple effective techniques that will lead you to stop stuttering for good! All through purchase of a $97 or $67 book will stop your stutter so good. Some such sites are apparently so successful that they clone themselves, with changes. (Instead of "my neighbor's son Zack" had a stutter which he cured, the clone sites will say "my business partner had a young nephew who" etc. I suspect we all share an opinion that such books are largely worthless, and are not ethical. By contrast, there are other cases of speech therapist organizations or groups or programs which seem legitimate and well-intentioned and professional, using perhaps widespread programs such as Lidcomb and Camperdown, but which still use phrases "stop your stutter" in the website of their advertising materials. Here's the issue I'm posing. We all know that a claim to "stop you stuttering" is far-fetched. Most programs do not "stop your stutter", while offering the still-legitimate goals of reducing speech anxiety, dealing better with themselves as stutterers, and finding lasting techniques that will help reduce their stuttering, and generally make themselves more effective in the world. These are laudable goals, and they are achievable, while "stop your stutter" is not. So my question: Is it legitimate for a legitimate professional speech therapy program to use the "stop your stutter" claim in their advertising and promotion, in light of the fact that "stop your stuttering" is an achievable goal for only a small proportion of real people? — (Judith: If you'd prefer not to "name names", please feel free to remove this comment.) KillYourStutter.com, is an example of a site that sells a $67 book, which will "kill your stutter". It's one of a series of similiar websites claiming similarly unrealistic results. "Stop Stuttering with Dr. Brendar Carey" (Stopmystutter.com) is an example of the second type - a legitimate program which uses unreal claims ("stop your stutter"), implying that they really can stop your stutter.
From: Ken St. Louis
Dear Ora, Good question, and well stated! I don't think ethical clinicians should state or imply that all potential clients can "stop" stuttering entirely in their XXXX program for three reasons. First, if one were to follow up with all the people who had undergone the program long term (assuming it ha been around for some time), it would almost certainly be clear that some/many former clients still stuttered, even if they were "stutter-free" during or right after the treatment. I'm not going to say that being stutter-free is an impossible goal for any future potential program, but we are not even close to being there yet. Second, even if many or most stutterers were to become stutter-free during the treatment and maintain those gains, it sets up the client who will not become entirely fluent to regard himself/herself as a failure. I've known many people who are disillusioned with speech therapy for precisely this reason. Third, a stated or implied "cure" also sets up the potential client to approach the treatment to NOT STUTTER, rather than learn to LEARN TO TALK IN A NEW WAY, regardless of the strategies used. Trying not to stuttering is the mindset that creates accessory (secondary) behaviors whereas trying to talk in a new way is the mindset that most often results in lasting gains. Keep up the good thinking and discerning view of the snake oil salesmen. Ken
From: Brenda Carey
Ora, I do thank you for your helpful . I certainly did not intend to mislead, and will be changing the wording of my site and its address promptly (as soon as I have the tech support). Regards, Brenda Carey
From: Ora McCreary
I have recently heard of the Camperdown program. Is anyone familiar with it? Any thoughts? What does the program consist of? Pros/cons? How widespread is its use? How successful is it? Are there any good studies of its effectiveness? Thanks.
From: [no name]
You view a video of Professor Mark Onslow demonstrating fluency shaping techniques while he is reading the rainbow passage. And you try to model how he talks, there are no implicit directions, it is more passive learning. Does it work??? Read his own publications on pubmed...some people go crazy and drop out.
From: Ora McCreary
Here's what PubMed shows for Camperdown + stuttering: http://www.ncbi.nlm.nih.gov/pubmed?term=camperdown%20stuttering Note particularly this one - http://www.ncbi.nlm.nih.gov/pubmed/12959471
From: Ed Feuer
If society regards stuttering as a sign of lower intelligence, shame, failure or incompetence, then it is bound to spur our blind maladaptive attempts not to stutter. The noxious conversational usages of the terms "stuttering" and "stammering" evoke some variant of the above meanings. Evidence? As far away as Google News. Just type in stuttering or stammering. And it's getting worse (despite The King's Speech). On Aug. 25, 2011, an online something called the pressofAtlanticCity ran an editorial on the issue of "Boys playing field hockey? N.J.'s ban is fair." The piece included the following: "So girls can be on football teams. But boys cannot be on field-hockey teams. We can hear the irate stammering already: 'Don't male and female students have to be treated the same? Isn't it unfair to allow female students an opportunity that is denied to men? Doesn't this NJSIAA rule amount to reverse discrimination?' " So here "irate stammering" means something to the effect of angry stupidities/idiotic ravings. it's the other side of the equation in stuttering therapy which too many members of the profession with their focus simply on speech mechanics regard as too horrible to contemplate ' so they don't. So that's Google News "stuttering" or "stammering".) Am I right? '
From: Judy Kuster
Ed, I am on a list of hundreds of parents of individuals who live with Down syndrome. The consumer group, including these parents, have worked very hard for years (with some success) to eliminate what they call the "R" word. Perhaps a similar campaign could be started by the consumer group of people who stutter if they find offensive use of the term "stutter."
From: Katie Erickson
What steps do you feel are important to include in an initial assessment? Do you feel that behavioral checklists are beneficial in evaluating PWS? What standardized assessment tools do you find to be the most helpful?
From: Lynne Shields
Katie, You are asking a very broad question which I don't think can be answered easily in this context. What I do to assess fluency depends on the age of the person, the presenting problems, and the goal of the person or their family, in the case where the client is a child. I will tell you that while I may use the SSI-4 to gain some data (percent of stuttered syllables, etc.), I do not see that as being the primary focus of the evaluation. I am more interested in finding out how the person perceives their stuttering (or how family members perceive it), and what impact stuttering is having on their life. There are many good rating scales that can help in these areas--most good textbooks on fluency disorders will give you a good sample of these. When the client is a young child, the focus may be on beginning the process of determining whether the child is developing a chronic stuttering problem or is likely to recovery normal fluency without intervention. That often takes more than one visit, and there is no simple 'test' that is available to make this decision. Looking at risk factors that are present is important in evaluating young children. Hope this gives you at least the beginning of an answer. Regards, Lynne
From: Tiffany
While doing some research for a class project online, I came across some interesting articles. There were people who stutter who discussed that they experienced a decrease in their disfluencies in speech when they had either a cold or the flu. Why would having a cold or flu possibly decrease the amount of disfluencies in a person who stutters?
