For the sake of "historical authenticity" we are reproducing this, the first time a "Prof is IN" feature appeared in the ISAD Conferences, in the same format that appeared online to users in 1999. For the "Prof" features from following years that are reproduced on this website, extraneous materials — times, dates, and such — have been removed. We have, however, added here the following index of discussion thread topics for the convenience of the reader.
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Office Hours: The Professor Is In — featuring Steve Hood, Walt Manning, Larry Molt, Bob Quesal, Nan Ratner Ken St. Louis, Woody Starkweather, and Scott Yaruss Thank you for your interest and participation in the Second International Stuttering Awareness Online Conference. The conference officially ended October 22, 1999. The papers and what is on the threaded discussions will remain at this address and you are welcome to read and/or copy them. The papers will be permanently archived on the Stuttering Home Page. However, the presenters have concluded their responsibilities for checking and answering any questions posted, so will not be responding here anymore. DAF/FAF use From: email@example.com Date: 10/1/99 Time: 7:24:08 AM Remote Name: 126.96.36.199 Comments What are the personal meanings of using DAF/FAF devices? Re: DAF/FAF use From: Date: 10/1/99 Time: 9:22:41 AM Remote Name: 188.8.131.52 Comments Hi Gert! I'm not sure what you mean by "personal meanings" of using DAF/FAF devices, so my answer may be off-base - please let me know. My viewpoint is that one use of DAF/FAF devices (as well as metronome/pacing devices and auditory maskers) is as a form of "prosthesis" - a fluency aid, similar to glasses, hearing aids, canes, etc., for other disabilities. Many individuals are not currently in a position to seek traditional treatment for their stuttering or have not had success in the past and are desperately searching for something that would help. DAF and FAF, as well as auditory masking devices such as the Edinburgh Masker fit the bill for many people. Herb Goldberg, who received the "Honors of the NSA" last year for his work in helping people via his efforts in distributing masking devices, is a wonderful example of what a masking device can do - had a fairly severe stutter, therapy hadn't helped much - he went to the Edinburgh masker, used it for many years and gradually weaned off of it, but gained so much confidence in his ability to produce fluent speech through using it that he no longer needed it. Marty Jezer has written eloquently on the list-serves about how he uses several devices as tools to help him in certain situations - they don't eliminate all stuttering, but they give him enough confidence and control that he feels more comfortable in the situation. The downside is that they don't work for everyone, and they may lose their effectiveness over time in some individuals. But as an SLP, and a person who stutters, I see nothing demeaning or negative in the use of such tools. Larry Molt daf From: Ashley Kirk Date: 10/1/99 Time: 8:55:31 AM Remote Name: 184.108.40.206 Comments I am currently a graduate student at East Carolina University and am enrolled in a stuttering class. I was wondering, do you think a hearing aid type device that provides delayed auditory feedback will produce fluent and normal sounding speech in a person who stutters? I understand that DAF does reduce the amount of stuttering, but can it actually be used in all contexts and be considered normal speech? Re: daf From: Larry Molt Date: 10/1/99 Time: 10:52:43 AM Remote Name: 220.127.116.11 Comments Hi Ashley Hope all goes well at ECU and that you didn't get hit by the floods from Hurricane Floyd - the pictures from Greenville look like it was pretty bad there! ( and please say hello to Drs. Shine, Rastatter, and Kalinowski for me). On to your question. In my viewpoint and experience, there are a variety of factors that probably play a role in well how a person responds to DAF: this includes how they employ the DAF - as a tool in producing a slower speech pattern, as a distractor that causes them to ignore the auditory feedback loop entirely, as a new feedback source for motor control, etc., as well as probably a wide variety of organic factors and even psychological/psychosocial factors. Not all individuals benefit equally from DAF, and not all use it the same way. Decisions need to be made about what delay setting to use, and choices might be made that negate some of the effects. Others seem to adapt faster and begin to see diminishing effectiveness. Probably the placebo effect plays a role for many individuals. You ask if it will provide normal sounding speech? The mechanism that its being used for will have an effect on that - I've used DAF in therapy as tool in teaching the use of slower speech with continual phonation, in which case the individual may be very fluent, but will not have normal sounding speech. For some individuals who employ it more for its effects on possible feedback links, some may end up with normal sounding speech, but many won't. Can it be used in all contexts? - my glib reply would be "only as long as the batteries work, and probably not real great if you're talking to someone while showering", but we do see varied uses - some people chose to only use it for certain situations, such as the telephone. It would also depend how the device operates - if there is an active microphone that is on all the time, then its also going to be picking up all the sounds surrounding it, so in a noisy environment (because the DAF feedback has to be very loud in the first place to be effective) what comes through the receiver may be useless. This could be overcome by using a throat-level accelerometer type of microphone, that would only respond to the speaker's own vocalizations. A final comment on the last part of your question - can it be used in all contexts and result in normal speeech - my guess would be "no" for many individuals. Its a tool, its effectiveness varies among users, and I would guess that some situations will have too many negative factors working against the device, reducing or even completely negating its effectiveness. I'm interested to see what others have to say - any comments from people who personally use DAF? Warmest Regards, Larry Molt DAF From: Mike Hughes Date: 10/2/99 Time: 12:33:00 PM Remote Name: 18.104.22.168 Comments Larry, I am pleased to see credit being given to electronic fluency devices. Personally, I think that the greatest good was generated the first weekend I used the Edinburgh Masker. It taught me something that I had come to doubt. THAT FLUENCY WAS POSSIBLE! After 30 years of failure and diminshing self-esteem, it was a wonderous feeling to discover that I could actualy speak. I could go on for hours, but the point has been made. When your stuttering has convinced you that you can not speak fluently, an electronic fluency aid might just be the "crutch" your broken speech needs! Re: DAF From: Ken St. Louis Date: 10/12/99 Time: 8:41:07 AM Remote Name: 22.214.171.124 Comments Hi Mike, Your comment about fluency devices is important. For some people they provide dramatic relief. See several of the related comments in some of the other discussion. Ken acquired stuttering From: Kate Clay Date: 10/1/99 Time: 5:03:28 PM Remote Name: 126.96.36.199 Comments I was wondering, from a neurological standpoint, how does one "acquire" stuttering. Also, is there a difference in the brain between a person who developed stuttering and one who aquired stuttering? Re: acquired stuttering From: J. Scott Yaruss Date: 10/4/99 Time: 8:58:49 AM Remote Name: 188.8.131.52 Comments Hi Kate The term "acquired stuttering" is typically used to refer to stuttering that has late, sudden onset -- due to some type of neurological or psychological trauma. In the case of neurological trauma, there would definitely be a difference in the brains of people with acquired stuttering since there is presumed to be a specific cause for the stuttering with acquired stuttering, but no such specific cause has been identified for people with so-called "developmental" stuttering. Some good papers on this can be found in Dick Curlee's recent book: Stuttering and related disorders of fluency (Thieme, 1999). Check out the chapter by Nancy Helm-Estabrooks (pp. 255-269). Good luck! JSY DAF succes after one month use From: Gert Reunes chair Belgium selfhelp student university slp Date: 10/2/99 Time: 5:17:16 AM Remote Name: 184.108.40.206 Comments Hi, We are now doing research on DAF long term use at the university GHENT-BELGIUM. After one month of use the results are amazing. Of course nobody is the same, but DAF seems to help a lot for heavy stutterers. Also in extreem stress situations the stuttering is less. Ofcourse the research is in full expantion and we have to do alot of research more. But off the record the people who uses DAF now for a month are enormous happy about the device. They also change their attitudes towards the stuttering problem. When they become more fluently they have less problems in being themselves. We hope to decrease the size of the DAF units so there will be more exceptance to use the device in ALL situations. If we can bring the size to a hearing aid I think there will be an eartquake in stuttering therapy. I am also a stutterer and I can say that DAF for me is also a good trick to speak more fluently. 90% more fluent. Also FAF effects my speaking in the good way. I do not understand why some SLP see no solution in using DAF. I think that DAF/FAF in the therapy room also can make the stutterers aware of speaking fluently. Acceptance of being a stutterer will be more easy when you become more fluently. In Belgium not many SLP uses DAF...??? I do not understand why... Re: DAF succes after one month use From: Larry Molt Date: 10/5/99 Time: 9:00:48 AM Remote Name: 220.127.116.11 Comments Hi Gert! I'd really love to know more about the methaodology employed in your clinic's DAF Program - especially as to how DAF is used. What are the instructions given to the participants when using DAF (i.e., is it used to promote a slower, prolonged speaking pattern, as a timing device for speech production, as an auditory distractor, etc.?). Re: DAF succes after one month use From: Ken St. Louis Date: 10/7/99 Time: 9:36:19 AM Remote Name: 18.104.22.168 Comments Hi Gert, I'm glad you have observed such good success with DAF both in yourself and in others. There is no doubt that it can make a dramatic difference in stuttering in a short period of time. In this country about 30 years ago, Israel Goldiamond, and experimental psychologist, announced that he had solved the problem of stuttering with his DAF research. Obviously, he had not, for there were many that did not like the kind of speech that they were left with. Also, there were many who had not been trained to speak WITHOUT the DAF machine. For these reason, most clinicians in the USA who now use DAF do so for a relatively short period of time at the beginning stages of therapy, typically progressing from about 220-250 msec delay to essentially no delay in about 50 msec steps. They use the machine to show the client how to prolong vowels, slow the overall speech rate, and "run one word into the next." This usually eliminates all or most of the stuttering. Then they demonstrate to the client, perhaps by turning the device on and off, that it is possible to speak the same way without the DAF influence. Once the client can maintain his or her gains without the DAF, then it is removed while transfer activities are undertaken. At this point, recent clinical research suggests that stutterers are much more likely to continue to use the news speech pattern if it sound reasonably natural or normal sounding. (Of course, this is true of all fluency shaping approaches.) It is important to "wean" the client from the DAF device, or make him/her less dependent on it, if the goal is to be able to speak fluently without it. This takes time, effort, and lots of systematic practice. Again, I'm glad you have had such good luck with DAF in Ghent. The FAF device is quite different. I have not used it clinically, although the preliminary results I have seen reported are encouraging. Ken FAF "Life": Does it Last? From: Mark Facer (Sydney Australia) Date: 10/21/99 Time: 4:06:19 AM Remote Name: 22.214.171.124 Comments Hello! I have experienced using an FAF device for three days now: my life seems in control for the first time since my intensive "smooth speech" course in the early 1990s. The questions are: Does anyone know how long this amazing effect lasts? In other words, do PWSs "adapt" to the new (FAF) feedback and go back to certain disfluent "set points" and so "relapse"? Thanks again for all your good work! Regards, Mark Facer, Sydney Australia Re: Will it last?� Oh God, will it last????? From: Joe Kalinowski Date: 10/22/99 Time: 8:03:16 AM Remote Name: 126.96.36.199 Comments Will it last? Oh God, will it last????? Will it last? Oh God, will it last????? Will it last--only empirical science will tell! No magic words from the guru atop the mountain. In our enthusiasm to find answers, as quickly as possible, to questions--- important questions-- such as; "Will this fluency last???" ; Will I have to feel the bitter and inconsolable pain, disappointment, and rage that I have felt time and time again when I have relapsed following therapy". "I don't want to get my hopes up too high. I don't want to have my dreams dashed!!" We can only circumvent the pain that PWS have felt when bombarded by all these "dog and pony acts", anecdotal evidence of magical remissions, and cult-followings------ when we engage in comprehensive, extensive, and independent clinical trials based on empiricism ----and not on belief-systems. These trials will show the true "successes" or failures" of the best laid plans of mice and me. We must embrace empiricism and leave belief systems and spiritual enlightenment to other domains. We must not make stuttering an ethical, moral, or spiritual dilemma. Many times I have pondered: "Why do I have to believe for this to work?" (I did believe, but THERAPY failed to work. I worked. I believed. THERAPY FAILED!!"). Why if I fail, am I a non-believer, one of those who must fall into the pits of Stuttering with other lesser souls--- lacking in moral fiber or character ?". This is crazy�. I believe in God. I believe in the love of people and the caring nature of the human soul. I shouldn't have to believe in stuttering therapy and revere the founders of the aforementioned therapy. Criteria for remission does not require belief nor reverence. . We can't blame the patient when one doesn't work and give praise to the therapy and therapist when it does!! This is not science --it is a belief system. Belief systems are problematic when mixed with science: Communism, Eugenics, Lysenkoism, evolution vs. creationism, Facilitated Communication (FC), Psychoanalysis & Sigmund Freud, --we must move beyond Belief systems to empirical and independent science. Depression and Stuttering From: Ira Zimmerman Date: 10/2/99 Time: 10:18:49 AM Remote Name: 188.8.131.52 Comments What is the percentage of stutterers who suffer from clinical depression and is it necessary for effective stuttering treatment to have a psychologist treat that depression? Re: Depression and Stuttering From: Larry Molt Date: 10/5/99 Time: 9:14:52 AM Remote Name: 184.108.40.206 Comments Hi Ira! I'm not aware of any research indicating that the incidence of clinical depression is any higher in the stuttering population than in the general population. What anecdotal evidence I've seen/heard on the stuttering list-serves also tends to bear this out - while a few participants report bouts of clinical depression, the majority don't. Relative to the second part of your question, is it necessary for successful stuttering therapy to employ the services of a psychologist to treat the clinical depression if present, it would depend on the nature of the clinical depression and its effect on the fluency therapy. Depression takes many different forms, and some forms may limit the ability of the individual to participate fully in therapy, in which case, physcian assistance might be very desirable. In addition, because of possible neurochemical links for both depression and stuttering, it could be that neuropharmaceuticals being used to treat the depression may help or hinder fluency therapy; the professionals treating the disorders should both be aware of this, be alert for signs, and be in communication with each other. Re: Depression and Stuttering From: Ken St. Louis Date: 10/7/99 Time: 9:46:37 AM Remote Name: 220.127.116.11 Comments Hello Ira, I second what Larry Molt wrote in response to your query. I simply wanted to add that a series of studies were carried out by Cantwall and his asociates on the US west coast from 1979-1987 looking at the likelihood of psychiatric disorders among speech, language, or hearing disordered individuals. Stuttering was not isolated specifically but included in one of the groups. You might want to check out Cantwell, D. P. & Baker, L. (1987) Prevalence and type of psychiatric disorder and developmental disorders in three speech and language groups. Journal of Communication Disorders, 20, 151-160. Not sure if this will help or not. Ken Child vs. Adult use of DAF From: Mckenzie Thompson Date: 10/2/99 Time: 12:35:56 PM Remote Name: 18.104.22.168 Comments While using DAF or FAF, has there been any evidence thus far to show that children or adolescents experience different effects than adults? This does not neccessarily have to be based on age differences, but possibly the persons amount of life experiences, their resistance level, or other factors. Also, does the feedback delay time differ in children as compared to adults? Re: Child vs. Adult use of DAF From: Nan Ratner Date: 10/3/99 Time: 11:35:11 AM Remote Name: 22.214.171.124 Comments Work on the responses of children to DAF is very old and not easily interpretable. There is some suspicion, and we have evidence from our current study to support this, that very young children (3-4) do not show much response to DAF (if you can get them to participate!). Then typically developing children seem more destabilized by DAF than older individuals, presumably because they are not as automatic in their speech. I don't know of a literature looking at the fluency responses of kids under DAF, but it would be interesting to see if it facilitates fluency. I don't think anyone knows. Do they, readers? Eye Contact From: Jonathan Bashor Date: 10/3/99 Time: 1:19:18 PM Remote Name: 126.96.36.199 Comments Where would you put maintaining eye contact in importance for a severe stutterer on a scale of 0 to 5 with 5 meaning critical ? Re: Eye Contact From: Steve Hood Date: 10/3/99 Time: 7:41:51 PM Remote Name: 188.8.131.52 Comments Jonathan You have asked a good question, for which I don't think there is a simple answer. Eye contact is important in stuttering, especially in cases of severe stuttering, but I think this needs to be put into perspective. Lack of eye contact, or loss of eye contact, is often associated with perceived guilt and/or shame regarding stuttering. Often this is the case. We often look away when we are uncomfortable. Many "normally fluent speakers" also have difficulty with eye-contact. PWS's are not alone with this. Some people "blame" poor eye contact on stuttering, and insist that PWS's need to work on eye contact "because" they stutter. Another way to look at it is by saying people should work on eye-contact because this is the pragmatically polite thing to do to maintain optimum interpersonal communication between speakers and listeners. Appropriate eye contact (and this does NOT mean staring the person down) is simply the polite and apropriate thing to do -- regardless of stuttering; albeit during severe stuttering, often there are PWS's who look