From: Kevin Eldridge
Tiffany, I find your question interesting. My own personal experience as a PWS and as an SLP working with people who stutter is that the opposite is usually true. IF someones stuttering is affected by a cold or flu the stuttering usually increases, possibly due to being more tired, or having less resources to maintain the same rate of fluent speech that is usual for that person. So why would stuttering decrease. Hmm. Possibly because the person was talking less, or talking slower and with less tension since they are physically weak. Can you think of any other possibilities?
From: Vince Vawter
Yes, I have experienced increased fluency with head colds, but it usually is short-lived. Remember that PWS find amazing ways to bring back their stutters. But I have another experience for you. When I was in my teens I flew with my father often in his private plane with an unpressurized cabin. My ears would start popping and "lock" as soon as we reached a little altitude. I would find myself not blocking on sounds that usually gave me trouble. This also was usually short-lived. I would always find a way to go back to my blocks.
From: Charley Adams
Hi Tiffany, this is an interesting question, and you already have some great replies. Stuttering is famous for its patterns, AND its exceptions. Most folks stutter less when they read, but some stutter more. Most are more fluent one on one (as opposed to speaking to a group), but some are less fluent. Perhaps some stutter less with a cold because they are distracted by their symptoms, and as a result are less able to worry or be fearful about their fluency - what do you think? Cheers, Charley
From: Paul Goldstein
I would like to add something here (though I'm not on the panel). I find that when I'm feeling sick (which, thankfully, occurs very seldom) my fluency greatly improves. The same thing happens when I'm very tired. I realize that for many people who stutter, the opposite is true. It's interesting to speculate on the reasons why experience improved fluency in such circumstances. It could be that if I feel weak, tired, or ill, I have limited energy to struggle with speech, and limited energy to focus tension on the speech mechanism. It also could be that in these circumstances I just don't think much about my speech, and therefore don't experience the speech fears that lead to blocking.
From: Jay
Hi, my job requires me to be fluent at work. My stuttering is mild, very situational, especially on business teleconferences. I have been through years of traditonal speech therapy for stuttering hoping to improve my fluency. Tried all kinds of therapy (University speech clinic, private SLP, intensive programs Hollins...) and had different speech therapists over the years. I read a lot about the potentials of pagoclone (how do I get pagoclone?). Does the pagoclone really work and will it really reduce my stuttering, or is my stuttering still going to be situational? I am desperate and willing to spend $4000-$5000 if the speecheasy will finally Work!!!I want to try the SpeechEasy. Any advice? What characteristics (of the people who stutter) is the SpeechEasy most likely to provide the most benefit. I am afraid if even the SpeechEasy, which is my last resort, does NOT work, then there is no hope. How do I know if the SpeechEasy will work for me, and the effects will not wear off.....Thanks! Jay
From: Vince Vawter (not a prof)
Jay, our situations appear to be similar although I'm probably several years older than you and I'm retired now. I also attended the three-week program at Hollins. I have owned a SpeakEasy device for about 12 years. (Do they really cost $5,000 now? I think I paid about $2,200 for mine.) First, I'll say that both Hollins and the Speakeasy device helped me. Hollins gave me my first feelings of fluency in 1985. The Speakeasy helped me gain confidence to stand up in front of large audiences and speak. But you must think of both of these things only as "tools." The SpeakEasy is not magic. It will help you focus on your speech targets (gentle onset, amplitude contour, etc). You will probably gain some increased fluency initially with it, but it you look upon it as the "cure" you will be disappointed. You may find this interesting. The last few times I have spoken to large audiences, I have worn the SpeakEasy but didn't turn it on. I used it like a fail-safe device. I had it in my ear if I thought I needed it, but it was only there as backup. I don't practice my targets now like I should because I have more interesting things to do, but on the occasion that I do practice I wear my SpeakEasy. The device is expensive, and if you can afford it without a strain on your budget, I say go for it. Do not, however, place all your fluency eggs in that basket. What you are looking for is freedom, not so much fluency. It took me almost 65 years to find a level of freedom that was acceptable to me. You will find yours also, but you will have to work at it. Good luck.
From: Vince Vawter (still not a Prof)
Jay, I meant to address the drug therapy you mentioned. I have not tried either of the drugs, but I have tried others. Once again, any drug therapy you might try should only be viewed as a tool. There is not a magic pill. I have searched the world over for one. I guarantee I would have found that pill if it existed.
From: J Scott Yaruss, Univ of Pittsburgh
Hi Jay - Pagoclone is just an investigational medication at this point. It is not available except through research studies, and there are not any studies presently underway. There have been a number of studies of various medications over the years, and a number of them do appear to show some promise for helping at least some people speak more fluently, but much more research is needed. Even after that research is done, I think it's fair to say that the medications will not completely eliminate stuttering. It will still be important for people taking the medication to address the other aspects of the condition...and as Vince pointed out, the goal is to be able to feel a sense of freedom - to communicate freely and say what you want to say without being held back by stuttering. In fact, this addresses your larger question - whether there is "no hope" - it sounds like you've really worked hard to achieve fluency in your life. Most people who stutter have sought to improve their fluency, and people are able to do that to differing degrees... but the question of whether there is any such thing as "no stuttering" or "perfect fluency" is really an important question to address. I hear you saying that in your job, fluency is viewed (by you, if not by others) as very important... but I wonder if it's really true that fluency is absolutely, 100% required for any job. I have known people in all walks of life who have found a balance between being able to manage their stuttering as needed, but still not feeling like the stuttering is standing in the way of their success or their ability to say what they want to say / do what they want to do. That is, of course, a challenging thing to do, but perhaps something to consider as you move forward in your process of coping with stuttering. I think you'll find that many of the people in this conference will emphasize a balance in goals, rather that focusing entirely on fluency... Just a thought to consider... Good luck with your journey and thanks to you and to Vince for participating in the conference! - Scott
From: Klaas Bakker, Missouri State University
Jay, I wanted to comment on your desire to find out if a SpeechEasy device could be the answer for your particular case. The way you described it it sounded like you already fully understand that its use is more an aid and not a therapy, but just something that could help you in your work setting. Importantly, DAF/FAF (this is what SpeechEasy does) doesn't always work the same way for all who have a stuttering problem, and it has settings that you can "tweak" and so I think it would be best to work with a speech therapist who would be willing and able to help you find out what the technology does in your case. Currently there are a number of freeware, or inexpensive software downloads that do very much the same thing as a SpeechEasy device would and could allow you to try out how it works in your case and if it seems something you would consider for your situation. Even the company that dispenses SpeechEasy has a freeware version of the program that works on PCs. Importantly DAF/FAF is not therapy but it can be used as an aid in situations like you described and I am convinced it could be helpful for you as long as you will consider trying other ways to make (improved) speech fluency "your own achievement" as a result of therapy. Unfortunatly I don't have much to say for the use of medications and believe others already gave you an excellent description of the status of its use. Klaas Bakker
From: Curious about stuttering
I have heard some say 50% (half of children who stutter will recover) and some say 80%?? Can the number change in the future, with more research evidence (tracking?)
From: Jean Sawyer
One of the reasons you find a wide range of children reported to recover is that different methodologies were used in various studies. For example, if the sample of children are older, researchers will have missed younger children who recover, thus lowering the percentages. If researchers are relying on parental report, rather than looking at children's speech directly, the data may not be reliable. The Illinois studies under the direction of Ehud Yairi and Nicki Ambrose, followed over 100 young children near the onset of stuttering for several years, collecting speech samples and reports from parents every few months. These studies found a high rate of recovery, near 80%, and were very thorough. Another study in Denmark by Mansson found similarly high levels of recovery. I worked in Yairi's lab, and I know that this was a well-funded, well designed study.
From: Tom Weidig
Hi Jean, Is there not the very recent Australian study that looks at 1000s of kids? I just did some statistical calculation for a sample size of 100. The statistical sample error (or standard deviation) is roughly 4%. That means that with 68% probability the true (or population) natural recovery rate is between 75% and 85%. As you said, it does also depend on how you define stuttering and recovery.
From: Ora McCreary
Can anyone offer an update on the latest research and treatment experience with drug therapies? I know that Gerald Maguire made a presentation at the NSA conference in July, but I haven't seen a report by Maguire or anyone who attended his presentation.
From: Judy Kuster
Ora, you might want to take a look at an early post by Scott Yaruss at http://www.mnsu.edu/comdis/cahn_mnsu_edu/15prof/_disc56/000000f1.htm
From: Tina Corey
Hi! I am currently a post baccalaureate student at Northern Michigan University. First, I would like to thank the panel for taking the time to answer our questions. It isn't often that we are able to communicate with such experts in the field! My question involves Charles Van Riper's Stuttering Modification (MIDVAS). The "variation" portion of it suggests that negative practice should be used. I was wondering if any of you have had a negative experience with the technique during treatment. I was wondering if it would be possible for client's to regress from this type of treatment. Thank you!
From: Ken St. Louis
Dear Tina, Good question. I just posted a reply to a reply in the thread above entitled, "How do you deal with blocks? C. Baerg 18 Oct 2011." I talked about Knight Dunlap's negative practice there. You might take a look at it. I'm virtually sure that Van Riper used the term in a similar context. Ken
From: Caitlin Falconer
I am currently a speech pathology graduate study enrolled in a stuttering course. For this course we must do a project pertaining to stuttering. We decided to go out into the community and pseudostutter for individuals varying in socioeconomic status, race, age, and sex and compare the reactions we received. In your experience have you noticed if there is any variation in reactions to stuttering among different classifications of people, or is the overall reaction pretty universal across the board?
From: Scott Palasik PhD,CCC-SLP
Caitlin. Nice to meet you! Listener reactions to stuttering are variable depending on each person who listens. What I mean by this is it depends on each person's exposure to stuttering, their perceptions toward disabilities and differences , and just their overall level of sensitivity and compassion they express in their daily lives (just to name a few variables that may influence physical, affective, and cognitive reactions to stuttering). Now the above are just a few thoughts on possible cause of behavioral reactions. The reactive behaviors could be separated into physical, cognitive, and affective behaviors (similar to the ABCs of Stuttering). On a physical level, listeners may look away, may shuffle their feet, they may walk away, they may fill in the person who is stuttering words or sentence, they may interrupt them, they may tease them (we see this behavior with children still today). The listener may possess cognitive reaction behaviors like 'Doesn't this person know how to talk.', 'What are they dumb?', 'How can I help them.', 'They look like they are in pain.', 'Talking like that must be so hard.'. Lastly, listeners could have affective (feelings) reaction behaviors, which have roots from their thoughts toward a person who stutters. These might consist of sadness, shame, frustration, superiority, and compassion (just to name a select few). The above is just a small piece of possible answers to this great question of how people react to stuttering. The project you did for your class is a great one and really can teach lessons in empathy and compassion, lessons you can apply not only to PWS, but to all people with communication disorders and other challenges. Great question Caitlin and good luck with the rest of your academic and professional future! With compassion and kindness, Scott
From: Ken Logan
I have stuttered for many years, and as you might have expected, have experienced a very wide range of listener responses. Most often people don't show any obviously negative reactions - many folks seem to sense what's going on, though it may take a moment or so for them to do so. One of the most common things is for folks to smirk or say "that's a tough one, huh??" when there is even a very slight hesitation in providing information for which the social/pragmatic expectation is that a prompt response is called for, e.g., What's your name? Where do you work? - in those situations it's not socially acceptable for the speaker (i.e., me) to hesitate for more than moment. One should know his name, right? Doing so, brings out the reactions I mentioned above. For kids, of course, peer responses can be much less subtle (and much more mean spirited, unfortunately). But even the subtle responses can be deflating for the speaker, and worth exploring and addressing in a therapy context. Good luck with your project. I've had my students do similar things and they find it challenging!
From: Lisa LaSalle
Hi Caitlin, For many years, I've asked students in my fluency classes to pseudostutter as an assignment. I've learned in recent years, that it is helpful to divide them into those who think they got a reaction that was: (a) positive, (b) negative, or (c) mixed/neutral, and they need to explain why. It would be interesting to learn that the positive / neutral reactions group is growing, but I can't say that it has. My results are countered by my need to require them recently in this assignment to "really stutter - really show a physically tense block or more frequent repetitions." And they practice pseudostuttering a lot more frequently in my classes as practice first. Understandably some students admit to just "g-going like this" once or twice and hoping their assignment is done. They are the ones who would end up in the positive or neutral reactions group. I've also learned that (a) students are more honest and objective if a partner (classmate or significant other) tags along with them; and (b) students have gone back to the barista or cashier or whatever after the assignment is over, tell them it was only assignment (seems important to many of them :) and then they wanted to either thank the person for their positive/neutral response or hand them a "how to respond to people who stutter" brochure from the SFA etc if they got a negative response. The popularity and sensitivity of the movie "King's Speech" has hopefully been a positive change agent for our advocacy on behalf of people who stutter, allowing them time to request, respond, express themselves, etc as well. Good luck with your assignment! Enjoy the simulation-based learning.