away. NOW -- to rate the importance of this? I cannot say. Eye contact is but one of many factors to consider in severe stuttering. Others include, but are not limited to, overall behavioral severity in terms of the frequency the person's stutters, the amount of effort/tension/struggle involved, the duration of how long stuttering moments last, and the type of stuttering (repetitions, blocks, prolongations, etc.) In addition to these behavioral factors we also have such things as the PWS's perceived feelings of confidence in the situation, whether they have something worthwhile to say, whether they feel at ease in the situation, seem relaxed, give the listener the impression that they are o-k with their stuttering (e.g., that they are comfortable with it, etc.) Eye-contact should be kept in perspective, and related to other behavioral and emotional correlates of stuttering. But to rate/rank it on a scale is potentially misleading. Hope this helps. Steve Hood Re: Eye Contact From: Peter Louw Date: 10/12/99 Time: 9:11:35 AM Remote Name: 184.108.40.206 Comments I agree that eye contact is important - but it also has a downside. I have found that eye contact can draw my attention away from using my speech technique. My own procedure is to establish eye contact so as to promote communication, but thereafter I immediately slightly lower my gaze in order to apply my fluent-speech technique. This is necessary, as applying a speech technique requires some effort and concentration. Then, after I have said what I wanted to say, I again re-establish eye contact. When averting my gaze, I usually drop it so that I look at the person's nose. Apparently people get the impression that you are having eye contact when you are in fact looking at their noses (try it! Look at someone's nose, and then ask him / her if he / she notes the difference!). Regards. Sibling behaviors From: Jennifer Tanner Date: 10/4/99 Time: 3:03:00 PM Remote Name: 220.127.116.11 Comments A great deal of research has been done involving parental behaviors influencing their children who stutter. Do you think sibling behaviors influence stuttering? Re: Sibling behaviors From: Steve Hood Date: 10/4/99 Time: 3:40:44 PM Remote Name: 18.104.22.168 Comments This is a good question, and I'll make a few comments based on clinical experiences. I am not aware of specific, well controlled research that deals specifically with this guestion. I think sibling relationships can make a difference. Above and beyond the general topic of "sibling rivalry" there is subcomponent that I think of in terms of "verbal competition." When there is a lot of verbal competition (between kids, adults, adults and kids) this can increase communicative pressure and stress. When people are interrupting and contradicting, when people are bombarding each other with questions, where there is verbal interrogations, etc, this is often stressful. AND, then these things are going on, there is usually more excitement in the verbal exchanges, and people often talk faster and louder. For some, this can be stressful. For some, this puts more pressues and demands on the child than the child has the capacity to deal with. In our clinic, we do lots of work with children who are stuttering, and we work on things such as turntaking. My turn..pause..your turn. We model talking that is a bit slower, more melodic, with slight paused between turn-takes. We do this with the child and his/her clinician. Later, when the child is talking more easily, we gradually begin to bring in the parent(s) and sibling(s), and we ALL work on turn taking, reducing interruptions, etc. (We might do this with a board game such as "Shoots and Ladders" -- where we also need to take turns. Often, this is a helpful component of therapy. Hope this helps, Steve Hood Making those AAF devices smaller! From: Mark Facer Date: 10/4/99 Time: 4:52:01 PM Remote Name: 22.214.171.124 Comments Hello Professors! Two simple questions: 1) what is the smallest FAF (or DAF) device available; and 2) is there more development being done to miniaturize these devices? I'm an electrical engineer (in electronics and communications) and in my mind I can EASILY imagine an anti-stuttering device worn like a hearing aid and linked via skin-coloured wires (or maybe via an infra-red or a radio link) to a throat microphone. Instead, all I'm aware of is a near-$USD600 not-quite-pocket-sized device. I'm sure there are many PWSs who would support development of a smaller and more sophisticated late-1990s device. Thanks and keep up the good work! Re: Making those AAF devices smaller! From: Steve Hood Date: 10/5/99 Time: 9:30:05 AM Remote Name: 126.96.36.199 Comments Hi, Mark I am not sure I am in a good position to answer your question, but I think I can steer you in a good direction. You might try to contact Thomas David Kehoe. He is a person who stutters, and an engineer. The most recent addresses I have for him (hope they are current) are: E-Mail: firstname.lastname@example.org Phone: 303/417-9752 Web Page: http://www.casafutura.com His company, Casa Futura Technologies manufactures a number of different units for such things as delayed auditory feedback,, frequency altered feedback, etc. You might find this information helpful. Steve Hood Re: Making those AAF devices smaller! From: Gert Reunes Date: 10/5/99 Time: 2:20:56 PM Remote Name: 188.8.131.52 Comments Hello, I have good contacts with the firm LERNOUT and HAUSPIE THE firm who makes that computers can understand our voices. The president of the firm Mister Jo Lernout himself was impressed by the problem 'stuttering' He will do an investigation in his firm of there are possibilitis to make the DAF and FAF devices as small as a hearing device. First they want more investigations of the university Ghent how the DAF works after long term use. So it is up to engineers to do the job for making those divices real small. Also Bill Gates is participating in Lernout & Hauspie!!! 'We have to give this man an E-mail to sponsor such a project' ;-) I hope also that one day there will be such a small device!!! How does acting create fluency? From: Leslie Brewer Date: 10/4/99 Time: 6:00:04 PM Remote Name: 184.108.40.206 Comments Just recently I watched a video that presented the assumption that people who stutter become fluent while acting because they are able to free themselves from the world and become someone else for the time being. I would have to disagree with this assumption. I conclude that acting is similar to choral reading and singing in that a different part of the brain is used. Therefore, I believe fluency is created because of a neurological component rather than "freeing yourself from the world and the person you actually are". I am interested to hear what your opinion is on this matter. Could you please write me back at email@example.com. Thank you, Leslie Brewer Re: How does acting create fluency? From: Ken St. Louis Date: 10/7/99 Time: 10:07:09 AM Remote Name: 220.127.116.11 Comments Hi Leslie, Good question about acting but, like most you might read in this section, one in which a simple answer will not suffice. I had one client who was a student training to become an actor. He had no difficulty at all on stage; in fact it was the easiest situation on his hierarchy of speaking situations. I also have stories from a number of others who stutter saying essentially the same thing. On the other hand, most of the clients I work with are terrified of getting up in front of others on stage (as in giving a speech). Accordingly, I would have to say that "It all depends..." I'm not sure that either explanation you mention (freeing oneself from the cares of the real world or speaking as in singing or choral reading) is wholly satisfactory, especially since the experience of being free of stuttering on stage is not at all universal. There are probably examples wherein these explanations for the salutory effect of acting on stuttering apply. But there may be many more. Some people are just "hams" and feel very comfortable in the limelight. Others may do very well with memorized material, not so much because it is memorized but that it becomes essentially artificial in terms of communication intent. Many years ago, Victor Frankl, a Holocaust survivor and psychiatrist, in his little book called "Man's Search for Meaning" described a new approach to psychotherapy called "logotherapy." He gave an example in the book of having stutterers play the role of stutterers in plays and finding that in such roles, they could no longer stutter. Food for thought.... On a related note, I have had two occasions, one about a year ago, where I was asked to coach acting students who were trying to learn how to fake stuttering convincingly on stage. Hmm.... And, when I was in high school trying my hand at acting, I stuttered. Thanks again for your question. Ken Re: How does acting create fluency? From: Walt Manning Date: 10/7/99 Time: 11:12:52 AM Remote Name: 18.104.22.168 Comments Leslie- My thoughts parallel Ken's and I will also add that the combination of using a stage voice, speaking with a dialect or accent combine with playing a role (especially with a costume, etc) all help to induce fluency while acting. I often wish that I would have had the courage to take part in school plays when I was younger but had no idea that I might be fluent in such a situations. I have known several clients who were able to be very fluent while acting and I don't think that it's unusual. James Earl Jones is very fluent in his stage voice but much less so when simply conversing. So, I guess I'm agreeing with you that fluency while acting can be an escape from one's usual role, enhanced fluency is better explained by the unique ways in which one is speaking in such a situation. Stuttering Cured after TBI/Stroke/Disease? From: Kim Mills, ECU Date: 10/4/99 Time: 9:57:24 PM Remote Name: 22.214.171.124 Comments I appreciate this opportunity to ask questions on stuttering as I am just now getting my first taste in this fascinating area. I have heard about people developing a form of stuttering after a stroke and was wondering if there has been any evidence of a person who stutters actually being "cured" of their stuttering after a stroke, Traumatic Brain Injury, or a disease such as Alzheimers. I was curious if something like this that does disturb brain function or activity would actually have an impact on the stuttering of a person. (This may be a far fetched question.) Again, thank you for your time. This online conference is great! Re: Stuttering Cured after TBI/Stroke/Disease? From: Judy Kuster Date: 10/5/99 Time: 11:51:53 AM Remote Name: 126.96.36.199 Comments There is a short article in New Scientist magazine 9/25/99 by reporter Alison Motluk which begins, "A stroke has cured an elderly man of his lifelong stutter, according to doctors in Japan." (http://www.newscientist.com/ns/19990925/newsstory7.html). Would be interesting to read the article in Neurology referenced in this short report. Re: Stuttering Cured after TBI/Stroke/Disease? From: Larry Molt Date: 10/5/99 Time: 11:55:07 AM Remote Name: 188.8.131.52 Comments Hi Kim - good question. As Scott Yaruss wrote in a reply to an earlier question concerning acquired stuttering, the dysfluencies we see following some instances of stroke, disease, or trauma aren't necessarily stuttering - they are a form of fluency disorder, but differ from stuttering in several behavioral patterns. So I wouldn't necessarily expect that disease or injury that causes one type of fluency disorder would have a bearing on a different type of fluency disorder. Off the top of my head I can't think of any research examining this, although I am aware of several anecdotal reports. Vicki Schutter, who is a frequent participant on the STUTT-L list serve, has written about her experience, following a severe head injury. Her stuttering disappeared at first, but returned after about eight months, as her recovery from TBI continued. There's probably a good reason why we haven't heard of many cases like this - for such an occurence to happen, the injury or disease would have to affect the part of the brain where the hypothetized neurological cause of the stuttering behavior had its root, and affect it only in a certain manner (either knocking it out so it loses the effect, or altering the effect in a positive way rather than exacerbating the problem), without other ill effects on communication. In other words, it would a take a very fortuitous set of circumstances! Keep asking questions - and be sure to ask the fluency folks at ECU these same questions (and lots more!) Warmest Regards, Larry Molt Re: Stuttering Cured after TBI/Stroke/Disease? From: Larry Molt Date: 10/5/99 Time: 3:52:33 PM Remote Name: 184.108.40.206 Comments Hi again, Kim! As I was thinking about your question some more, I did remember coming across a couple of articles on this, some time back, and I tracked down the references. Here they are: Helm-Estabrooks N. Yeo R. Geschwind N. Freedman M. Weinstein C. Stuttering: disappearance and reappearance with acquired brain lesions. Neurology. 36(8):1109-12, 1986 Aug. (This is a report of a single case, following TBI) Miller AE. Cessation of stuttering with progressive multiple sclerosis. Neurology. 35(9):1341-3, 1985 Sep. (Miller reports two individuals whose stuttering disappeared as their MS progressed, and he speculated that the disappearance was linked to cerebellar influence. The bad news is that other communication disorders surfaced as the disease continued.) Re: Stuttering Cured after TBI/Stroke/Disease? From: Ken St. Louis Date: 10/7/99 Time: 10:14:22 AM Remote Name: 220.127.116.11 Comments Hi Kim, Let me weigh in on this one too. I have had my students collect interviews wherein folks were asked to "tell their stories" of stuttering. One student interviewed the wife of man who after a lifetime of stuttering, had a stroke, recovered, and no longer stuttered. (No one offered an explanation.) And the famous/infamous (?) study by Jones who found that language laterality for four stutterers who underwent brain surgery no longer stuttered and experienced a shift of language laterality to the unoperated side. Just to add to the mystery..... Ken Amygdala role in stuttering From: Mario Moretti Date: 10/5/99 Time: 9:41:28 AM Remote Name: 18.104.22.168 Comments I red the news about the impaired interemisferic auditory cortex syncronization and in may opinion is very interesting. As you know the emotion like fear produce the stuttering also in a normal people. Do you think that amygdala could produce some interference with the auditory cortex syncronization process ? Re: Amygdala role in stuttering From: Larry Molt Date: 10/5/99 Time: 2:51:40 PM Remote Name: 22.214.171.124 Comments Hi Mario I think there are many possible ways that the amygdala (and other limbic structures) may play a modulating role in some aspects of stuttering behavior, although my own feeling, at least at first glance, is that its role in interhemispheric auditory synchronization would be minimal or more likely nonexistent. There is a considerable amount of research indicating central auditory abnormalities in at least some PWS, and this was done without the subject speaking (which should minimalize or negate limbic influences). As I said, there are many other opportunities for the amygdala to influence stuttering behaviors. Darrell Dodge, who is just finishing his degree at the University of Colorado with Peter Ramig, has long been a proponent of an amygdalar role. I would encourage you to visit his website, where he posted a very well-written and insightful theoretical model for stuttering dealing with reactive inhibition. The url is: http://telosnet.com/dmdodge/reactinh.html Warmest Regards, Larry Molt Re: Amygdala role in stuttering From: Darrell Dodge Date: 10/6/99 Time: 1:32:34 AM Remote Name: 126.96.36.199 Comments Thanks, Larry, for referencing my Web article on the role of reactive inhibition and the limbic circuits (including the amygdala) in stuttering. It's intended as a "jumping off" place for people, so Mario should find plenty of grist for the mill (to mix a metaphor). I haven't received a lot of critical feedback on the article from people with knowledge of neurology and psychology and would really welcome that. My impression of the body of research on organic differences between stutterers and fluent speakers is that the *deficits* found during non-speech measurements were relatively minor. I emphasize *deficits* because that's what the researchers were usually looking for. Unfortunately, that means they may have trashed a lot of results that indicated *increased neurological sensitivity* or hyperactivity of stutterers in a number of areas. Read Jerome Kagan for some ideas suggesting that stuttering could even be a "temperament," with a physical basis in many cases -- including (but not limited to) hypersensitivity of the amygdala. Conversely, I've often wondered if the presence of a continuing habitual pattern of violent inhibition of key brain functions could have a lingering effect on those specific functions during non-speech activities. The key missing data are the neurological characteristics of children who go on to stutter. Without that, we're whistling in the dark. I don't think that measurements of people who have been stuttering for 20 or 30 years are very useful for finding the original neurological cause of stuttering. Regards, - Darrell Dodge Handedness From: Jaime Fernandez , graduate student Date: 10/5/99 Time: 8:16:31 PM Remote Name: 188.8.131.52 Comments A relative of mine ,who is in his seventies,told me that when he was a child, students who were left handed were forced to learn how to be right handed. When they tried to make him right handed, he began to stutter. His teachers finally gave up when they realized that this child was not going to become a "rightie", and he was fluent again. Is this because he was using a different part of the brain when trying to write with his right hand instead of the left? How is this linked to stuttering? And would a person who stutters become fluent if they tried to write with their less dominant hand? Re: Article 30 (Handedness issues) From: Larry Molt Date: 10/6/99 Time: 9:12:44 AM Remote Name: 184.108.40.206 Comments Hi Jaime! Forcing left-handed children to use their right hand was a fairly common practice even into the 1950's - I come from a family where everyone is left handed except me - and my older brothers were both forced to write right-handed in school (until my parents found out and raised a ruckus). There isn't, as far as I know, any evidence that this created many stutterers - although it probably created another communication disorder - several generations of kids with poor handwriting, as they were forced to use their non-dominant hand. As to your relative's experiences, it points out a common problem we have with reports of anectdotal experiences like this - what speech behaviors was he exhibiting, was it actually stuttering, were there symptoms before the forced hand change, etc., before one could postulate cause and effect. The issue of handedness and cerebral dominance for speech was exhaustively examined in the 1930's & 40's in attempts to support the Orton and Travis cerebral dominance theories. I'd encourage you to read Oliver Bloodstein's "Handbook of Stuttering" for a very thorough review of the research in that area. Finally, you asked about switching hand usage in individuals who stutter. Charles Van Riper, in his book "The Nature of Stuttering" (1971) writes about his own attempts at this, wearing a cast on his right arm for several months to keep from using it, and doing a daily quota of 50 pages of simultaneous talking & writing with his left hand. He reported no benefit, and abandoned his efforts (pg. 354). Warmest Regards, Larry Molt Re: Article 30 From: Steve Hood Date: 10/6/99 Time: 7:41:23 PM Remote Name: 220.127.116.11 Comments Hello, Jaimie Larry molt gave you a good answer and said some of the things I would have otherwise said. Since he said these things, I'll take a different tack, and then add some personal anecdotes. I'm not sure if it is the attempted change of handedness per se that **might** make some different, or associated stress. Those who would force a child to change handedness, might want to change lots of other things, including speech patterns, and this could be stressful. ((Left handers are bad -- stutterers are bad.)) I am a normally fluent speaker, although I talk rapidly, and occasionally run syllables together. I am very mixed dominant. UNILATERAL activities fine me left handed: I play tennis left handed, write left handed, eat left handed,throw a ball left handed. "BILATERAL activities find me using my right hand: I play golf and hockey right handed, bat a baseball right handed. My right eye is dominant. As a kid my printing and penmanship was terrible. I was initially using my left hand. We tried slanting the paper to the left, slanting the paper to the right..... nothing worked. I'd come home after school with ink all over my left sleeve. My mother was on my case to not get ink on my shirt. After spending several months writing left handed, my third grade teacher "switched me to right handed" and we tried this for several months. Didn't make any difference in my penmanship,nor (to best of my knowledge) my fluency. To this day my penmanship stinks. I prefer the keyboard, and find computers to be a wonderful substitute to the inked word. (I was also, and still am, a miserable speller. I find spell-check programs a delight. And -- speaking of spelling -- When I don't have a dictionary handy, I will switch words and circumlocute in order to avoid a word I cannot spell. For what it's worth........ Thanks for posting to ISAD, Steve Hood Male to Female Ratio From: Amy Medlin Date: 10/5/99 Time: 10:57:20 PM Remote Name: 18.104.22.168 Comments I have always been interested in the fact that so many more males stutter than females. Are there some concrete reasons for this? Or are there many theories on this? Re: Male to Female Ratio From: scott yaruss Date: 10/6/99 Time: 9:04:07 AM Remote Name: 22.214.171.124 Comments Hi Amy You've asked a good question...I'm afraid I don't know the answer...I do know that there has been some debate recently about exactly what the M/F ratio really is and what it means. Take a look at the paper by Bobbie Lubker here on the ISAD list for a little more from an epidemiologist's point of view. As to what it means...Good Q...the common answer I hear is that males are more susceptible to most disorders than females...I never found that answer too satisfying, though I have used it from time to time... S Re: Male to Female Ratio From: Larry Molt Date: 10/6/99 Time: 11:05:13 AM Remote Name: 126.96.36.199 Comments Hi Amy Just want to follow up Scott's comments. Norman Geschwin has written some thoughts on the possible role of testosterone on shaping brain development and that might play a role in the higher number of males with various developmental problems and disorders. Off the top of my head, I think that David Rosenfield (who has an article further down screen in the "Poster Section" of the ISAD2 conference), might have had some comments on that in his article on the brain and stuttering, that appeared in the Jornal of Fluency Disorders, (about 1980). Good Question! Larry Re: Male to Female Ratio From: Walt Manning Date: 10/7/99 Time: 9:53:17 AM Remote Name: 188.8.131.52 Comments Hello Amy- The research and writing that I have seen indicates that, at the outset of stuttering, boys and girls begin to stutter at about the same frequency but that, for a variety of reasons (linguistic, motoric, etc.) females are more likely to "recover" from stuttering tham males. Thus, around the time of early adolescence, we see a ratio of 3 or 4 males for every female who stutterers. There has also been some suggestion in the literature that females who stutter may be more "severe" than the typical male but I don't know of much supporting evidence for this. Thanks for posting. Male to Female Ratio From: Woody Starkweather Date: 10/7/99 Time: 3:37:21 PM Remote Name: 184.108.40.206 Comments Of course, we should mention genetics here too. Genetic differences between males and females are expressed in a number of behavioral characteristics, and it doesn't seem unreasonable to conclude that because of these behavioral tendencies, males are more likely to react to the frustration of early stuttering more intensely, for example, or that female children, because of superior early lang- uage skills are better able to cope with the ex- perience of early stuttering. Woody Male to Female Ratio From: Andy Floyd Date: 10/8/99 Time: 11:28:33 PM Remote Name: 220.127.116.11 Comments This question has always intrigued me. About 8 years ago, I saw a report on a show like 20/20 that had male and female toddlers. The mothers put their son and/or daughter behind a barrier (separating mother from child) and waited. A significant number of boys tried to push through the barrier to reach the mother, whereas the girls sat down and started to cry. Now, I know this is far from scientific, but I've always wondered if at least one reason more boys stutter is that boys try to "fight" through aversive stimuli whereas most girls may not. Just a thought. Re: Male to Female Ratio From: Ken St. Louis Date: 10/11/99 Time: 7:44:54 AM Remote Name: 18.104.22.168 Comments Hi Andy, Interesting hypothesis. I don't know of any solid data that directly supports the notion that boys being more inclined to "struggle" or "fight" through a physiological barrier is related to the sex ratio in stuttering. Woody Starkweather's post on this topic is germane to your query. Reaction to stress, indeed, might play a role. My guess is that it is much more complicated that all of this, reflecting multiple influences. Ken Botox Injections From: Jennifer Harper Date: 10/5/99 Time: 11:20:10 PM Remote Name: 22.214.171.124 Comments I was recently reading an article on the internet that discussed Botox injections as a means of reducing stuttering. I was curious as to what exactly these injections do and have they proven to be effective? Re: Botox Injections From: Nan Ratner Date: 10/8/99 Time: 10:07:32 AM Remote Name: 126.96.36.199 Comments Although Brin (1994) has a study suggesting that some folks got benefits from Botox injections, work done by Ludlow and Stager at NIH suggested that Botox was not a useful treatment for stuttering. Not only did stuttering not improve for all subjects, the resulting weak breathy voice was just as undesirable as the fluency disorder. Few people who have had Botox injections pursue them for additional rounds (it wears off and must be readministered periodically). So, while Botox may aid a select few individuals, it is not likely to emerge as a standard effective treatment for most people who stutter. regards, Nan Ratner Re: Botox Injections, answering another question in your post From: Nan Ratner Date: 10/8/99 Time: 3:17:17 PM Remote Name: 188.8.131.52 Comments I am sorry, I missed one of your questions. You asked how Botox injections work for stuttering. They weaken the laryngeal muscles, thus softening the strength of vocal contacts. Nan Vocal-cord spasms causing stuttering From: Peter Louw Date: 10/6/99 Time: 9:43:13 AM Remote Name: 184.108.40.206 Comments Dear Sir/Madam Some people are saying that the root cause of stuttering is a vocal-cord spasm triggered by tension. I would be most obliged if you could give your opinion. Thanking you in anticipation. Sincerely yours. Re: Vocal-cord spasms causing stuttering From: Judy Kuster Date: 10/6/99 Time: 10:23:56 AM Remote Name: 220.127.116.11 Comments Hi Peter! I would suggest that you might also want to post this question to Fran Freeman after reading her interesting article below. Judy Re: Vocal-cord spasms causing stuttering From: Walt Manning Date: 10/7/99 Time: 10:08:27 AM Remote Name: 18.104.22.168 Comments Hello Peter- Vocal-cord spasms in one form or another have often been implicated as a cause of stuttering. This view was especially popular in the late 1960s and 1970s and many people thought that the vocal folds were at the "core" of stuttering. Since the vocal folds provide the most constricted point for closure in the vocal tract and since they often respond to various forms of tension or effort (physical and/or emotional) by constricting, vocal fold closure is characteristic of many stuttering form-types. Conture's research using fiber optics and other research in the area of vocal fold physiology do not support the idea that stuttering developes as a result of aberrant vocal fold functioning. Stuttering is lots more multidimentional than that. Thanks for your post. Sensory Delay From: Katie Kiser Date: 10/6/99 Time: 10:06:37 AM Remote Name: 22.214.171.124 Comments I have observed both delayed auditory feedback and delayed visual feedback increase fluency. Has anyone studied a tactile approach to the delayed feedback theories. If so, what methods were used, and was it effective? Re: Sensory Delay From: Ken St. Louis Date: 10/12/99 Time: 8:48:37 AM Remote Name: 126.96.36.199 Comments Hi Katie, I did not respond to your question immediately, waiting to see if one of the other readers might have a definitive answer for you. Let me say that I don't know of any research that has attempted to do some kind of delayed tactile feedback. It would be fun to see what would happen to say some finger movements with some sort of elaborate tactile delay arrangements. I wouldn't speculate as to whether it would disrupt movement the same way DAF disrupts speech or not. As I think about it, my impression is that it would be VERY DIFFICULT TO PRACTICALLY IMPOSSIBLE (Oops! We should not use the "i" word, should we?) to devise an arrangement to simulate delayed tactile feedback for say the tongue tip during speech. Not sure if this helps or not. Ken How can I as an individual who has intermittent contact with a 9 y.o. boy who stutters help? From: Regine Neiders (childs godmother) Date: 10/6/99 Time: 11:13:33 PM Remote Name: 188.8.131.52 Comments I see my godson about 2 - 3 x per year. He initially had problems with th and several other sounds as he began speaking. He saw a speech therapist and this mostly cleared up. Then around the age of 5-6 he began to stutter during the divorce of his parents. During the summers the stuttering would subside and then as school started it would start again and now it seems to be getting more frequent with longer blocks, etc. Finally, it has been determined that he also has dyslexia and is currently being tutored in his reading skills. Where would I as an outsider start, to provide information and assistance to his mother? Is there anything I can do? Also, his mother has been given this website. Re: How can I as an individual who has intermittent contact with ... From: Dear Ms. Neiders, Date: 10/7/99 Time: 8:54:54 AM Remote Name: 184.108.40.206 Comments I posted a reply to your question earlier but am not sure it went through. I'll wait to see. If not, I'll try again. Ken Re: How can I as an individual who has intermittent contact with ... From: Ken St. Louis Date: 10/7/99 Time: 9:18:44 AM Remote Name: 220.127.116.11 Comments Dear Ms. Neiders: Sometimes computers make me crazy. I hit the wrong "Post" button in spite of the careful instructions in an earlier reply. Then, as you see, I put your name in the slot of my second test message where my name was to go. Oh well, let me try again. ------------------------------------------------ I am sure that it must be frustrating indeed to stand on the sidelines and watch your godson's speech getting worse. I appreciate your concern and am sure that you will be able to help. I don't know how old your godson is, but I assume he is in or beyond elementary school. In any case, I also assume he is getting speech therapy now for his stuttering along with tutoring for his reading problems. Those services are necessary and should continue, perhaps for some time. From your description, it seems to me that your godson is not quite typical of most youngsters who stutter. His early articulation problems, reading difficulties, and stuttering suggest--but by not means prove--that he has a physiological problem that affects several manifestations of his language system. At the same time, the fact that he reportedly began to stutter concurrent with a divorce and that he gets worse before each school year, indicates that psychological stress probably plays a role as well. (It makes sense that school would be stressful since he has a reading problem.) I could not say with confidence without evaluating your godson, but such psychological factors usually don't play a major role in the "cause" of the stuttering; instead, they usually serve as "triggers" to make it emerge or become worse. You asked what you should do. If a second opinion is possible financially, I would suggest you find the link in the Stuttering Home Page to the Stuttering Foundation of America and search for a speech-language pathologist who has indicated a willingness and interest in evaluating and treating stuttering. I would also suggest looking seriously at university or hospital clinics that have access to other professionals such as LD or AD/HD specialists, neurologists, psychologists, etc. A second opinion, while not guaranteeing optimal advice is the best way to find approaches to treatment that have the best chance of success. If your godson's mother decides to get a second opinion, she should talk candidly with his current SLP and tutor (who might be doing great jobs) and assure them that she is only wanting to better understand her son's problems. If a second opinion is out of the question, then the Stuttering Foundation of America has lots of inexpensive materials that his current SLP could get to assist her/him. There will be lots of additional information in this ISAD2 Conference. In your two to three times a year that you get to spend with your godson, give him lots of loving attention (which I am sure you do), listen to him carefully without filling in stuttered words or offering advice on how to talk, and enjoy your times together. If you have this kind of interaction, he will remember it his entire life regardless of stuttering, reading problems, or any other problems he encounters. Good luck. Ken Re: How can I as an individual who has intermittent contact with ... From: Jerry Johnson Date: 10/14/99 Time: 10:52:26 PM Remote Name: 18.104.22.168 Comments Dear Godmother Neiders: What a caring person you must be. I am impressed with your willingness to help your godson. Keep caring. People need people and you can do so much good if you don't become discouraged. Your godson needs you. Please keep trying to connect. Intermittent contact need not always be physical. Call your godson as often as your can. And you know something, a letter means so much more because you took the time and effort to actually write something to him. Email is great too, but there is something special about a handwritten, I love you and care about you, note. Pick out a special postal stamp too. Kids love the whole presentation. You are computer literate person. Good for you. Is your godson? How did you become a 21st century person anyway? Now then. Is your godson REALLY stuttering or is he expressing himself in a disfluent behavioral mannor? He is 9 years old and he is going through much hell. What kind of divorce counseling is he getting? Are his parents still talking? Are there other children in the family? Ages and how are they taking it? Are they talking? There are so many questions to ask. Lets not overlook the trees for the forest. Is stuttering the primary problem or are there other unanswered questions? Did deeply into the family situation as it exists now and in the past to find some answers and possibly solutions as to this boys future. How much influence do you have? You are his godmother--are you related in any way? How far do you live from this boy? The list goes on. Have you received counseling? And now getting back to your godson. What is going on anyway? Speech is the barometer of the soul. He feels much pain and torment. What is being done to solve this problem? What about his home and school environment. Is there a school person who could be his mentor and confidant? Search one out. I would suggest an environmental analysis be done. Log on to this website again and key into the Other Homepages About Stuttering and pickout the Gerald Johnson Library. You will find much information there to help caregiver like yourself. Look for "Stuttering Information For Caregivers, Children and SLPs." Please continue to care for your godson. He needs you to be a constant in his life. Care about him. Love him. Call him. Write to him. Offer support to his mother and father too. Do not cut anyone out of your life and continue to care deeply about your godson. There is much to talk about but you have made the right step. I would suspect that his "stuttering" is the tip of the iceberg. Keep trying to help, be generous in your love and understanding. Hold him close to your heart. My tears and emotions are to share with those of your own. Hold strong and steadfast. My love to you for your depth of caring. Best wishes. Jerry Question� regarding the article Reaching Out To Kids who Stutter From: Juli Merrick Date: 10/7/99 Time: 6:59:10 PM Remote Name: 22.214.171.124 Comments Hi, I am a student and I had an assignment to read one of the articles. I really enjoyed the article by Bonnie Weiss. I was wondering if there is going to be any information presented on new treatment approaches on stuttering to these children and their parents at the workshop. My e-mail address is firstname.lastname@example.org. Thank you. Cure for stuttering From: Jonathan Corazon������ (Puerto Rico) Date: 10/8/99 Time: 9:52:21 AM Remote Name: 126.96.36.199 Comments Hi, I am doing my research of stuttering to my science fair , I am going to try to find the cure of stuttering, but i need help because i have only 16 year old If you want to contact me: write me to : Jonathan Corazon Calle Juan R.Ramos l-7 urb,Santa Paula Guaynabo P.R. 00969. write as possible you can. only for researches and Doctors Re: Cure for stuttering From: Ken St. Louis Date: 10/8/99 Time: 2:25:53 PM Remote Name: 188.8.131.52 Comments Hello Jonathon, When I was 16 years old I had just experienced my first summer of speech therapy at the University of Wyoming. I was so successful in controlling my stuttering, that I decided then and there to enter the field of speech therapy. My goal was to solve the problem of stuttering and find a cure. I haven't yet come close to achieving my goal. But what a wonderful goal--to find a cure for stuttering. Maybe you will. Most of us who have worked in this field for many years have become rather cynical, believing that no one will ever really find a cure. If anyone tells you that, understand that that person no doubt knows a great deal and is aware of incredible complexities surrounding the disorder of stuttering. But never underestimate your own potential. Go after your goal. If you don't succeed, you will no doubt make significant progress in helping us better treat this mysterious disorder. If you succeed where so many have failed, life will be better for millions on this planet. I suggest you start by reading all the papers in this on-line conference. See where it takes you. My guess is that you might well end up with a fine science fair project. Good luck, Ken Re: Cure for stuttering From: Nan Ratner Date: 10/8/99 Time: 3:13:07 PM Remote Name: 184.108.40.206 Comments Hi. It is good to pick a topic such as stuttering for a Science Fair project. However, I think you will have a better product if you check out some of the very good library resources on this topic. Try a basic text, such as one written by professors Curlee or Starkweather in this conference, or by Oliver Bloodstein, Barry Guitar or Ed Conture. Also look in PubMed on the internet for abstracts of scholarly articles on the subject. Your teacher will probably find these sources more appropriate for such a research assignment. The Stuttering Foundation of America also has good resources, including some written in Spanish. best regards, Nan Re: Cure for stuttering From: Judy Kuster Date: 10/8/99 Time: 8:11:00 PM Remote Name: 220.127.116.11 Comments Hi Jonathan, I am glad you found this conference! There are also some good ideas for High School Science Experiments that were suggested by Tom Kehoe. You can find his ideas at http://www.mnsu.edu/~stutter/kids/scienceexperiments.html Good luck with your interesting project! Judy Kuster Distractions From: Peter Louw, Cape Town, South Africa Date: 10/8/99 Time: 10:15:11 AM Remote Name: 18.104.22.168 Comments Dear Panel As a PWS I have on many occasions used light, inconspicuous distractions, such as a slight movement of the head etc., being well aware that these should not be allowed to get out of control so as to become a problem in itself. Charles Van Riper also mentions distractions as a real factor in stuttering. Naturally distractions should not be used as real therapy, as they are obviously of limited value and have negative potential. However I have recently read articles suggesting that distractions are no longer recognised as a scientific fact in stuttering. I would be most obliged if you could give me the current view on distractions in stuttering. If distractions are no longer recognised as an entity, what have I been doing all these years? Thanking you in anticipation and kind regards. Re: Distractions From: Joe Kalinowski Date: 10/8/99 Time: 1:01:17 PM Remote Name: 22.214.171.124 Comments Arm movement, head jerk, facial contortions etc. are a group of self-initiated motoric behaviors which PWS use to release themselves, in a partially successful manner, from a stuttering moment. The argument in not whether PWS initiate these behaviors in anticipation and/or in reaction to stuttering-- to that there is no debate. PWS usually perform a series of ancillary behaviors to release themselves from a block (stuttering moment). However, the refutation of distraction hypothesis by Stuart (1999) as a testable phenomena is not a refutation of the behaviors exist-- but in the "intuitive construct" espoused by "founders of stuttering modern stuttering therapy". These constructs were shaped by how they viewed stuttering and their notions of "communicative responsibility". This "communicative responsibility" was alleviated via head, neck, leg, and arm movement (How? We do not Know!!)