From: Alan Badmington
Having had the privilege of contributing to the ISAD Online Conference in each of the past 10 years, I have come to appreciate the prestigious position that it occupies in the annual calendar. Reading about the experiences of other PWS can provide us with an interesting insight into how they deal (or have dealt) with their respective difficulties, as well as offering reciprocal inspiration. It can also alert us to possibilities of which we were previously unaware ' in relation to therapies, techniques and opportunities that allow us to unearth our true potential when we are prepared to expose ourselves to uncertainty and change. We discover that there are exciting and fulfilling paths available for us to tread. In effect, it can open our eyes to possibilities that we could never have imagined. Fear and self-doubt figure prominently in the lives of many people, not just those who stutter. They can sabotage hopes and aspirations. When left to our own devices, it is possible that we may never summon up sufficient courage to confront the issues that are impeding our progress, thus causing us to exclude ourselves from participating widely on life's stage. However, upon learning about the expansive lifestyles of other PWS, some people gain confidence and encouragement. If they happen to be members of an Internet discussion forum, or self-help group, they are also able to lean upon the knowledge, camaraderie and collective support that exist within that gathering. Interestingly, those who author such articles (and/or share their experiences with others) also derive benefit from recounting those events. Each time we relive a successful occurrence, it reaffirms what we have achieved. In fact, research has shown that bringing such incidents back into our consciousness serves to strengthen that positive memory. My purpose in writing this post is to express my deepest appreciation to everyone who makes this conference possible. You are all owed an immense debt. Kindest regards Alan
From: Alan Badmington (Part 2) :-)
In my initial post, I wrote 'Each time we relive a successful occurrence it reaffirms what we have achieved. In fact, research has shown that bringing such incidents back into our consciousness serves to strengthen that positive memory.' In view of this, I wondered if clients are encouraged to talk/write about their successful experiences. I have benefited immensely from sharing my stories/challenges over the years, via online discussion groups/support groups and forums such as this. Relating those incidents has had a very powerful impact upon me. Each time I relived a successful incident, it reaffirmed what I had achieved. I genuinely believe that my progress has been helped considerably by the fact that I have been able to tell myself (and others) about the positive experiences I have enjoyed. Some people may be of the opinion (and it's their prerogative to think whatever they choose) that speaking about one's successes is egotistical. Well, I happen to hold an opposing view. That has certainly not been my motivation for sharing. It's simply that re-living the successful episodes strengthens my memories of those events. When we savour and foster positive experiences, it intensifies our positive responses to them. The longer something is held in our awareness, the more emotionally stimulating it becomes. Since early childhood, my stuttering was fuelled and perpetuated by the difficulties, setbacks, pain and catalogue of lost opportunities that I encountered. For over half a century, I constantly reminded myself of what I could NOT do, or the dire consequences of attempting to speak in certain situations. I spent a lifetime accumulating, recounting and giving far too much prominence to the memories of negative speaking experiences. As a result, my stutter flourished and thrived. The more I nourished and sustained it, the more it impacted upon my daily existence. I make no excuse for having reversed that trait. In direct contrast, I now constantly remind myself of my successes. I truly believe that you should never shirk from telling yourself how much you have achieved. I would welcome your . Kindest regards Alan
From: Lynne Shields
Alan, Thank you for your kind words. And, to answer your question, YES, I think it is very important to guide clients to focus on their achievements. It is an important vehicle for people to begin to change the way they think about their communicative abilities. In fact, when a client walks in and starts off by telling me a negative communicative experience over the previous week (I forgot to do "x", or I stuttered really badly at school....), once that has been reflected on, I then ask them to tell me about a communicative success. Focusing on the positives has an empowering effect; it helps to promote a cognitive shift in the way a person thinks about his or her speaking abilities, as you pointed out so clearly. Thanks, Alan! Lynne
From: Alan B (to Lynne)
Hi Lynne, Thank you for taking the time to share your thoughts about the points I raised. Kindest regards Alan
From: Ari (Israel)
I read in that conference and in other places from slp's, that they work with their client to improve their fluency. I feel that my problem is not dis-fluencies, but the struggle and the fear that i have when i want to talk. Sometime it seem to me that we are not talking about the same problem. So do the SLP's treat the wrong problem?
From: Gary J. Rentschler
Ari, there are many roads to treating stuttering and so when SLPs talk about improving fluency, they usually do that by teaching clients how to change their stuttering, speak in ways which result in more fluency (like speaking more slowly) and addressing the feelings, emotions, and beliefs that go along with the stuttering. I think that you are actually on the "same page" as SLPs.
From: Ari (Israel)
Thanks Gary for all your answers! I have the feeling that "fluent people" have problem to figured what is the problem,i feel that they look too much about the fluency above the surface. The insights in this section(the Prof) are very unique,in other forums you heard almost only about fluency. Sometimes i think maybe for other stutterers, the problem is indeed lack of fluency,maybe i am the exceptional,but than i read other stutterers that tell the same story. I feel that Joseph Sheehan said it the best: "Taking the role of a stutterer,finding out what it is the stutter experiences is the principal way the clinician can overcome the handicap of being a normal person".
From: Alan Badmington
It has been my experience that some (if not many) PWS are, unfortunately, deficient in interpersonal/social skills. I have encountered cases where even those who acquire greater fluency confide that they lack the art to fully engage in conversation. This is understandable due to the fact that some tend to remain on the fringes of social interaction, thus denying them opportunities to develop the expertise that 'fluent' people progressively attain from a young age. In view of this, would you ever recommend to your clients that they should consider seeking assistance in this important area? Alternatively, should SLPs be trained to provide this help? Kindest regards Alan
From: Gary J. Rentschler
I would concur that many PWS are "underexperienced" in making conversation and small talk.... not all, but many. Those who are not as skilled at conversation are often very aware of it, which makes them anxious, which makes conversation harder and usually increases stuttering. In my experience, most know the social rules of conversation. Teaching a few "conversation starter" techniques might be a good starting point. Other maxims, such as "get your communication partner talking about themselves" may also be helpful... There's a good deal to becoming a conversationalist... but no better teacher than practice, practice, practice! Thanks for raising the important point Alan. Warmest regards, GJR
From: Scott
Alan, it is nice to meet you and thanks for the great observation and question. I'm going to echo Gary a little here (wonderful answer to the question Gary!). I think there are many PWS who lack the experiences of interacting socially and due to fears and anxiety pertaining to the exposure of "Creating" a dialogue with people, they have challenges carrying on a conversation. For example, if you fear /w/ words, you might tend to avoid asking people questions like: "What brings you here?", "What kind of movies do you like?", "Where do you go for pizza?", "Where do you come from?", "Why do you like pumpkin seeds?", or "What is your occupation?". Without these vital words of "what, where, why, when" a conversation can only go so far. As SLPs we have the skills and training to help clients with "pragmatics" (social use of language). During therapy we can bring in novel people (with client's consent of course) and practice these skills along with desensitizing the client to feared sounds or words. These are just a very few ideas related to this great observation and question you pose Alan! Keep asking questions! With compassion and kindness, Scott
From: Ed Feuer
Professors, as a PWS (some of the time), my view is that it is important to examine the dynamics of how the lack of interpersonal skills arose and to consider that in dealing with the problem. Knowing that there are many listeners who aggressively interrupt and fill in when they hear stuttering, our real-world experience has been that we have to get to the point fast before our reluctant interlocutors tune out, turn off and walk away (sometimes not only figuratively). Such people don't want to us to make small talk with them, they don't want to have conversation with us ' and the negative public image and widespread ignorance about stuttering has more than a little to do with that. Even though these types may be in the minority, we tend to remember the worst possible scenarios. As someone wise said, he who has been bitten by a snake is afraid of a piece of rope. However, interpersonal communication skills should be taught at auspicious points in stuttering therapy and there are good ways to do that. (See the thread, Why don't SLPs teach improving comm. skills?) What do you think? ' Ed edfeuer@mts.net
From: Alan B (to Gary and Scott)
Hi Gary and Scott, Thank you for your prompt responses. As a police officer (now retired), I experienced considerable difficulties as a consequence of my stutter, particularly when giving evidence in court. I was transferred to a non-operational role when a supervisory officer reported that I was "an embarrassment to all'. The severity of my stutter caused me to purchase a prosthetic device (the Edinburgh Masker) which I wore at all times while on duty. I also used it on social occasions and always kept it near to the telephone at home. It became my mechanical crutch for more than 20 years, during which I did not hear my voice while the machine was activated. Although the apparatus never eliminated my stutter, under the umbrella of that infernal masking sound, it somehow gave me the confidence to venture into situations that I might, otherwise, have avoided. Consequently, I expanded my comfort zones and developed useful interpersonal skills. Despite experiencing considerable setbacks, I built a system that would eventually support greater fluency and self-expression later in life. I am in no doubt that, had it not been for the Edinburgh Masker, I would never have been in such a favourable position to take advantage of another approach when it subsequently became available. By this point, I had discarded my crutch and chosen to walk unaided. The point I'm attempting to make is that (due to the Masker) I had become proficient in the art of conversation, albeit that I still struggled and stumbled on many words. When I acquired new physiological techniques (in 2000), I found that I was immediately able to engage meaningfully (and confidently) with everyone I encountered. I knew how to initiate, maintain and respond to conversations. Conversely, some of the others who had been simultaneously equipped with such tools (via the same stuttering management program) were far more inhibited in comparison. Please accept that this statement is not made with any derogatory intent, it's simply something that I observed. I feel that this was due to their understandable inexperience in the area of oral communication and social banter. During my police service, I should point out that I enjoyed abundant opportunities to engage with members of the public, particularly when I resumed an operational role after obtaining the Edinburgh Masker. As a result of my personal experiences and observations (during recent years), I believe that other PWS could also benefit from improving their social skills, maybe in conjunction with speech therapy or by introducing them to specialised resources/agencies. I appreciate you taking the time to participate in this discussion. Kindest regards Alan
From: Margaret
I just found this conference and, hopefully, in time for a reply. Since mid-summer, my 10-yr old son's stuttering has increased. He can umm for over a minute and recently has gaps where he cannot get a sound out. He is advanced in his math and verbal skills, so it's a difficult thing to watch, especially when he is among friends. We have no history of stuttering in our families. After an evaluation, he started with a SLP at school 1x a week. He is relieved to have some help but has recently become frustrated to the point of tears. Although he has been a regular ummm-er and was excruciatingly detailed in his stories and descriptions, the recent severity of the condition is a bit overwhelming. Can it go away as quickly as it came? Should we arrange for more intense therapy? Of his 4 sessions, 2 have been taping him and allowing him to hear his speech, but I don't know if he wants to hear it.
From: Vince Vawter (not a prof)
Dear Margaret: I won't answer your questions except to say that I'm a 65-year-old person who stutters and I'm sure that if this ISAD conference had been around five decades ago and if my parents had read it, my life would have turned out differently. I encourage you to invest study time on all of this year's papers and subsequent threads. The answers for your son are in there, and those answers will be unique to his situation. Please, tell your son for me that I was exactly where he was 55 years ago, and it does get better. Much, much better.
From: Jean Sawyer
Dear Margaret, Your son sounds like a very talented boy and he is fortunate to have a supportive parent like you. It is difficult to give you advice without having seen your son, but I will tell you that it can take time to see improvement, and improvement may come in small steps, such as having shorter "ums," or showing less frustration when stuttering. An SLP who has had experience treating children who stutter will tailor treatment to the child, helping him learn about stuttering and what he does when he stutters, connect him with others who stutter, help him speak effectively in spite of stuttering, give him tools to lessen the severity of stuttering, and help desensitize him to stuttering when it does occur. Above all, the SLP will work to establish a good relationship with with your son, to learn the kinds of things he would like to improve with his speech. It will take time to see results, and although one session per week in the school is helpful, you might see more progress if you supplement that therapy with additional private therapy from a speech-language pathologist who has experience treating stuttering. In the clinic at the university where I work, we have several school age children who either supplement their therapy or have decided to just have therapy in our clinic. I would also recommend support groups, such as the National Stuttering Association, or Friends. The NSA has groups across the country, and there may be a children/teen chapter near you, and Friends is an organization dedicated to children and their families. I wish you and your son the best as you help him with his stuttering.
From: Ken Logan
I just want to add that the above are based upon things I've done in instances where children are doing things similar to what you described above as a result of stuttering. As I said, those ideas may or may not apply specifically to your son - so it's important to consult with a therapist who is experienced with treating stuttering first. The other point is that practice activities are typically quite focal (i.e., during therapy sessions, of course, and then for short, specified periods outside of therapy — not just "any old time, all day, everyday," etc :-). Again, good luck to both of you.