-- Dr. Stuart and I challenge the notion of " communicative responsibility" in much further in the next issue of JSHLR. Stuart (1999) did not dismiss the behaviors of leg movement, arm movement., and so forth. He dismissed the attribution to the construct of "distraction". That is, the distraction construct suggests that the purpose of the behaviors is to pull attention away from a locus of attention. He challenged this notion's testability in a scientific realm. My colleague speaks for himself,--but I believe that the gestures of the arm, leg, neck, etc are an attempt to jump start a system in oscillation- Not to "DISTARCT". This is similar to banging on an engine that is "riding rough". The behaviors are not to distract but more likely to create sensory-motor input to the CNS which will break the oscillatory cycle. We use it as a preventative measure after learning that it works. However, it is a poor tool and as it has not fixed of the locus of the problem. Sort of like banging on the set of a TV or a rough riding engine" .. The whack helps for awhile, but then the initial problem worsens.. I'll let Dr. Stuart speak for himself� Stuart, A. (1999). The distraction hypothesis and the practice of pseudoscience: A reply to Bloodstein (1998). Journal of Speech, Language, and Hearing Research, 42, 913-914. Re: Distractions--Please Ignore My prior reply-computer messed up From: Joe Kalinowski Date: 10/8/99 Time: 1:13:21 PM Remote Name: 126.96.36.199 Comments Arm movement, head jerk, facial contortions etc. are a group of self-initiated motoric behaviors which PWS use to release themselves, in a partially effective manner, from a stuttering moment. The argument in not whether PWS initiate these behaviors in anticipation and/or in reaction to stuttering-- to that there is no debate. PWS usually perform a series of ancillary behaviors to release themselves from a block (stuttering moment). However, the refutation of the Distraction Hypothesis by Stuart (1999) is not a refutation that the behaviors exist-- but a refutation of the "intuitive construct" of distraction espoused by "founders of modern stuttering therapy". These constructs (distraction, stuttering lies in the ear of the listener �etc.) were shaped by how the founders of modern stuttering therapy viewed stuttering and their notions of "communicative responsibility". This "communicative responsibility" was somehow alleviated via head, neck, leg, and arm movement (How? We do not Know!!)-- Dr. Stuart and I challenge the notion of " communicative responsibility" in further in the next issue of JSHLR. Stuart (1999) did not dismiss the behaviors of leg movement, arm movement., and so forth. He dismissed the attribution to the construct of "distraction". That is, the distraction construct suggests that the purpose of the behaviors is to pull attention away from a locus of attention. He challenged this notion's testability in a scientific realm. My colleague speaks for himself,--but I believe that the gestures of the arm, leg, neck, etc are an attempt to jump start a system in oscillation- Not to "DISTARCT". This is similar to banging on an engine that is "riding rough". The behaviors are not to distract but more likely to create sensory-motor input to the CNS which will break the oscillatory cycle. We use it as a preventative measure after learning that it works. However, it is a poor tool. It is a poor tool because it has not fixed of the locus of the problem. Sort of like banging on the set of a TV or a rough riding engine" .. The whack helps for awhile, but then the initial problem worsens and the whack no longer helps.. I'll let Dr. Stuart speak for himself� Re: Distractions--Please Ignore My prior reply-computer messe... From: Peter Louw Date: 10/14/99 Time: 7:42:18 AM Remote Name: 188.8.131.52 Comments Hi Joe Thank you for your response which I found very interesting. Just one further question: should the definition of "distractions" not be broader than just encompassing actions such as gestures, blinking etc.? Shouldn't we also include things such as stress? Also stress due to illness, exhaustion etc.? I can remember that Van Riper (was it in The Nature of Stuttering?) mentioned the case of a member of a submarine crew. He was a PWS, and one day an emergency arose in the submarine while deep below sea level. Despite being under severe pressure, this guy managed to utter a series of emergency commands 100% fluently, and they all survived. In retrospect he ascribed his fluency at the time to distraction. He said that he completely forgot about stuttering at the time due to the intense stress. This seems to me to be a case of distraction due to stress, and being a PWS myself I can relate to this - I have also found that stress, which usually aggravates my speech, can occasionally help my speech. My experience of distractions is that about anything can act as a distraction. For me, it can be the stuttering itself, or an unobtrusive blink, or the application of a fluent-speech technique - but also exhaustion, illness etc. When I speak very fast, it can also act as a distraction for me. Whilst travelling abroad I can be 100% fluent due to the unfamiliar surroundings, though after a while the effect wears off. Surely this, too, amounts to distraction? PS Though the guy in the submarine survived, his hair turned grey that day ... Laughing At Ourselves From: Ira Zimmerman Date: 10/9/99 Time: 12:07:22 PM Remote Name: 184.108.40.206 Comments There is a big difference between laughed at or laughing at ourselves because of stuttering situations we find ourselves in. I think that it is healthy to tell funny stories about stuttering situations I find myself in. Not only do I feel better about myself but I believe it puts the listener at ease. I had one incident that I first found frustrating but I later saw the humor in it. I'm an American Online (AOL) subscriber. When you connect to AOL, the first thing you get is a verbal "Welcome" greeting. For months, I had intermittent problem of not getting beyond a stuttering "WelWelWelWelWelWel..." greeting. It would go on forever. To get out it, I would have to power down my computer and reboot. It usually worked fine the second time around. I must admit that I was too embarrassed to call AOL about it because I thought they would think this was a prank, that is, a stutterer having a stuttering computer problem. When I finally did contact AOL when the problem was occurring repeatedly, they didn't take me too seriously. I then contacted an on the air Los Angeles TV station computer guy who calls himself "cyberguy." He first thought I was crazy or this was some kind of publicity stunt. Although he immediately saw the humor in situation as did I. But I had videotaped the stuttering computer glitch to prove that I wasn't lying. He called a top Executive at AOL and with their help we solved the problem. Last Thursday, the LA TV station sent a video crew to my home to interview me for a news broadcast next week in a segment that I'm sure will be funny to many, including myself. Is this a healthy attitude or am I just in denial about the seriousness of my stuttering? Didn't Dr. Manning do some research on humor being a measure of one's attitude toward their stuttering? Re: Laughing At Ourselves From: Walt Manning Date: 10/10/99 Time: 5:19:35 PM Remote Name: 220.127.116.11 Comments Ira- I haven't done any research on the topic but I have pulled together some research and suggestions from health-related fields about the value of humor as a variable in the process of change. The literature indicates that as one is less overwhellmed and helpless about a situation or condition, begins to get some distance from the problem, and starts to shift their conceptual view of what is going on, there is the opportunity to see humor in the situation. Clearly, much of stuttering is far from humorous, but I think that you are correct in suggesting that a humorous interpretation of events can signal change and progress both in and out of formal treatment. I have seen many clients share wonderfully humorous stories as they get some distance and begin to see their situation from a greater distance. It would be great to document this aspect of change during treatment. Re: Laughing At Ourselves From: Benedikt Benediktsson Date: 10/11/99 Time: 5:35:42 AM Remote Name: 18.104.22.168 Comments Ira I think it is healthy to be able to laugh at yourself, even if it is because of the stuttering. Life is wonderful and why not see the positive aspects of everything. 12 years ago I started therapy for my stuttering. The psycologist I went to, who was supposed to have some knowledge of stuttering, told me after two sessions that he couldn't help me. My attitude towards the stuttering was so positive and I could see the humour in it, but he expected to see a depressed stutterer. Re: Laughing At Ourselves From: Gina Waggott Date: 10/20/99 Time: 10:46:19 AM Remote Name: 22.214.171.124 Comments Hey Ira Great story... as a matter of fact, AOL used to do that to me, but it stopped by itself... I'm kinda glad that I'm not the paranoid type ("My God! Even the computers are out to get me!" ;-) I find that bringing humour (or humor, as you USA people spell it) into a situation with strangers always helps. When people see you are not so "hung up" on your stuttering, and are comfortable and informal through joking about it - it makes people relax more. At least, that's what I've learned from experience. I've devised a bunch of "sayings" and bad pick-up lines with reference to stuttering... but I'm going to make you read my paper to see what they are! :-) Best, -Gina What does the research say regarding family environment and stuttering? From: Regine Neiders Date: 10/9/99 Time: 12:09:04 PM Remote Name: 126.96.36.199 Comments I am interested how family environment i.e. divorce, single parent family, counseling for other concerns (i.e. trauma of divorce), parental overload, etc. are shown to interact or not with stuttering? for children ages 3 - 9? Re: What does the research say regarding family environment and s... From: Nan Ratner Date: 10/9/99 Time: 1:05:05 PM Remote Name: 188.8.131.52 Comments Many families try to find an explanation for a child's stuttering in the environment. A stressful environment can make it difficult to families to deal constructively with ANY childhood disorder (that is, respond most effectively to it), and stress can negatively affect MANY childhood conditions and exacerbate symptoms, including asthma and allergies. Stuttering would not be unique in these respects. However, there is no evidence to suggest that specific factors in the family environment CAUSE stuttering. best regards, Nan Re: What does the research say regarding family environment a... From: Woody Starkweather Date: 10/18/99 Time: 5:22:21 PM Remote Name: 184.108.40.206 Comments Although there is little research in this area, it would be a mistake to conclude that family issues do not influence children who are in the process of developing stuttering. Other aspects of childhood functioning are strongly influenced by such issues, and I think it would be the height of foolishness to assume, in the absence of evidence, that stuttering is somehow an exception. In my own experience, the family issues can have a potent effect on the course of treatment for stuttering, particularly when the issues center around stuttering itself. One of our early failures in the stuttering pre- vention center was with a child whose parents were divorcing. Unfortunately, they each blamed the other for causing the stuttering. Try as we did to dissuade them from this destructive course, they persisted and the child did not recover. I met him later and, still stuttering, he was con- vinced that his father had caused him to do so. Woody about family environment and stuttering ... From: Ren� Stes - Belgium - ren�.email@example.com Date: 10/20/99 Time: 8:44:02 AM Remote Name: 220.127.116.11 Comments Hi Nan, Woody, Ken... thanks for your wonderfull job for international stuttering awareness day!! About ... environmental influence / research - stuttering ... some comments. A range of factors will make the stuttering persist (research evidence), even after recovery of other causal factors (f.e. after recovery of possible cortical malfunctioning or after elimination of stress factors...). There is evidence that negative emotional, cognitive and behavioral reactions on stuttering can and do contribute to chronic stuttering problems. These emotional and cognitive reactions are both the consequence of personal experience and from the environment (modeling, abstract modelin - in verbal labels, even instructions, "vicarious learning"!). Stuttering children learn models on how to treat and manipulate problem-behaviors. Parents and other persons in the environment play an important role in this process. In my opinion it's unlikely that interventions of a speech therapist/pathologist - stuttering therapist ... psychologist .... and other -ists ... can have any impact on a very important human behavior - speech, speech disorders and speech problems ... and those of the environment not! Therefore, one should - at least with young children - always work with children and/or via their parents. Our clininal experience in Antwerp and from mayn other therapists, shows moreover that parents can have a very significant and a real positive influence on the speech problem! Ren� Stes Re: about family environment and stuttering ... From: Nan Ratner Date: 10/20/99 Time: 9:16:45 AM Remote Name: 18.104.22.168 Comments Thanks! I agree with you strongly. We always try to look at each family to detect those things that seem to make a difference. Often parents are good problem solvers with us. If we ask them, when is your young child's stuttering worse? we often identify situations, behaviors, circumstances that we can then adjust to make the situation better. My work is not meant to suggest that parents do not play a role in stuttering: I believe that they do. However, I become uncomfortable with blanket advisements for which we have no real evidence, either through systematic studies or even series of carefully done case discussions. So, I do agree with you: as Ed Conture and Trish Zebrowski said a while back, it makes no sense to consider stuttering amenable to the intervention of speech language pathologists, but not parents. Best regards, Nan Re: about family environment and stuttering ... From: Ken St. Louis Date: 10/20/99 Time: 12:41:09 PM Remote Name: 22.214.171.124 Comments Hi Rene, Thanks for the kind words. This has been fun. I agree with you and Nan. Parents are extremely important in the process of treating children, if they are available and able to help out. Ken Questions concerning Basal Ganglia's possible role in stuttering From: Stefanie Thibodaux Prothro (graduate student) Date: 10/10/99 Time: 10:32:32 AM Remote Name: 126.96.36.199 Comments Questions for Online Conference Stefanie Thibodaux Prothro Southern University-Baton Rouge 1. If the basal ganglia is involved in stuttering, are there any specific treatment options to remediate stuttering? 2. Would surgery or medication be involved in the remediation of stuttering? 3. Is there a specific difference between an adult male/female or child male/female if the basal ganglion is the cause of the stuttering? 4. Is there a specific cultural difference among the various ethnic groups? 5. What types of treatment or therapy options are available to a school based speech language pathologist? 6. Is there any specific intervention strategies, in your opinion, that would benefit a classroom teacher who has a student who stutters? 7. What are some future topics for research? 8. Is cerebral dominance the cause for language based stuttering? Why or why not? 9. If language based stuttering is influenced by the cerebral dominance theory would treatments differ? For Stefanie From: Judy Kuster Date: 10/10/99 Time: 12:41:43 PM Remote Name: 188.8.131.52 Comments Stefanie, Thank you for your participation and interest in the online conference. I am going to leave your questions here, but would suggest that you choose one of your questions about basal ganglia involvement and post it for Larry Molt after you have read his paper below. If any of the professors keeping "office hours" for this conference wishes to answer that question or any of the others, they of course are welcome to do that. But nine questions in one post gets a little overwhelming and confusing in a conference like this. I hope you understand. Judy Re: Questions concerning Basal Ganglia's possible (response to questions 1-4) role in stuttering From: Larry Molt Date: 10/13/99 Time: 9:15:58 AM Remote Name: 184.108.40.206 Comments Hi Stephanie! First, never apologize for asking questions � that�s part of the purpose of a conference like this, and its what we need � the next generation of SLPs continuing to question and explore. I�ll tackle the first few of your questions with this posting, and reply to the remainder in a few more postings. 1. If the basal ganglia is involved in stuttering, are there any specific treatment options to remediate stuttering? It certainly opens up a number of options that might not be considered in traditional SLP therapeutic approaches. This includes viewing stuttering from a different paradigm and changing therapeutic emphasis, or such things as the use of neuropharmaceutical adjuncts to therapy/management 2. Would surgery or medication be involved in the remediation of stuttering? I certainly don�t see surgery as an option; the majority of basal gangliar disorders are not dealt with surgically, and there have been few successes with the surgical attempts. There has been some limited speculation about surgery in light of the transcranial magnetic stimulation research on PWS currently being carried out by Drs. Peter Fox, Roger Ingham, and Janice Costello Ingham. This technique can be used to temporarily disrupt neural activity within specific regions of the brain, and the researchers are investigating its effects on several regions identified in previous PET studies as showing aberrant function in (some) PWS. The outcome of their research may have many different implications for treatment, and surgery has been hypothesized as one (i. e., if electromagnetically "knocking out" a certain area results in normal fluency with no other observable negative side effects, then surgical ablation of that area might be considered an option). Personally I have doubts that will be the outcome � the majority of attempts to deal with neurological dysfunction seem to carry a price tag of unwanted side effects that is often too high to pay. Medication is currently being considered as an option, although its important to point out that no medication has yet to be found 100% effective for ameliorating stuttering, and all have noticeable side effects. I wrote an article for last year�s ISAD Conference on the use of neuropharmaceutical agents, and its still accessible via The Stuttering Home Page (ISAD98 Online Conference) � I�d encourage you to check it out if you�re interested in this area, and especially the writings of Dr. John Brady: Brady, J. P. (1991). The pharmacology of stuttering: A critical review. American Journal of Psychiatry, 148, 1309-1316. Brady, J. P. (1998). Drug-induced stuttering: A review of the literature. Journal of Clinical Psychopharmacology, 18, 50-54. 3. Is there a specific difference between an adult male/female or child male/female if the basal ganglion is the cause of the stuttering? I�m a little bit unsure of your question. There are differences in male-female ratio patterns for many of the basal gangliar disorders, and also evidence of differences in recovery rate between the sexes. Tourette syndrome is a good example of this, with a male-female ratio pattern that looks similar to that reported for stuttering. 4. Is there a specific cultural difference among the various ethnic groups? The research hasn�t held this out to be noticeably true in stuttering. One of the areas of research explored in attempts to support Wendall Johnson�s Diagnosogenic theory was that as attitudes to communication (and success/competition) varied among cultures, so would the prevalence of stuttering � yet the research results generally support a prevalence figure fairly close to 1% across all cultures. I�d encourage you to look at a copy of Oliver Bloodstein�s "Handbook of Stuttering" which should be available at your university library for a nice summary of the research in this area. If it turns out that some cases of stuttering are caused by basal ganglia involvement that is hereditary, it is possible that there would be ethnic differences (but there doesn�t have to be differences). For example, several years ago there was some speculation that sickle cell anemia, a hereditary disorder that is more prevalent in the African/African-American population might put children with it at slightly higher at risk for stuttering. Great questions, Stephanie! I�ll tackle the rest in my next posting. Warmest Regards, Larry Molt Re: Questions concerning Basal Ganglia's possible role in stuttering (reply to questions 5-9). From: Larry Molt Date: 10/14/99 Time: 9:14:00 AM Remote Name: 220.127.116.11 Comments 5. What types of treatment or therapy options are available to a school based speech language pathologist? I assume you�re referring to the possibility of a basal gangliar link, and what options that would leave the school-based SLP. First, if for some individuals medication might alleviate some of the symptoms, then the relationship between the SLP and the prescribing physician would be a vital one � with the SLP providing feedback to the physician to help with getting blood levels set correctly � reporting on symptoms � both how well the stuttering is being addressed as well as the presence of side effects � to achieve the best therapeutic dosage. But I would expect much more would be needed from the SLP. Currently, none of the dopaminergic drugs totally alleviate stuttering symptoms, and the SLP would be vital in dealing with the remaining symptoms. (as has been suggested by Dr. Gerry Maguire, at Univ. California-Irvine, in his research with risperidone). There�s a second point to be made, however, and that is that the presence of a BG link need not mean that the SLP may have to make many changes in the therapeutic approach. Many of the therapeutic techniques currently in use are ones that have positive effects on BG disorders. The psychological/counseling approaches aimed at alleviating fear would help to reduce triggering by the limbic/BG links; motor simplification techniques taught in fluency shaping approaches attack some of the neuromotor components. These techniques have shown great success in reducing stuttering symptoms in a large percentage of the population; they just haven�t been effective at removing all stuttering (possibly because of the underlying neural function abnormalities that still remain, at least in some PWS). 6. Is there any specific intervention strategies, in your opinion, that would benefit a classroom teacher who has a student who stutters? As I mentioned in the previous answer, what has worked well in the past still works well today, even if our etiological models may shift for some PWS. Techniques aimed at reducing fear towards stuttering and towards speaking situations, and techniques aimed at changing and simplifying speech production are still vital and useful strategies. 7. What are some future topics for research? Great question! It�s always fun to prognosticate. Continuing the research into genetic links is vitally important, for it should give us much greater insight into the disorder. Further brain imaging studies during speech production are also vital � we�ve learned so much already, and we�re just seeing the tip of the iceberg. Another key component is doing more research in very young children � examining what is going on as stuttering first starts to appear � we�ve got lots of great researchers examining this right now � Ehud Yarii, and Nan Ratner, and Scott Yaruss come immediately to mind but there are plenty more. This is particularly vital information. And we need much more research examining physiological and neurophysiological components in these young children � Tony Caruso has been emphasizing that for more than a decade. But there are other important research areas that need emphasis that don�t directly involve etiology. These include systematic investigation of therapeutic techniques and continuing the search for new and innovative techniques. Lots of people are attempting to apply new approaches to therapy � for example, Woody Starkweather and Janet Givens� use of gestalt approaches; and similarly, the use of REBT, talked about by Gardner Gately about a decade ago and now being pushed vociferously by Gunars Neiders; and even other cognitive psychotherapies. 8. Is cerebral dominance the cause for language based stuttering? Why or why not? Well, I�ve got to admit you�ve got me nervous in your choice of words, both with "cerebral dominance" " language based stuttering". I�m not comfortable with the latter � for it implies we are confident of the etiology, and I don�t think we are at all. I would agree that in some PWS language adeptness, or rather a degree of ineptness, plays a vital role � but is that the sole source of the stuttering? Lots of kids have much worse language disorders or delay - but they don�t stutter � what makes the difference? Its got to be more than just language. As to your use of the former term, cerebral dominance implies that it works the same way for everybody, and I don�t think that�s necessarily true at all. As a brain imaging researcher � I�ll tell you that language appears to be all over the brain, both in left and right hemispheres, subcortically, even cerebellar, with brainstem, and even corticospinal components. We can talk about a predominant hemisphere for language, where damage or disorders result in more easily seen symptomotology, but there are activities going on everywhere, and disorders anywhere have the potential for disrupting the exquisite temporal demands of such an incredibly complex system of systems that is language, and thus impairing fluency. The imaging research does demonstrate altered patterns of activation across myriad levels of neurological function in PWS when stuttering, some of which don�t exist when they speak under fluent conditions. I still feel we don�t have enough information to determine what is really important, and what�s not, in trying to make a determination about altered hemispheric dominance in PWS. 9. If language based stuttering is influenced by the cerebral dominance theory would treatments differ? Returning to my answer to question 8, above, I really don�t think we have enough information on what�s wrong or different in PWS, or what the "correct" pattern is, to think about changing treatment approaches. Thanks for your interest, Stephanie. Southern University is lucky to have a student with such a bright, inquisitive mind. Keep asking questions! Warmest Regards, Larry Molt Addendum to questions concerning Basal Ganglia involvement From: Stefanie Thibodaux Prothro (graduate student) Date: 10/10/99 Time: 5:28:11 PM Remote Name: 18.104.22.168 Comments Panel: I am terribly sorry, in my haste to post my questions I failed to introduce myself. My name is Stefanie Thibodaux Prothro and I am a second year graduate student in the Master's Degree Program at Southern University- Baton Rouge. I was intrigued by the article by Larry Molt, "The Basal Ganglia's Possible Role in Stuttering", from reading that article I was able to generate the list of questions that are in your possession. I work in the school system in Rayne Louisiana, I presently have three students (males) with a fluency disorder, from working with them I am concerned with treatment options and the possible causes of stuttering. Your input on the questions that I submitted would be greatly appreciated. I thank you in advance for taking the time and patience to read and answer my questions. Thank you, Stefanie Thibodaux Prothro stuttering in other forms? From: Salena Date: 10/10/99 Time: 12:54:40 PM Remote Name: 22.214.171.124 Comments I have heard of a few rare cases of people who stutter, stuttering while using sign language. Have any of you ever heard of or seen this? Why do you think this might happen? Re: stuttering in other forms? From: Ken St. Louis Date: 10/11/99 Time: 8:06:33 AM Remote Name: 126.96.36.199 Comments Dear Salena, Yes, it is fascinating to see "stuttering" in other behaviors besides oral speech. There are numerous cases in the literature (mostly anecdotal) of "stuttering" during sign language (as you indicate), but also speaking with esophageal speech (after laryngectomy), sending Morse code, playing the trumpet, signing one's name, reading silently, doing finger tapping patterns, and so on. I don't have a good explanation of the causes of these unusual "stutters." It would be easy to speculate that stuttering reflects a generalized motor or linguistic deficit that can appear in a variety of performances. The problem with such an explanation across the board is that, typically, stuttering does not occur in such behaviors. No doubt we will have lots of unexplained phenomena to explore about this disorder for a long time. Ken questions concerning stuttering From: Stefanie Thibodaux Prothro Date: 10/10/99 Time: 5:39:22 PM Remote Name: 188.8.131.52 Comments Dear Panel: I apologize for the list of questions that I presented. As a graduate student I am constantly searching for more answers. I am submitting just one question and I apologize for the inconveince it may have caused you. Thank you, Stefanie "Is there a specific difference between an adult male/female or child male/female if the basal ganglion is the cause of the stuttering?" FAF, DAF in "Real" Life Situations From: Mark Facer (Sydney, AU) Date: 10/11/99 Time: 3:14:01 AM Remote Name: 184.108.40.206 Comments Hello Again Professors! Has there been any research work done to study the effects of AAF devices in real life situations? Specifically: 1. What is their effectivness in reducing stuttering in life situations? 2. Comfort level - how do PWSs feel after hearing the feedback for an extended period? 3. Comfort level - how do PWSs feel about wearing the device? 4. Statistically, how do PWSs as a group sound while using AAF devices? Thanks in advance! Regards, Mark Facer Re: FAF, DAF in "Real" Life Situations From: firstname.lastname@example.org Date: 10/11/99 Time: 11:36:20 AM Remote Name: 220.127.116.11 Comments Hello, There is now a research at the unicersity of GHENT BELGIUM with 10 people who are using DAF (duration = 3 months) in life situations. Results are espected in june 2000. You can mail me for the results in september 2000. Best regards, Gert Stutterer and student slp Stuttering and stress From: Peter Louw Date: 10/11/99 Time: 9:05:03 AM Remote Name: 18.104.22.168 Comments Dear Panel Being a 49-year-old PWS who has been involved with self-help groups for PWS for many years, and who wrote a book on my experiences, I am fascinated by the important role of stress in stuttering. Time and again one hears the same story: stuttering is worse during times of university examinations, or when speaking to an authority figure, or when changing jobs / spouses, or when feeling "under pressure" etc. etc. I know that "stress" and "tension" are vague terms, but so be it. I also know that stress control / management is not the whole answer to stuttering, even though many people should benefit from it. It would seem that many (if not all) people who stutter have a stress or tension threshhold which, if exceeded, will result in stuttering. My question is: would you agree with the (admittedly wide and non-scientific) statement that, for most people who stutter, excessive stress or tension of one form or another probably accounts for more than 60% of their stuttering problems ? (Also having regard to the fact that much "stress / tension" has become fixed and habitual through conditioning.) My own view is that the whole issue of "stress" is not at all getting the formal and academic attention it deserves, to the detriment of therapy. Many thanks and kind regards. Re: Stuttering and stress From: Bob Quesal Date: 10/11/99 Time: 12:05:40 PM Remote Name: 22.214.171.124 Comments Hello Peter: You make some good points. I think you�ve hit on a couple of important points: First, terms like "stress" and "tension" are vague. They may be difficult to operationalize and therefore study in a systematic way. The other issue is that much of what we �know� about these factors comes from anecdotal evidence. I don�t know where your �60%� figure comes from, but my take on things is this: in at least some stutterers, the motor system is more prone to interference from �stress,� and when �stress� is introduced, the system is more likely to break down. In many cases, when we analyze our �bad days,� we find that there are nonspeech �stressors� at work--a test, an interview, a bill that is due, an upcoming trip, etc. These factors may be sufficient to interfere with the operation of our motor systems, and therefore we are more likely to stutter. I like to ask my clients to do an �inventory� when their speech is not going well. Frequently, they are able to identify a variety of (nonspeech) things going on in their life which *could* contribute to fluency breakdown. One of the skills to learn is to be able to �perform� in the face of heightened �stress� or �emotional arousal.� I hope this helps to address your question. Bob Q. Re: Stuttering and stress From: Ken St. Louis Date: 10/11/99 Time: 4:18:55 PM Remote Name: 126.96.36.199 Comments Dear Peter, You bring up a pivotal point about stuttering, i.e., the role of "stress." I don't believe there is any question that stress plays a role in the occurrence of stuttering in most stuttering individuals. In fact, at least half of the nonstuttering population will admit to "stuttering" at least once in their lives (meaning that they knew what they wanted to say but momentarily could not get the word(s) out), and this typically occurs in stressful situations. The problem comes when we try to ascribe causation. Those who stutter don't always stutter in stressful situations and sometimes stutter in very unstressful situations. (But perhaps that's why you speculated that stress is related to about 60% of the problem). I would hypothesize that there is a minority of those who stutter who have over-reactive autonomic nervous systems. That is, they simply react to stimuli with physiological reactions that would be more vigorous than normal. My prediction would be that such individuals would almost always stutter more in stressful situations. But I have seen a few individuals for whom stuttering is not the least bit stressful and for whom external stress makes very little apparent difference. When it comes to determining the form of therapy, the so-called "experts" disagree on whether or not desensitization to stress is necessary. Some believe that reducing stuttering is sufficient to reduce any attendant stress. Others, e.g., Van Riper and his followers, believe that desensitization is necessary in order for stutterers to maintain control or attention to fluency targets in difficult speaking situations. I have begun to use desensitization activities more and more in the past few years and have been more successful. Ken Re: Stuttering and stress From: Steve Hood Date: 10/11/99 Time: 8:42:44 PM Remote Name: 188.8.131.52 Comments Hi, Peter -- You have raised an interesting issue, and I think Bob Quesal and Ken St. Louis have hit some important issues -- and I agree with Bob and Ken. For whatever reason (and I think and for many PWS's the original, etiologic factor(s) may have been "organic" in some type of neurobiologic way) by the time stuttering has developed into a more advanced and severe form, things have changed. It is not a question of Nature **VERSUS** Nurture, but rather, it is a question of both Nature **AND** Nurture. To me, stress and increases in stuttering are corrlated, but correlation does not show cause-effect. Correlation means that two things are related to others. In the case of authority figures, exams, giving a presentation at work -- we have examples of negative stress. There are also examples of positive stress: being excited while telling someone about a positive experience, telling the puchline of a funny joke, gong off on a family vacation, upcoming holidays, birth of a child, etc. So -- we have both positive and negative stress. It seems reasonable that the PWS is for some reasons (some unkown combination of possible some organic PREDISPOSITIONAL plus learned emotional factors) make the PWS more susceptible and vulnerable to breakdown: e.g., the motor break-downs that have been discussed earlier. As for the 60% figure..... I dunno. I suspect it is a high persent, but would be on thin ice to speculate. Good question, Peter. I hope others will offer their opinions. Steve Hood Re: Stuttering and stress From: Peter Louw Date: 10/13/99 Time: 3:27:08 AM Remote Name: 184.108.40.206 Comments Dear Ken