From: Retz
Margaret — A child who stutters best hope is/are their parent, and a parents best hope is a good professional. I strongly encourage you to obtain the book entitled "VOICE UNEARTHED: Hope, Help, and a Wake-Up-Call for Parents of Children Who Stutter" by Doreen Lenz Holte. It is a newly published book for parents of CWS written by a mother of a CWS. It will definitely help you regarding making decisions about therapy for your son. Details for obtaining it? http://voiceunearthed.blogspot.com/
From: Vince Vawter
If 1 is the loneliest number then stuttering is the loneliest disability. We all look so normal and then we open our mouths and the world stops. This is the first ISAD Conference I've had the pleasure to take part in, and I couldn't be more appreciative and inspired. My 2012 New Year's Resolution on which I will start early is to read all the archives of the first 13 conferences. Thanks to all the Profs who posted and replied. I could hear the care and concern in your words. Also, thanks to all the PWS for opening up. Remember that we are all in this together. I hope my passion for freedom of the tongue never came across as anything but that. I realized too late in the process that I had gotten carried away and I was on the Prof site answering questions like I knew what I was talking about. I apologize if I offended anyone and said anything "non-clinical." I always tried to use a disclaimer that I have no formal speech therapy training. A special thanks to Judy Kuster, the grand ringmaster of this operation. I have some inkling of what it takes to pull off a multi-national online conference like this. Judy, you are truly amazing. This unwieldy thing called the Internet destroyed my profession, but it certainly gave PWS a new venue where we can learn and be heard. We are not so lonely anymore.
From: Jean Sawyer
Hi Vince, I'm so glad to hear you benefitted from this conference. It really is a wonderful way to get the word out about stuttering and help connect people who stutter, professionals, family members, and students. I really enjoyed reading your questions and the replies to them. Your question about the "C" word really generated a lot of good discussion. Best to you and will look forward to "seeing" you again next year.
From: Caitie Doherty
Hello all!! My name is Caitie and I am currently in my last semester of graduate school for Speech Language Pathology. This semester I am taking a stuttering course and some interesting points have been brought up about preschool age children who stutter. Some supervisors and professors have differing views about whether or not it is beneficial or harmful to make preschool age children, in therapy for stuttering , aware of their disfluencies. I am interested to know your opinions and what your recommendations are in terms of the types of therapy you use for preschool age children who stutter.
From: Lynne Shields
Caitie, I don't see this as a 'should I' or 'shouldn't I' issue, really. During the initial evaluation, I interview the child to ascertain whether or not he/she is aware of the stuttering on any level. If they are, and identify this (e.g., "I get stuck sometimes"), then I'm perfectly comfortable talking about this with the child in therapy. I use the same term for stuttering that the child used. If they seem unaware, I'm not sure what is gained by telling the child. Rather, I focus on talking about good talking skills--being a good listener, thinking about what to say before starting to talk, etc. Your second question relates to what type of treatment I recommend for preschoolers. Again, this depends quite a bit on the age of the child, their level of awareness, and the parents' wishes. I begin with indirect therapy for many young children, helping the parents determine ways of interacting with their child that reduces communicative stress. Therapy can be modified to increase the level of direct engagement of the child in using a skill, varying from my commenting when I see the child take a turn or allow someone else to take a turn, up to requesting that they say something the way I modeled it. Hope this is helpful. Regards, Lynne
From: Lisa LaSalle
Hi Catie, You've asked a hot button question for me. A graduate student at the University of Wisconsin Eau Claire just completed a thesis on this topic with me last year (Mancuso, 2010). She cited a lot of the literature by Yairi and colleagues regarding studies that have been done with preschoolers using puppet shows, whereby one puppet stutters and the other puppet does not and the child is asked to point to which one he or she talks like. What we know from this literature is that children who stutter are often not aware of their own stuttering until about the age of four. My thesis student Jessie Mancuso was interested in whether normally fluent four-year-olds would be able to identify mild and severe stuttering in a peer who stutters, and she found that by and large they just do not comment on "stuttering" or even any differences at this age. In summary we know still very little about awareness and preschoolers. (Perhaps you would like to do some research on this topic!) It makes intuitive sense that bringing negative awareness to the behavior that we know of as stuttering may make stuttering worse in a preschooler, and that bringing neutral awareness to the difference between fluent speaking and stuttering might assist a child who stutters in learning to speak more fluently. You may already know this due to your SLP academic program(s), but in the last decade an impressive evidence base has been built up for a relatively new treatment approach known as the Lidcombe approach. The approach is named after the place in Australia where it was developed, a suburb of Sydney. Its developers are Mark Onslow and colleagues. (For further reading, you could try for example, Harrison, E. & Onslow, M.(2010) The Lidcombe Program for preschool children who stutter. In B. Guitar & R. McCauley (Eds.) Treatment of stuttering: Established and emerging interventions, Lippincott-Williams & Wilkins, pp. 118-140). The Lidcombe approach is based on operant conditioning principles, specifically response contingent stimulation, so that the parent and/or clinician, contingent on the child's fluent utterance, responds with the comment of something like, "good smooth speech." (praise). Then, contingent on a stuttered utterance, the clinician something like "that was a bit bumpy," and perhaps request for the utterance to be said again together smoothly (correction). A key feature of the techniques involved in this approach is a "5:1 rule" whereby five praises are delivered for smooth speech to every one bumpy correction. There is also an older, more established, so-called "Indirect" approach, whereby the child's stuttering is not referred to (e.g., Conture, 1990) and whereby adult modeling is quite important. I could cite many authors here but it is important to consider that the basis for this approach includes from the 1970s paradigms such as the Gradual increase of length and complexity of utterances (GILCU) and Extending the length of utterances (ELU) (Costello-Ingham, Ryan etc.) We know that preschoolers who stutter are much more likely to stutter when they are speaking spontaneously, in longer, more complex utterances, and that they are more likely to speak fluently when they are speaking in short, rote utterances. So in this approach the clinician can really get a lot of mileage out of that phenomenon by setting the child up to be fluent in carrier phrase-based activities. There is often good generalization at the early ages from these fluent shorter, more predictable phrases to more fluent spontaneous speech. Meanwhile, clinicians and parents can recast stuttered utterances, which is also its own form of contingency, and they can speak at slower rates, bring the dyadic rate gap down, etc. There's also an evidence base for showing that these slow, simple adult models improve the fluency of the preschoolers' speech. Finally, many clinicians counsel parents to follow their child's "awareness lead" with like "Everybody has trouble talking sometimes," "It's ok" etc. if their child says, even at a very young age something like "I can't say it" - "My mouth is broke" etc. When late 4- and 5-year-olds make negative awareness , at this stage the child has often been stuttering for more than a year or two. Length of time since onset and response to Tx considerations are just another part of the "art and science" of effective therapy at the preschool age ranges - how long the chlid has been stuttering and all the other risk factors, worth paying attention to such as family history of stuttering, etc. (e.g., Yairi & Ambrose, 2005). My own bias about these two approaches (Direct, or Lidcombe-like