Many thanks for your valuable comments and those of the other panel members. May I make the following comment regarding those PWS who stutter even in seemingly relaxed circumstances, i.e. where there are no obvious external stressors: I suspect that, here too, there is a stress link, but that in these cases the tension / stress comes from inside. I feel that these people, or at least some of them, suffer from what has been called "word stress" (or sound stress). It is "internal stress" rather than "external stress". The mere fact of these people speaking results in some stress, and the resultant stuttering. PWS who stutter even when alone also suffer from word stress, according to this model. Word stress is mainly learned. The subconscious "remembers" all the previous stuttering of the past, and when you want to say the difficult word, the past "pops" out of your subconscious and you stutter. In other cases the physical act of speaking may also create some muscle tension, resulting in stuttering. Again in other cases there may be internal stress which is not obvious to an outsider, or even to the PWS himself. Stress experts say that many people are in fact not aware of their own stress levels, even though this may have an effect on the PWS. In all of these cases the stress factor is present. I am not saying that stress causes stuttering; but I do suspect that stress / tension has an effect on some or other part of the PWS's physical apparatus. What that "some or other part" is - well, that's the big question, but it seems that, in the PWS, that part is extremely sensitive to any kind of tension / stress. Stuttering, according to this model, can only be understood when one understands stress in all its manifestations. Kind regards. Re: Stuttering and stress From: Ken St. Louis Date: 10/13/99 Time: 8:09:56 AM Remote Name: 220.127.116.11 Comments Hi again Peter, Your thesis that stress plays a role in stuttering even when the speaker is unaware of it is very similar to some of Bloodstein's writing about expectancy. He, as you no doubt know, postulates that stuttering is an anticipatory avoidance reaction which could be triggered by anything that makes the person believe that speech is difficult. This was a more generic version compared to Wendell Johnson's view of stuttering as reaction to others' reactions to essentially normal disfluency. In any case, when the research on anticipation (or expectancy) did not show that stutterers could identify every single stutter in advance (i.e., anticipate them), Bloodstein hypothesized that expectancy (which could almost be viewed as latent anxiety) occurred at a "low level of consciousness." You are in good company with your position. Personally, I would rather not invoke something that cannot be measured or perceived to explain such stutterings. I believe that, with a compromised mechanism, stuttering is simply the natural result of trying to talk. Here's an oblique example: I have intermittently tried for years to speak at my usual rate under delayed auditory feedback in a class demonstration, but I simply cannot ignore the delay. My speech is VERY, VERY FRACTURED AND REPETITIVE. I repeat syllables anywhere in the word, even while enjoying the experience. I do stutter from time to time. But this does not in the least feel like real stuttering to me. OK. This is not real stuttering, but the point is that the disruption the DAF causes me simply results in repetitions, hesitations, retrials, etc. Why is it such a large jump to assume that the same sort of thing could be happening with some stutters in most stutterers or with most or all stutters in a very few stutterers? I don't expect we'll agree, but the debate is fun. Ken Re: Stuttering and stress From: Woody Date: 10/18/99 Time: 5:30:45 PM Remote Name: 18.104.22.168 Comments Of course there are many ways to measure stress and no clear agreement on what way is best A study done in the Netherlands a few years ago, and I don't remember exactly who the authors were, but it was done by Herman Peters' group, found that stutterers were no more anxious before speaking than nonstutterers were, but that AFTER speaking the stutterers were more anxious. I don't remember how they measured anxiety in this study, but assuming it was one of the traditional measures, and that the experiment was carried out with the same care that Herman's group always uses, it shows pretty clearly that we assume too much when we assume that the anxiety that is known to be associated with stuttering is causal. Woody Does technique matter? From: Joe Kalinowski Date: 10/11/99 Time: 1:34:27 PM Remote Name: 22.214.171.124 Comments When I was getting my master's in speech pathology back in 1982-85, I was instructed in Johnsonian techniques of parent counseling, reducing speech demands--never mentioning the word "stuttering" . A good number of patients "recovered" from stuttering with this method --and I was taught this to be true and fair. Now I am much older and getting back to notions about therapy and the pendulum has swung the other way. Now children who stutter get much better BUT with direct intervention and modification of "stuttering' Not only that, but the term "stuttering" is used freely. If the end result is the same, how can I attribute the results to diametrically opposed therapies? Or does technique matter? Help Re: Does technique matter? From: Walt Manning Date: 10/11/99 Time: 2:24:31 PM Remote Name: 126.96.36.199 Comments Hi Joe- It is technique you are talking about or overall treatment strategy? If a clinician is going to use a technique it's probably best to do it correctly. On the other hand, some variation (intentional or not) of a techique may well work pretty well in many cases. While techniques are important, other things are probably more important- the timing of the techniques, the enthusiasm of the clinician, the motivation of the client, the understanding of the technique. Specific techniques associated with an overall treatment stragegy and the choice of the strategy probably matters also. It's OK, I think, that many strategies and techniques appear to "work" to lessen the handicap of stuttering and to decrease the frequency of stuttering. I do think it's silly to spend a lot of time and research effort trying to find which stragegy/technique "works" best (whatever thay may mean). That type of "race horse" research was done several years ago in psychology. The results indicated that some approaches won some of the time and other approaches at another time. It's easy to get into discussions about which approach is the "correct" one but I think that is missing the point. We (the client & clinician)often need to experiment for a while to see what will be the best thing to do at a given time. Fortunatly, lots of things often help. Re: Does technique matter? From: email@example.com Date: 10/11/99 Time: 4:34:59 PM Remote Name: 188.8.131.52 Comments Hello Dr. Kalinowskij, I have to write down this story that happened this evening. One client of the research DAF group has phoned me today with the following message: '' FOR THE FIRST TIME IN MY LIFE I HAVE GIVING AWAY AN INTERVIEW IN A NEWSPAPER'' Nobody has asked him to do this, now not only his stammering has changed with the device but also his way of thinking and his way of self-esteem!!! (5 weeks ago... he was an introvert person and also very ashamed about his stuttering... So why are we waiting for to make a device that has DAF/FAF/MAF and even LAF MODE and is so small as a hearing aid????????????????????????? Why we have to wait for technical aid if other handicaps have there own devices. Schindlers list in mind... we cann't save a whole nation but we can save/help a single unique person who has also the rights to become free of his handicap. Best regards, Gert Re: Does technique matter? From: Steve Hood Date: 10/11/99 Time: 8:59:17 PM Remote Name: 184.108.40.206 Comments Hi Joe -- The old Johnson notion, following his diagnosogenic theory, seemed to be telling the parent: don't lable it, don't call it anything, don't react to it, and it will go away. This was pretty simplistic, I think. Many kinds had more than just the "normal nonfluencies" that Johnson referred to (or fluency failures if you follow Brutten and Shoemaker, or discontinuities if you follow Starkweather.) These kids had enough stuttering to be concerned about in terms of frequency, effort, duration, and degree of fragmentation (sound syllable reps, prolongations, hard contacts/tense pauses, etc.) We know each other, so I can say this: I did my master's work a few years prior to the time you did. When I was a master's student, the idea was that therapy should be "indirect." -- e.g., do NOT work directly with the child, but work with parent counseling. In our clinic, we do work directly with the child, and with the parent(s) and sometimes siblings when possible. We work directly on talking: easy talking, "turtle talking." We work on the pragmatics of speaker-listener interactions: e.g., turn-taking, pausing between speaking. We add some increased prosody to our speech (intonation, pitch, melody, inflection.) We work to reduce stresses such as being interrupted, contradicted, put on verbal displan, given verbal demands. We work to reduce verbal competition among family members: both the children in the family, and the adults. I really cannot answer your question in terms of how this relates to techniques, or the old Johnson notions. I do suspect that the "techniques" may have some things in common, even though the way clinicians go about them may be diffent. Johnson died in about 1965. Maybe we have learned some things in the past 34 years. Maybe if we have not learned "new things" maybe we have learned to do the "old things" in newer and hopefully better ways. NOTE: My response to your very good question is geared to Kids in the beginning stages of developmental stuttering. i am not referring at all to techniques that might be applicable to more confirmed/chronic/severe cases of stuttering. Thanks, Joe -- thanks for your question. Steve Hood Re: Does technique matter? From: Bob Quesal Date: 10/12/99 Time: 8:15:56 AM Remote Name: 220.127.116.11 Comments With all due respect to my friend and colleague Steve Hood, and as (apparently) the only living "Wendell Johnson apologist" (even though I'm really not all that old), I think that Steve has continued to present the simplified and distorted picture of Johnson's views. If one reads Johnson's "Open Letter to the Mother of a Stuttering Child," it is clear (at least to me) that the things we are doing today with children who stutter are *very similar* to the things that Johnson suggested in that letter. Not that Johnson had it all right, but as Steve points out, 34 years of research has a way of changing one's view of ideas from 30, 40 or even 50 years ago. As far as "techniques" are concerned, I agree with Walt Manning. One could use a very "Johnsonian" approach with parents (don't label it, don't make a big deal about it, etc.) and get a good outcome. Similarly, one could be more direct, both with the parents and the child, and get a good outcome. Conversely, if we intervene and don't know what we're doing, or if parents and clients react negatively to our information or clinical style, we may get a bad outcome, regardless of the approach we use. (Shameless plug: Have a look at my essay, "One Size Fits All" which is posted on this online conference.) Anecdotally, we always hear people say "I used to stutter and I grew out of it." The extent to which those folks truly "stuttered" is subject to question. The point is, there are a lot of variables that we are dealing with when it comes to treating stuttering. Our outcomes, as Walt pointed out, are based on a lot more than just the "technique" we choose. Interesting question, Joe. Hope this addressed it at least to some extent. Bob Q. Re: Does technique matter? From: JSYaruss Date: 10/12/99 Time: 9:49:26 AM Remote Name: 18.104.22.168 Comments interesting dialogue...I hate to bring up, but kind of have to...that at least some of these kids would have been likely to recover anyway. I don't know how many...that's another thread...BUT, the fact that even some get better on their own, regardless of what we do, makes it difficult to know what is the technique and what isn't. Plus, it's also likely that different types of intervention can lead to the same outcome. It may be that the two intervention approaches would work for everybody equally well, or that one would work better or some than for others. We just don't know that yet...but it's an interesting and important question to ponder. Thanks Joe! Scott Re: Does technique matter? From: JSYaruss Date: 10/12/99 Time: 9:49:29 AM Remote Name: 22.214.171.124 Comments interesting dialogue...I hate to bring up, but kind of have to...that at least some of these kids would have been likely to recover anyway. I don't know how many...that's another thread...BUT, the fact that even some get better on their own, regardless of what we do, makes it difficult to know what is the technique and what isn't. Plus, it's also likely that different types of intervention can lead to the same outcome. It may be that the two intervention approaches would work for everybody equally well, or that one would work better or some than for others. We just don't know that yet...but it's an interesting and important question to ponder. Thanks Joe! Scott Re: Does technique matter? From: Woody Date: 10/18/99 Time: 5:37:55 PM Remote Name: 126.96.36.199 Comments What Scott, and the others, say is true enough, but that doesn't mean that technique doesn't matter. When parents refuse to talk to their child about stuttering, it naturally creates the impression that stuttering is something that can't be talked about. Surely this contributes to or causes outright a sense of shame in the child. Johnson may have had some things right, but in my opinion he was very wrong on this one. I understand that the parents mean well when they do this, but it still hurts the child. Woody Re: Does technique matter? From: Bob Quesal Date: 10/19/99 Time: 9:07:23 AM Remote Name: 188.8.131.52 Comments Allow me to quote from Johnson's "Open Letter to the Mother of a Stuttering Child": "2. Do nothing at any time, by word or deed or posture or facial expression, that would serve to call Fred's attention to the interruptions in his speech. Above all, do nothing that would make him regard them as abnormal or unacceptable. If he has begun to notice his own hesitatings help him to feel that they are understandable under the circumstances and so, of course, acceptable. In doing this, however, do not make the mistake of "protesting too much." You can make Fred self-conscious about his speech even by praising it�if you praise it to excess. Err, if you must, on the side of approving it a bit more than is justified. "I am not suggesting that you 'pay no attention to Fred's stuttering.' You may often be given advice in these exact words. The people who give it to you have good intentions. Meanwhile, the wording of the advice is not quite right, in my judgment. Here is what I mean: If Fred repeats and hesitates (speaks disfluently) in the ways that are more or less ordinary for his age and for the sorts of situations in which he is talking, he is simply not doing anything that might usefully be called by such a grave-sounding name as 'stuttering' in the first place. He is just speaking normally, and normal speech is more or less disfluent. If he is more hesitant in speech than most children are, and especially if he hesitates with strain or tension, look about him, and at yourself, and try to find out the reasons. Then do what you can to remove them. Don't 'pay no attention' to the unusual reactions Fred is making to the unusual things in his surroundings that need to be changed." [Lots deleted] "Unless the speech problem that you and Fred are in together is in some way exceptional, or has developed into a truly serious form, these suggestions should prove helpful. You will not, I am sure, expect more from the printed page than would be reasonable and you will remember that Fred is only human. His speech-or yours or mine�will never be as fluent as a faucet. All children hesitate and repeat and stumble more or less in speaking�and so do all adults. Even the most silver-tongued orator makes an occasional bobble. But if within six months or so you feel, for any reason, that Fred is not talking as smoothly and easily as he should, I hope you will consult a speech clinician�preferably, of course, one who is certified by the American Speech and Hearing Association [sic]." I think the "Open Letter" should be required reading for folks who try to "say what Johnson said." Most of the advice in the "Open Letter" is what many of us do today with early childhood stuttering. Johnson's advice, as I read it, applies to children who are disfluent, but who are not clearly "stuttering." It's almost exactly what we do today. (I have a copy of the "Open Letter," but I am not sure if it is still copyrighted or if it is in the public domain. I contacted the publisher, but have not heard back from them.) Once again, I feel like the sole Wendell Johnson apologist on the planet. But I feel that a careful reading of the "Open Letter" gives a much more complete sense of what Johnson was talking about than to say "he told parents not to talk about it" or "he told parents to ignore it and it would go away." FWIW Bob Q. Stutterer being a SLP???????????????? From: firstname.lastname@example.org Date: 10/12/99 Time: 1:01:50 PM Remote Name: 184.108.40.206 Comments Hello, Can a stutterer be an effective SLP? Re: Stutterer being a SLP???????????????? From: Bob Quesal Date: 10/12/99 Time: 2:38:25 PM Remote Name: 220.127.116.11 Comments Well, I'm a stutterer and I'm an SLP. I'll leave it to others to determine "effective." ;-)>> I know lots of SLPs who stutter. Some of my best students have been stutterers. Some of the best clinicians I know stutter. Some of my best friends are stutterers and SLPs. (Some fit in only one category, some fit in both.) Oh, and by the way, some of the worst SLPs I have known have been nonstutterers. Re: Stutterer being a SLP???????????????? From: email@example.com Date: 10/12/99 Time: 4:10:23 PM Remote Name: 18.104.22.168 Comments Hello BoB, Thank you for the support. I am also a slp student (last year university Ghent-BELGIUM). Here in Belgium many slp's find it real bad that a stutterer becomes a slp. If a succeed in june 2000 I am the first slp (university degree) who will succeed. Some schools will not allowed a stutterer to become a slp...can we do anything about it, to make this stupid thought dissapear? Thanks, gert Re: Stutterer being a SLP???????????????? From: Steve Hood Date: 10/12/99 Time: 5:02:38 PM Remote Name: 22.214.171.124 Comments Gert Good luck in your quest to be an SLP who is a PWS. In the United States, there are some university programs that encourage and support PWS's who which to become SLP's. Unfortunately, there are other univertity programs that openly frown on this, and make life pretty miserable for the student. The Stuttering Foundation of America has published a book entitled: ADVICE TO THOSE WHO STUTTER. Listed below is a partial list of contributors. ALL of these people are both SLP's and PWS's. Dorv Breitenfeldt, Hugo Gregory, Lois Nelson, Joseph Sheehan, Fred Murray, Peter Ramig, Dean Williams, Harold Luper, David Daly, Joe Agnello, Richard Boehmler, Bill Murphy, Larry Molt, Walter Manning, Rebert Quesal, Gary Rentschler, Kenneth St. Louis, Charles Van Riper. Above and beyond this list, there are dozens and dozens more. Some of the PWS's who are also SLP's (both listed above, and not listed above) will be contributing to the ISAD program. I hope they will respond to your question. Thanks for your question. Steve Hood Re: Stutterer being a SLP???????????????? From: Ken St. Louis Date: 10/13/99 Time: 8:22:24 AM Remote Name: 126.96.36.199 Comments Thanks, Steve, for providing the "Advice to Those Who Stutter" reference relative to stutterers becoming speech clinicians. I also agree with Bob's answer as well. I do think that it is incumbent on those of us who train SLPs and who also stutter to be open about it and to perhaps work a little harder to be as controlled or fluent as possible. (Reactions to this statement could keep me busy for the next week!) But, Gert, of course, stutterers should be able to become SLPs. Yet, Steve is correct. In spite of some laudible examples to the contrary, there are many in this country--and yours--that do not want the profession filled with those who are not examples of speaking excellence. These folks populate universities, school programs, hospitals, clinics, and our national officers. How short-sighted this view is! Where would we be without Charles Van Riper, Joseph Sheehan, Wendell Johnson, Einer Boberg, etc. etc.? I wish you well in your quest. Ken Re: Stutterer being a SLP???????????????? From: Darrell Dodge Date: 10/14/99 Time: 1:04:54 AM Remote Name: 188.8.131.52 Comments Hi Steve: Since you invited new (or almost new) stuttering SLP's to respond to Gert's comment here, I thought I'd add a "word or two." Gert, it might interest you to know that the entire field of speech pathology in the U.S. (and, hence, the world) was virtually started by PWS in the American midwest in the 1920's. Charles Van Riper (one of the founders) is not only known as a PWS therapist for stuttering, but was until just a few years ago considered the pre-eminent therapist in the world for articulation and phonological disorders as well. His work in that area is still taught in most grad schools. It is very sad and somewhat perplexing that you are not getting the support that many PSW get in U.S. graduate schools. Not only can PWS be effective and senstitive clinicians in the full range of communication disorders -- even including aural rehabilitation (speech reading) and aphasia therapy -- but we can also be very valuable members of a graduate school, providing examples of therapy in action and giving students an invaluable opportunity to learn first-hand about stuttering from people who are down in the trenches with them. My school -- the University of Colorado at Boulder -- almost always includes at least one or two people who stutter on the graduate class rolls. Of course, they must also meet the academic and entry requirements. I have received nothing but total support here and there was never a question that I could raise and discuss my doubts and fears with anyone on the faculty, just as any other student can. Regards, - Darrell Dodge Re: Stutterer being a SLP???????????????? From: Jerry Johnson Date: 10/14/99 Time: 9:22:26 AM Remote Name: 184.108.40.206 Comments Hi Gert: And why not? I would think however that the PWS should have his/her stuttering under pretty good control and be able to communicate very effectively. I do remember a statement attributed to Dr. Van Riper that given a choice he would prefer the fluent speaker but this was because he was afraid that the PWS would not be able to objectively treat other stutterers. Personally I have found this not to be the case. I have known many PWS and have found them, for the most part, to be very objective about their own stuttering. How many times have I heard from parents and others that they were glad to have a PWS treat them because they felt that PWS would know more (?) about the disorder and how to treat it and how it "feels" to be one. Good luck to you. Damn the torpedoes and full speed ahead. Topics? 6th world congress ISA BELGIUM 2001 From: Martine De Vloed Date: 10/12/99 Time: 4:16:34 PM Remote Name: 220.127.116.11 Comments Which topics are hot at the moment for the 6th worldcongress of ISA? Re: Topics? 6th worldcongress ISA BELGIUM 2001 From: Ken St. Louis Date: 10/22/99 Time: 1:57:08 PM Remote Name: 18.104.22.168 Comments Hi Martine, I had hoped someone else might tackle your question, but let me try before the the conference is over. Obviously, the answers would differ based on the person answering. I believe that the ISA 2001 Congress should continue to foster new international member organizations that serve the stuttering community. Obviously you will do that! (I have been very impressed with the remarkable progress that has been made already.) Here are a few ideas for what you might want to consider for the Congress. At some point, as has happened to some extent in the USA, consumers will no doubt need to begin to assist speech therapists, logopedists, SLPs, or whatever they might be called to get better academic and hands-on training in treating fluency disorders. Maybe a round-table discussion on that might be useful. In addition, you might want to get a report from the Specialty Commission on Fluency Disorders in the USA. This is not a new concept in Europe, but it is the first specialty program to get "off the ground" to recognize specialists in this country. (Current members of the Commission are Dick Curlee, Diane Hill, Glyndon Riley, Michael Sugarman, and myself). I don't know if there would be any interest in other fluency disorders such as cluttering or stuttering coesixting with other conditions, such as Tourette's Syndrome, phonological problems, language problems, etc. These people are typically not in the forefront of the self-help movement. In fact, many clutterers are unaware that they have a problem until someone intervenes and says, "Hey, your speech is hard to understand." It would be wonderful if those who stutter could help get these people identified and into treatment programs if they choose to try to get some help. And the problem of spasmodic dysphonia... It would be cool to have someone in that new and emerging self-help movement interface with those in the stuttering self-help movement. My last thought is public attitudes toward stuttering. I was singularly pleased, honored, and humbled when Dr. John Van Borsel invited me to be a speaker at the 2001 Ghent Congress on the topic of international public attitudes toward stuttering. (See the last paper in this ISAD2 Conference.) I think that public opinion will become a hot topic in the future. We need to know if there are differences in public attitudes around the world and, more important, what kind of public education campaigns change attitudes and what kinds do not. Well, there are a few thoughts. Good luck. Warm regards, Ken WHAT AGE? From: Petra Velghe Date: 10/12/99 Time: 4:20:14 PM Remote Name: 22.214.171.124 Comments At what age can you start a therapy for children? Re: WHAT AGE? From: Ken St. Louis Date: 10/13/99 Time: 8:27:57 AM Remote Name: 126.96.36.199 Comments Dear Petra, I'd start therapy at any age (even 2 years) if they have been stuttering for more than a few weeks. There seems to be very little risk of needless therapy compared to the risk of becoming worse without therapy. But see the paper in this conference by Dick Curlee for a different perspective. Ken Re: WHAT AGE? From: Scott Yaruss Date: 10/13/99 Time: 10:46:33 AM Remote Name: 188.8.131.52 Comments I've started therapy pretty early with some (as early as 2 1/2) but this is mainly in cases where there is a clear family history of persistent stuttering or other apparent risk factors (family hx of speech/langugae problems or apparent speech/language problems in the child). Otherwise, I try to wait just a little bit -- not too long -- before beginning direct intervention with the child because of the clear evidence that many very young children recover early. How long? Hard to say...depends upon the situation, but I might wait 3 months before beginning formal intervention with the child. Of course, in nearly all cases, I immediately provide information to the parents about the nature of stuttering, the developmental course of stuttering, and things they can do to help the child develop fluent speech. This often takes the form of a short course of "parent training treatment" -- 4 to 6 sessions. I never just say "wait and see" -- the work with the parents is clearly aimed at being an intervention of sorts, though it doesn't require me seeing the child on a regular basis. Then, I schedule a re-evaluation to see if the child requires more direct treatment. My colleague David Hammer and I will be presenting a seminar at ASHA this year on the parent training component -- a formalization of common recommendations often made to parents about how to facilitate their children's fluency. We do this for several reasons, not least of which is to help the parents stay calm during a period of fluctuation in the child's fluency. This also keeps us in the loop in case the child's stuttering seems to persist. AND, though there ain't much data, it seems to help the child's fluency. Whew! Long answer. Hope this helps. Thanks for a good question. JSY Re: WHAT AGE? From: Woody Starkweather Date: 10/18/99 Time: 4:41:52 PM Remote Name: 184.108.40.206 Comments Age, I think, has little to do with it. We had a very successful intervention with a child who was 15 months old. Of course, what you do with the child depends strongly on his (or her) age, but not WHETHER you intervene. I too usually wait a little bit -- a couple of months -- particularly when the behaviors are relatively simple. But if the child is already struggling (as was the 15 month old) or avoiding, then there is no point in waiting because stuttering, and not just the risk of it, is already present. Woody Starkweather Cerebral Dominance in Stuttering From: Stefanie Thibodaux Prothro Date: 10/12/99 Time: 9:49:08 PM Remote Name: 220.127.116.11 Comments Panel: My name is Stefanie Thibodaux Prothro. I am a second year graduate student at Southern University in Baton Rouge. After reading the article written by Larry Molt "The Basal Ganglia's Possible Role in Stuttering" I was intrigued and motivated to generate a list of questions that you have in your possession. I apologize for the list of questions that I submitted to you, it was unfair of me to present so many questions. I would, however, like to submit the following question to the panel in hope for a response. Thank you in advance for taking the time and patience to consider my request. Thank you again, Stefanie Thibodaux Prothro "Is cerebral dominance the cause for language based stuttering? Why or why not?" Re: Cerebral Dominance in Stuttering From: Ken St. Louis Date: 10/13/99 Time: 8:40:00 AM Remote Name: 18.104.22.168 Comments Dear Stephanie, Apology accepted. Your questions were good ones, but tough, like, "What is the meaning of life?" It kind of depends, doesn't it? I don't if language-based stuttering is due to cerebral dominance or not. I don't know for sure that there is language-based stuttering, although I am reasonably sure there are subgroups of stutterers. You would have to be specific about what you mean. Also, I assume you are referring to something atypical about language dominance in your question, not language dominance, per se. If I am correct, I still cannot answer the question. I would say that there is evidence that stutterers (unselected samples) show differences in language dominance compared to nonstuttering controls. The weight of the evidence from dichotic listening studies, blood flow studies, EEG studies, tachistoscopic reading studies suggest less distinct left hemisphere dominance among stuttering samples than nonstuttering samples. If this is not what you were searching for, sorry. That's the best I can do. Ken Re: Cerebral Dominance in Stuttering From: Woody Starkweather Date: 10/18/99 Time: 4:48:05 PM Remote Name: 22.214.171.124 Comments I would like to second Ken's comments, and then add my own special take on the cerebral dominance issue. One of the pieces of information that is often overlooked in this discussion is that people with other disorders of communication tend also to lack clear dominance for language. It's not just stutterers, but also language delay, articulation disorder, learning disability, and hearing loss. So it seems to me that we ought to consider the possibility that the presence of a communication disorder, of any kind, during early development causes the brain to develop with less clear domi- nance for language. Such a developmental response has substantial survival value in providing more flexible options for a brain that might not be developing normally. Woody Starkweather Helping the PWS, or allowing him to finish the words himself? From: Peter Louw Date: 10/13/99 Time: 10:05:34 AM Remote Name: 126.96.36.199 Comments When we hear a person stuttering severely, do we help him/her, or do we allow him to finish the words himself? Traditional wisdom has it that one should allow the PWS to finish the words himself, and it would appear that the majority of PWSs hold to this opinion. However I would suggest that one should not be too dogmatic as far as this is concerned. As a child there were many occasions when I actually prayed for someone to help me out, and I have since then also met others who would welcome appropriate help. In my book "Coping with stuttering" I mention the case of a young boy, a PWS, who attended a magician's show. The boy was part of the audience, and suddenly the magician asked the boy his name, probably with a view to inviting (or ordering!) him to participate in a magical trick. It was a disaster. The boy stood up, but was completely unable to pronounce his name and stuttered severely. Some of the other children in the hall began to giggle, and the result was that the boy ran from the hall in tears. This was a very traumatic experience for him, and he never forgot it. Some people who knew him were also in the audience, and surely if they had helped him in saying his name it would have prevented the trauma. So my question is: are we not being too dogmatic when we say that "the PWS should be allowed to say the words him/herself"? Surely this depends on the individual and the circumstances. In appropriate circumstances it may be a good idea to ask the PWS whether he/she would like to be helped. Kind regards. Re: Helping the PWS, or allowing him to finish the words himself? From: Walt Manning Date: 10/13/99 Time: 10:23:08 AM Remote Name: 188.8.131.52 Comments Hello Peter- At last, a question I feel quallified to answer...I enjoy watching Larry and Ken respond to the really heavy stuff. I agree with you and think it's silly to say that a listener should "never" say a word for someone. Usually it's not a good idea to be such a "verbal bandit" as Dr. Van used to say. It can make a bad experience even worse. But, in the circumstance you describe, it probably would have prevented the situation from becoming more traumatic. It's virtually impossible, I think, to predict what might be the best response in many of these situations but taking the view that you should NEVER say a word for someone is rather narrow minded. Re: Helping the PWS, or allowing him to finish the words himself? From: Bob Quesal Date: 10/13/99 Time: 3:01:15 PM Remote Name: 184.108.40.206 Comments Dogma is never a very good thing, and it's usually a pretty strong word. In this case, I'm not sure if the dogma really exists. I'd say it's more of a "rule of thumb." I think Wendell Johnson (or maybe it was Yogi Berra) said "'Always' and 'never' are two words we should always remember never to use." So to say we should NEVER fill in words for a stutterer is too strong. We have to use our best judgment in any situation, and if someone is really struggling, I think it is probably appropriate to offer some assistance. It's a lot easier if we know the stutterer, because we probably have some sense of how they feel about this type of assistance. With strangers, we have to make a best guess. If they don't want us to do it, they will likely let us know in some way. "One size does not fit all." BQ Re: Helping the PWS, or allowing him to finish the words hims... From: Woody Starkweather Date: 10/18/99 Time: 4:52:41 PM Remote Name: 220.127.116.11 Comments Of course, as Bob and Walt noted, there are times when helping the person out is both appreciated and occasionally can prevent even more painful events from transpiring. But it is also worth noting that there is a cost to helping the person out by finishing their sentence. Even if they appreciate your doing it, and even if it saves them from something more painful, when you finish someone's sentence you are in effect telling them that they are not competent to finish their own sentences. That cost needs to be weighed against the cost of not helping them. Woody Stammering & Breathing pattern From: Sandeep Desai, Bombay, India Date: 10/13/99 Time: 12:26:45 PM Remote Name: 18.104.22.168 Comments I have been feeling of late that stammering happens on account of an unnatural breathing pattern that a PWS has learnt over a period of time. Now this breathing pattern is natural and smooth at times when the PWS experiences smooth and fluent speech, but on occassions the breathing pattern changes that does not facilitate speaking. Now this unnatural breathing pattern which makes a PWS stammer is triggered off by certain states of mind........like speaking on phone, speaking to authority figures etc........thats the reason stammering is more pronounced in some situations. Has any research on stammering been done to look into the "state of mind" and tackling it so that the breathing pattern remains smooth? I was reading about Neuro Linguistic Programming and I feel maybe the answer to control the state of mind lies here. Tell me what you speech patholoists and experts feel about this theory Re: Stammering & Breathing pattern From: Ken St. Louis Date: 10/13/99 Time: 2:30:27 PM Remote Name: 22.214.171.124 Comments Dear Sandeep, You are certainly not alone in speculating that abnormal breathing patterns play a major role in stuttering. Lee Edward Travis, the "father of speech pathology" in the USA, carried out some very sophisticated studies of the breathing patterns of stutterers in the 1920s which followed other investigations carried out earlier (e.g., Fletcher, 1914). As you suggested in your question, Travis found that stuttered speech was characterized by lots of breathing abnormalities, such as anagonistic thoracic and abdomenal movements, prolongations of inhalation, clonic and tonic spasms of the breathing musculature, and so on. In 1932, Murray found that stutterers even had a number of breathing abnormalities when they were reading silently. And since that time, investigators (e.g., Hutchinson, 1975) have looked at aerodynamic measures of stuttered speech. Others have looked at voicing irregularites, and many others have investigated articulatory abnormalities. The point is that breathing movements are often distorted in stuttering, but so are air pressure and airflow, voicing, and articulation. And if you think about it, you cannot have speech without breathing, voicing, and articulation. In stuttering, the problem occurs when you try to decide which system is the most basic to the problem. In the 1970s researchers were quite sure that the larynx was the seat of the central problem of stuttering, but more recent writing has suggested that this may not necessarily be so. So this "expert" (perhaps meaning: "ex" = "has been" and "spurt" = "drip under high pressure") would say that the problem of stuttering might be in breathing, but it might just as well be in voicing, articulation, motor programming, central reprogramming as a result of auditory/tactile/kinesthetic feedback, etc. I believe that stuttering is far to complex to ascribe unitary causes to it, that take into account only part of the behavior that characterizes this disorder. When I talk to stutterers or my students, I tend to agree with many in this country and elsewhere that stuttering probably reflects a neuromotor timing/coordination problem in breathing, voicing, and articulation. But I use that explanation primarily to differentiate the problem from a habit or