vs. Indirect, or GILCU-ELU+modeling-based) is that why not combine them? Sometimes children will do very well in terms of their overall recovery after less than one year of therapy with the indirect approach alone (e.g., see data provided by Richels and Conture 2010 in the same Edited Guitar & McCauley book). But other times preschool children plateau in their progress (perhaps due to higher risk factors to persist) in the Indirect-alone approach and then it makes sense to introduce the concepts of smooth and bumpy, be sure that the child can auditorily discriminate between the two, and then begin the 5 to 1 verbal contingencies as Lidcombe-like augmentation. I just began teaching and supervising at a new-to-me university clinic where I have a caseload of six boys - late 5-year-old and early 6-year-old boys who stutter. They all had fairly pure Lidcombe approach therapy backgrounds. So each boy is aware that speech (my/yours/ours?) is sometimes smooth and sometimes bumpy. Interesting to note that they're all currently at what I would call a "residual stuttering level." With one exception of a boy who's at a more moderate level of severity (his father stutters), the five boys each average 2-7 stutters per 100 words of spontaneous excited basline levels of talking, with not too many advanced types (Audible sound prolongations and blocks). But talk about awareness! They've got it. One boy reportedly said to his mom last week, "How many more days until we go to the class where we don't talk bumpy?" She framed this in a positive light. As a clinical supervisor, I frame it positively as she does, but an interesting question about all this awareness at late 5 and 6 is what do we now do with it? All of the boys will apparently allow A LITTLE BIT of clinical talking about about smooth and bumpy speech here and at home, but most boys have shown us in their verbal and nonverbal behaviors that they don't want to talk about it TOO much. Make sense, because, think about it, they're mostly smooth now, and deserve to be treated as just 6-yr-old conversationalists who only occasionally speak bumpy. (And want to be heard for WHAT they are saying, not only HOW they are saying it). A couple boys are negatively aware of even the smooth praise - e.g., ignore the clinician or parents reportedly said they "don't like to talk about their speech" anymore. I encountered this at my previous university clinic. Anyway, loooong answer, Catie, but again, it's a really hotbutton question for me right now, as the Lidcombe approach is relatively new to our field of practice. I wonder why we would want to throw the good ol' effective Indirect Childhood Stuttering Tx methods out. Frankly, I also can't help wonder if these boys would be fully recovered by now if Indirect GILCU+modeling methods had been included as an augmentation to the "direct or awareness-based method" belonging to the Lidcombe approach. Replacing early negative awareness with neutral and positive awareness seems to be a good thing, and these boys are much more fluent than they were at one time, no doubt, based on records and parent reports. We need more treatment efficacy studies in this area of Direct (awareness-based or Lidcombe-only, Lidcombe-based) vs. Indirect approaches with 3- to 5-year-old children who both stutter and who show risk factors for persisting in stuttering (another area of research for you to pursue :)
From: Retz
Caitie - I am not one of the experts on the panel of prof's; but I do have a really good suggestion for you! I strongly recommend you obtain and read a newly published book titled "VOICE UNEARTHED: Hope, Help, and a Wake-Up-Call for the Parents of Children Who Stutter" by Doreen Lenz Holte. She is the mother of a child who stutters and wrote the book for parents of children who stutter. I believe the book will offer terrific and spot-on answers to many of your questions regarding pre-schoolers, stuttering and therapy. How to obtain the book? http://voiceunearthed.blogspot.com/
From: Jim
Dear Stuttering Experts, A major thank you to all the stuttering experts and Judy Kuster who volunteered their time to answer questions. I look forward to next October!!! One more question before the conference is over. Thank you so much! What do you think will be important (major findings in the stuttering research and treatment) in the field of stuttering in the next 20 year? For example, stuttering genes was a major finding in the past two years, and more biological/physciological research focus in stuttering. But what about treatment and better treatment for people and children who stutter? Will the Lidcombe program be further established as the #1 treatment option? I heard of some new research findings out of Australia: more children actually start stuttering (not just the 5% prevalence as we previously believed). Thanks! Jim
From: Ken Logan
Interesting question... here's two predictions... (1) a well-specified model of stuttering will be developed (one that includes not only exact genes, but what those genes regulate, the ways in which environmental factors affect their expression, and how that expression relates to the neuro-anatomical and neuro-physiological correlates of stuttered speech; (2) this will lead to a move away from behavioral therapies, toward ones that are more medically based... Can it be done in 20 years? I'm not sure. We're along way from it now, but hey, 20 years ago, there was no internet to speak of... See you at the next conference!
From: Stefanie Durr
Hello everyone, my name is Stefanie and I am currently in my last semester of classes in graduate school for Speech Language Pathology. I am enrolled in a stuttering course and am beginning to gain clinical confidence with this disorder as I continue to learn. However, I am not as confident with the bullying aspect that comes along with stuttering. I know it is different for each individual, but are there any suggestions on how to decrease bullying in schools? I have heard from professionals that a presentation on stuttering to school aged children may help, but I have also heard from people who stutter that this would have made them feel uncomfortable or made bullying worse. Is there any tips or responses that are helpful for the kids to use if they are being bullied?
From: John Tetnowski
Stephanie, One of the best defenses against bullying is strong education. Yes, it does help to make class presentations, but that can make many teens and younger kids feel uncomfortable. I do think that the more education the kids/teens and their parents receive can also build a great deal of confidence (just as you are building your confidence with more experience around others that possess the skills that you want to acquire). If you do not have a local NSA or FRIENDS group, I suggest starting one. Seeing others cope with teh same difficulties can be incredibly empowering. Go to a grouo and take this teen with you. It is an amazing experience! Congratulations as you finish your degree. if you really love stuttering, consider doing a PhD in that arae. We need people like you! Best of luck, John Tetnowski
From: Alan Badmington (to Stefanie)
Hi Stefanie, I'm not a Professor, or a speech-language pathologist ' but someone who commenced stuttering at a very early age. So I hope that the professionals will forgive me for intruding into their territory. I sincerely hope I won't be bullied as a result of my transgression. :-) I just wanted to let you know that many SLPs/therapists have told me that they use my poem 'Everyone's Different' (which I wrote for the 2004 ISAD Online Conference) to illustrate the fact we are all unique. If you are interested, you will find it at:http://www.mnsu.edu/comdis/isad7/papers/badmington7/badmington27.html Kindest regards Alan
From: Brittany Loomis (undergraduate student)
My name is Brittany Loomis and I am currently an undergraduate student studying Speech-Language Pathology. One of the areas that I am very curious in as a future Speech Pathologists is working with different cultures. My first question is if there is a program out there that allows Speech Pathologists to travel to other parts of the world to work with stuttering therapy or if it is just something that you have to set up yourself, if anyone has any information on this I would be very interested to know. I'm also curious if language barriers ever play into stuttering therapy when a clinician is trying to help a person who stutters from a different culture than the clinician? I can imagine there are some obstacles that may be difficult, but could the obstacles be helped with the assistance of a translator? Any information is appreciated! Thanks for all the great advice on this site, I've really enjoyed reading all the articles and discussions and have learned a lot!
From: Ken St. Louis
Dear Brittany, Interesting questions... Let me offer a few ideas, but I really can't entirely answer either of them. With regard to the question of training programs that offer experience in other cultures, most, in this country do not. Yet, I'm certain that a few programs do have some kind of study abroad options, such as Michigan State at least used to have. I'm at West Virginia University, and we are about to inaugurate such a program, and we hope to start an exchange with a university in Turkey, maybe as early as next summer. If you'd like to be in the loop about that, feel free to write to me off line. You can find my email in the Directory for the WVU home page. (I hesitate to put it in here in case spammers might pick it up with their search procedures.) Second, regarding the likelihood of language barriers being an issue in stuttering therapy, let me make a few points. Language/accent differences are far less important in stuttering therapy than they might be in articulation or language therapy for obvious reasons. That being said, if you work with individuals who do not speak English, and you don't speak their language, then therapy can be difficult. People in many locations are faced with this problem and do use translators. My limited experience doing this sort of thing has not been entirely positive. So long as the therapy is based on fluency shaping or stuttering modification, it is probably not necessary to explain everything; modeling could be even more effective. But when you try to discern and address the client's emotions and thoughts about stuttering, then the language barrier can loom very large. Most clinicians simply defer to others to try to treat in such situations or give only perfunctory treatment. Yet, as the world gets more and more interconnected, this is a problem that we in the USA will no longer be able to ignore as much as we have in the past. I hope this addresses your concerns and questions. Best wishes, Ken
From: Isabella Reichel
Your profound presence radiates light on many key aspects of stuttering and cluttering. But equally important is your ability to build relationships and engage people from a local stuttering support group to powerful international organizations (IFA and ICA). You created a unique paradigm of a researcher and a clinician who share wisdom, motivational messages, and unconditional support. We all become better people and professionals because we are fortunate to know you. Isabella
From: Brittany Loomis (undergraduate student)
One of the things that I think would be one of the hardest parts of being a Speech Pathologist that works with stuttering therapy, would be having to confront parents about some of the environmental factors that they are doing and are affecting their child's stuttering. I imagine that most parents are very willing to change what they are doing and probably feel very guilty that they were affecting their child's stuttering in a negative way. However, what if parents are not willing to change their routine or the environment that is around the child, as a Speech Pathologist how do you deal with that? Also, how do you deal with parents who are not willing to help out with therapy by practicing with their child at home? Any advice or tips would be greatly appreciated! Thank you!
From: Dick Mallard
Brttany, you ask good and relevant questions. Yes, it is interesting working with families. I would not approach therapy from any other perspective. You do need experience doing family work. The long range benefits of working with the child's communication environment are worth the effort. Best of luck to you.
From: Mark Irwin
As a consumer attendee at the NSA Research Symposium I was delighted to see the emergence of the recognition for closer liaison of SLPs with the psychology and psychiatric professions. It seems though one of the barriers to this is the delineation between what is stuttering (to be treated by SLPs) and what is social anxiety disorder (to be treated by psychologists). My understanding of the research is that between 75% (Stein, Baird, Walker 1996) and 60% (Menzies 2008) of adults who stutter seeking therapy have diagnosable Social Anxiety Disorder. This fact is clearly disputed by some therapists (one of whom stormed out of my NSA presentation while another argued it was his experience that only 2% of pws clients ever had SAD.) May I ask what differential diagnostic tool is used by members of the panel to screen for SAD in their clients? (This question is obviously also relevant to the behaviourist vs cognitivist debate as to the better therapeutic approach.)
From: markgel
any therapists with expertise in cerebral palsy and dysfluency? especially anyone in San Francico Bay Area. Any literature regarding CP and dysfluency. ? Intermittent blocks are primary issue worse with social anxiety settings.
From: Lynne Shields
I am sorry not to be of help, but I did want you to know that your post was read -- I simply have never worked with a child or adult who stuttered and also has cerebral palsy, nor am I aware of any literature specific to that co-diagnosis. While the cerebral palsy might make it somewhat more difficult to manage muscle tension related to stuttering, I would think that a good fluency therapist might work out some ways to provide assistance for the stuttering. You can check online for fluency specialists in your area by going to the website for the specialty board on fluency disorders: http://www.stutteringspecialists.org/ There is a link for consumers and a list of specialists there, categorized by name or state. Best regards, Lynne
From: Judy Kuster
Dr. Shield's suggestion to contact a Board Recognized Fluency Disorders Specialist is a good one. I tried to find information in the research and you might want to check scholar.google.com with the key words stuttering +"cerebral palsy". It appears most of the references are from the '40's and even early, but I spotted one article pretty quickly that might be worth taking a look at -- Woods, Fuqua, and Waltz, Evaluation and elimination of an avoidance response in a child who stuttering: A case study, Journal of Fluency Disorders Volume 22, Issue 4, November 1997, Pages 287-297 reports treatment of a 6-year old child with cerebral palsy who also stuttered.
From: [no name]
I always look forward to every Oct. for the stuttering conference. i wonder if the stuttering conference can start earlier like Sept. 22, for the consumers and students to get advice, ask questions, and for the parents to get help. The stuttering experts seem to be very willing to donate their time. A three window is a bit short? how about experimenting with four week window?
From: Lynne Shields
It is truly gratifying to know how much you enjoy this conference each year. Judy Kuster will be happy to read your post! I can understand your wish to have a good thing available for a longer period of time. However, Judy Kuster works many, many hours prior to the conference getting everyone to submit their papers, formatting everything and getting it all set up. During the conference, she is quite busy, as well, taking care of all sorts of technical issues, along with being sure that authors are responding to questions. Those of us who answer questions are quite happy to do so, but all of us have full time jobs, and it does add quite a few hours to each week to follow up. So, while it is quite nice to know people would like it to go on longer, I think we need to give Judy a big hand and let her have a rest! Thanks for your post. Regards, Lynne
From: Judy Kuster
The live, threaded discussion part of the 2011 ISAD online conference is now closed. The conference papers and responses made during the conference will remain online. Thank you for stopping by. Judy Kuster