a psychological problem (but even those factors are present). In fact, I look forward to authentic genetic explanations of measurable neurochemical changes, affected by autonomic and emotional changes and conditioning, which in turn lead to repetitions, prolongations, and blocks. In the meantime, I'll join everyone else as one more blind man describing the elephant of stuttering. Incidentally, Travis was instrumental in forming a lateral dominance theory of stuttering, which he later gave up to embrace a psychoanalytic view. And a few years before he died, while dean of a theological seminary, I heard him speculate that neurochemistry would be the field in where the most significant advances would come from. This has been too long, so I'll leave it to the real "experts" to speculate about NLP in treating stutterers. Ken Re: Stammering & Breathing pattern From: Woody Date: 10/18/99 Time: 4:57:48 PM Remote Name: 126.96.36.199 Comments When Ken says he will leave it to the "real experts" that has a way of cutting off debate. But seriously, what is so difficult about this, and many other such notions, is that one cannot distinguish very easily the cause from the effect. As Ken notes all kinds of things are abnormal dur- stuttering. Stuttering is not a normal way of talking. So how can we know whether the abnormalities are a cause of the disorder, an effect of the dis- order, or whether they simply ARE the disorder? I don't think there is a satisfactory answer to that question. Woody Changing the name "stuttering" ? From: Peter Louw Date: 10/15/99 Time: 3:39:01 AM Remote Name: 188.8.131.52 Comments Is the stigmatised name "stuttering" really appropriate for this defect? And if not, should we perhaps think of a better term? "Stuttering" as a word mainly reflects sound repetition. But we PWSs do so many other things. We prolongate sounds, have silent blocks so that we cannot say anything, we avoid difficult words and use easier ones, we distract ourselves, or we simply remain quiet because of our fear of speaking. Why then is the defect known under a name which describes just one of the many things we do? Does this misnomer not add to the ignorance and confusion so prevalent among the general non-stuttering public as far as stuttering is concerned? In my book "Coping with Stuttering" I mention that "stuttering" is a layperson's word. It is a term probably coined by nonstutterers to describe our defect, and it as well as its derivations such as "stutterer" have to some extent become stigmatised, so that these days we are known as "people/person(s) who stutter" (PWS) instead of stutterers. So we are no longer "stutterers", but we still "stutter", and still suffer from "stuttering"! How about taking this change further, so that "stuttering" and "stutter" are dumped into the wastebin together with "stutterer"? Surely another and more appropriate term for our defect can be coined? Changing the term may have many benefits. From a marketing point of view, for instance, it could be a good news item which would provide opportunities for getting public attention and promoting our cause. I would be most obliged to hear your comments. Many thanks and kind regards. Re: Changing the name "stuttering" ? From: Bob Quesal Date: 10/15/99 Time: 8:11:37 AM Remote Name: 184.108.40.206 Comments Idiot. Imbecile. Moron. No, I'm not talking about you, I'm talking about words that were intended to be descriptive, and at one time were, that have since come to be misused. Obsessing about what to call "stuttering" seems to me to be a waste of time. Regardless of what we call it, someone will decide that the word is not good enough, and coin another one. And another one. And another one. And probably a few more after that. And after that. And so on and so on.... "Stutter" and "stutterer" and "stuttering" seem to have held up pretty well until the last few years, when some people decided that somehow calling it something different would make some sort of difference. I don't see that happening. If you disagree, I guess you can call me an idiot. Or an imbecile. Or a moron. Or a stutterer. Bob Q. Re: Changing the name "stuttering" ? From: Ken St. Louis Date: 10/15/99 Time: 8:12:12 AM Remote Name: 220.127.116.11 Comments Hi Peter, I should probably avoid the temptation to respond to your question about terminology, since my view may not be particularly "mainstream" these days. But, I won't. Here goes. I just published a study this year in the Journal of Fluency Disorders which addressed the issue of person first (e.g., "person who stutters") vs. direct label (e.g., "stutterer"). [Note the abstract of the article has these two examples erroneously reversed.] I won't attempt to summarize all of the article for it has lots of pieces that need to be all fit together. Nonetheless, the clear finding was that people (members of the lay public, SLP students, current or former speech/language/hearing clients [including a substantial percentage of stutterers], and parents of younger clients) all found the word "stutterer" no less pejorative than the phrase, "person who stutters." The only words that *sometimes* made a difference were "person with leprosy" over "leper" and "person with psychosis" over "psychotic." There were no significant differences, for example, for murderer/person who murders, composer/person who composes, bed wetter/person who wets the bed, stammerer/person who stammers, etc. This was so, even though *all* the groups were very uniform in their ratings of 28 different terms, including such words as "moron," "person with cancer," "trustworthy," etc. I argued in the article that we should be very careful about changing terminology for the sake of attempting to enhance sensitivity. What often happens is that language changes are equated with greater sensitivity, even when basic attitudes are left unchanged. This, in my opinion, trivializes the issue and often leaves real victims in the same situation they have always been. I don't honestly believe that calling someone a "PWS" or "CWS" is more sensitive than calling someone a "stutterer," although I am fairly sure that you and many others would disagree with that position. You will note that I do not use those acronyms in any of my postings in this conference. As a stutterer myself, I would find them kind of silly and a little bit negative if applied to me on a regular basis. I say that because I have never heard one time in my entire career where the word "stutterer" was used by a clinician, researcher, or client in any kind of a pejorative sense. Sure it is often negative, but will referring to someone as a "PWS" or "floggerer," or "reword maker" or whatever reduce the pain caused by getting stuck on words? I doubt it. My research shows that we all know when a word is pejorative, and then, such words should be changed. But doing so when the words are simply descriptors invites confusion, creates artificial insensitivity (i.e., when some haven't learned the new politically correct terms), and shifts the sensitivity issue to language useage rather than changes in behavior. Well, that's more than 2 cents worth. I hope some others who agree with you will also reply. And, to you, Peter, thanks for your thoughtful questions and proposals. Let us agree to disagree on this! Ken Re: Changing the name "stuttering" ? From: Walt Manning Date: 10/15/99 Time: 10:36:07 AM Remote Name: 18.104.22.168 Comments Well Peter, since I'm on the panel and I'm "IN" today, I'll respond to your thoughts about using the word "stuttering". My thoughts go along with the great responses of Bob and Ken. As a person who stutters (although not much anymore) I understand why people would want to use person first terminology. But I also that acronyms such ase PWS and CWS (not to mention terms like "fluenter")can easily add confusion to layperson who is already mystified by the problem. Actually, I'm rather proud to be a stutterer, or PWS or whatever. As I described in my contribution to this conference, for many reasons, dispite the shame and pain and all that stuff, I now consider the fact that I stutter(ed) as as a gift. Had I not stuttered I very likely would have been on the front lines in Viet Nam. I would not have met the many grand people that I have including colleagues and clients. I would not have a career that I consider to be very rewarding. I suppose that it's up to each person to decide what words are associted with some sort of stigma. But they are only words and it's what we make of them that counts. Some people go a bit far, I think, and wear their stuttering as their "red badge of courage" but if that helps them to take part in life, so be it. It's better than hiding and not taking part and interacting with others, as scary as that may be. So, I like the word stuttering just fine. As Bob pointed out, there will always be someone who will object to whatever term we might use. A good question though Peter and I'm glad you gave us the chance to respond to the issue. Re: Changing the name "stuttering" ? From: Steve Hood Date: 10/15/99 Time: 10:13:33 PM Remote Name: 22.214.171.124 Comments WOW !!! What a question. You already have wonderful responses from Bob Quesal, Ken St. Louis and Walt Manning. I have known these three guys for many, many years. Bob, Ken and Walt are "brothers of the tangled tongue" as Van Riper might have said. I am the "bastard cousin" who is a "fluenter." This may temper your reaction to what I have to say. Bob, Ken and Walt have made good points, so I'll not elaborate. But the fact remains that we need to "call it something." And, I think this may be more than just the so-called lable. Society has been exposed to terms such as stuttering and stutterer. Ken has made reference to how folks in general respond. If it is politically correct to use first-person-first language, as is often REQUIRED in some journals, then I guess this is mandated. Fact is: lots of people really don't care. I think that for the person who stuterers -- e.g., the stutterer -- the issue is really more personal. Those who get overly hung up on terminology (e.g., stutterer, person who stutters, person who at times speaks with stutering, etc.) seem often to have unresolved conflicts involving guilt, shame, self concept, self acceptance, etc. Those who are still fighting the battle with stuttering seem overly concerned about this issue. Those who have resolved (or at least largely resolved the issue) seem less sensitive. I suspect that this has to do with the fact that they are more self acceptant, more tolerant, more at peace with themselves, and less in denial, etc. They are moving on with their lives, moreso than living in the past. You have referred to your book. I am sorry to say I am not aware of it. Please post TITLE, PUBLISHER, and other needed identifying information. Hope my comments have helped, and not muddied the waters. It is hard to write about this, on line, and not be able to easily go back to edit.... I hope this all at least makes sense (not that you readers agree) but makes sense in that you understand my point. This is an important topic, and one that is difficult to capture in words -- especially in an ASAD format. I look forward to comments from others. Steve Hood Re: Changing the name "stuttering" ? From: Peter Louw Date: 10/18/99 Time: 6:49:30 AM Remote Name: 126.96.36.199 Comments Dear Steve Many thanks to you and the rest of the panel for responding so thoroughly to my question! You have asked for more details of my book, and here they are: "Coping with Stuttering", by Peter Louw, 1996, Delta Books, Jonathan Ball Publishers, Box 33977, Jeppestown 2043, Johannesburg, South Africa. Their international telephone number is (2711) 622 2900 and the international fax number is (2711) 622 3553 or 7610. The e-mail address is firstname.lastname@example.org You and the other panel members have made some good points. Changing the name, if at all practically possible, would obviously create some problems. At the same time the current terminology also seems to be problematical. It would be interesting to study the terminology in other languages. The English "stuttering" is related to the Middle Low German "stotern" (with the umlaut on the o) and the Old High German "stozan", meaning "to push against", and this last word seems to derive from the Latin "tundere", meaning "to beat". It would also be interesting to look at other medical terms which have fallen into disfavour, for instance the old "manic depression" which is no longer used by psychiatrists. Before making a serious attempt at changing our own terms one would have to carefully study similar changes in medical language, and whether those changes were in fact beneficial. In my book I did not propagate a change - I merely pointed to the current terminology which I feel is unsatisfactory. I did pose the question on this discussion forum as it seems to be topical and relevant. Anyway, thank you for an interesting debate! Kind regards. Re: Changing the name "stuttering" ? From: Ira Zimmerman Date: 10/16/99 Time: 5:09:51 PM Remote Name: 188.8.131.52 Comments Personally I like the term, "Repetitively Challenged." At least that describes my form of speech impairment. Re: Changing the name "stuttering" ? From: Steve Hood Date: 10/16/99 Time: 9:49:23 PM Remote Name: 184.108.40.206 Comments Ira -- Hello, and thanks for your post. I guess for those whose major disfluencies are repetitions, "repetitively challenged" is o-k. But this might be oversimplification. For example: But what about those who are are prolongers, repeaters, silent blockers, recoilers, word changers, paraphrasers/circumlocuters, postponers, avoiders, etc. I'm not sure we can come up with a single unitary term that will be appropriate for a problem which is known to be multidimentional. This, to me, is a continuously perplexing issue, and one which is not easily solved. Steve Hood Re: Changing the name "stuttering" ? From: JSYaruss Date: 10/18/99 Time: 10:29:28 AM Remote Name: 220.127.116.11 Comments Furthermore...not to be trite or to make light, but the problem is not with the repeating. The repeating is fine -- many people who stutter are quite good at repeating. So, it doesn't seem right to say they're "repetitively challenged" the challenge is in not repeating. My ONE cent... Re: Changing the name "stuttering" ? From: Ira Zimmerman Date: 10/19/99 Time: 7:48:08 AM Remote Name: 18.104.22.168 Comments Yesterday my interview was broadcast on KTLA-TV and I repeated the first sound of the word, "Download." I call that being repetitively challenged. Would you rather call it, Verbally Challenged? What does it matter anywhere now that speech pathology students are being granted ASHA's Speech Pathology Clinical Competence Certificates without any required expose of those of us who are repetitively challenged? Re: Changing the name "stuttering" ? From: Woody Date: 10/18/99 Time: 5:03:00 PM Remote Name: 22.214.171.124 Comments All of the above, plus it is really difficult, and usually futile, to legislate language. It grows like Topsy and doesn't seem to respond well to attempts to manipulate its growth. There is also the issue that using names in order to soften the stigma may simultaneously feed the stigma. If this problem is so awful that we can't even call it by its proper name, it must be really unspeakably awful. No, I think it is better to call it what it is and show that we are not afraid of it. Woody Changing the name "stuttering" From: Ed Feuer Date: 10/22/99 Time: 2:51:40 PM Remote Name: 126.96.36.199 Comments Bob Quesal said: "You say, " casual conversational sense, these words always imply some variation of shame, failure or incompetence." I guess I fail to see how "stutter step" or "stutter dial tone" denote failure, shame, or incompetence. " You cite the two benign examples. I can give you many, many more instances of where the terms do connote shame, failure or incompetence in everything from good literature to the comics. As I've said elsewhere in ISAD 2, some recent examples in Associated Press stories were reference to Dan Quayle's "stuttering presidential campaign" or a foe of Senator John McCain saying that he was "stuttering and stammering on the issue of abortion." The problem arises when people who know nothing about real stuttering impose those attributes on people who really do stutter. Unfair discrimination in employment is a key example of where the difficulties arise � such as when a personnel department staffer meets a job applicant who really does stutter. His/her only point of reference is the casual, conversational useage � leading in turn to fixed notions about what PWS *CAN'T* do. � Ed Feuer Re: Changing the name "stuttering" From: Bob Quesal Date: 10/22/99 Time: 4:17:55 PM Remote Name: 188.8.131.52 Comments Ed, I'm sorry, but you won't convince me that the word has all that much power. Your statement implied that *ALL* uses of the word "stutter" imply weakness or some other negative thing. I'm sorry if my two "benign" examples were insufficient to refute your argument (in your mind). People who are strong are not highly offended by what others call them. People who are strong are not personally offended by others' ignorance. People who are strong do not look for excuses or scapegoats. To suggest that misuse of the words "stutterer," "stutter," or "stuttering" somehow contributes to the "opression" of those of us who stutter is simply going way out on a limb that I prefer not to join you on. I think reasonable people can disagree. BQ Changing the name "stuttering" From: Ed Feuer Date: 10/20/99 Time: 2:52:59 PM Remote Name: 184.108.40.206 Comments As I have argued elsewhere in ISAD2, rather than changing the name, we should claim a monopoly over the words "stuttering" and "stammering." I say that because when used in the casual conversational sense, these words always imply some variation of shame, failure or incompetence. Given the massive public ignorance about real stuttering, these attributes tend to automatically imposed on people who really do stutter. The homosexual community now has a monopoly on the world "gay". Language useage does change. � Ed Feuer email@example.com Re: Changing the name "stuttering" From: Bob Quesal Date: 10/20/99 Time: 4:07:39 PM Remote Name: 220.127.116.11 Comments Ed: You say, " casual conversational sense, these words always imply some variation of shame, failure or incompetence." I guess I fail to see how "stutter step" or "stutter dial tone" denote failure, shame, or incompetence. Words are only "bad" to the extent that we allow them to be. I think Steve Hood's point is a good one: folks who have come to grips with their stuttering don't seem to be bothered by what others call it. Folks who still have "issues" to resolve seem to feel that the "label" somehow is the root of all trouble. I just don't see it that way. BQ throw in two bits- From: Michael Sugarman Date: 10/16/99 Time: 11:11:10 AM Remote Name: 18.104.22.168 Comments ISAD'99 has been very coool! -Professors, thank you for your active participation in the Internet Conference. I look forward in a couple of years to an Oct.22nd video Internet conference to every university class on fluency disorders and sites for consumers around the world. In the late 1970's National Stuttering Association members used the first person language in describing their experiences as persons who stutter (PWS). (BTW at the 1978 ASHA convention there was a very heated arguement about the linguistic shift from stutterer to PWS). Until there is a cure for stuttering, quality of life issues and management skills confront PWS. Today, consumers with chronic disabbilities share these concerns and are using the term person living with _______. For us it would be "person living with stuttering" (PLWS). My second bit is for information. How did ASHA come up with Fluency and Fluency Disorders for Division #4 rather than Stuttering? Its wild this internet conference-It keeps the mind active- no need for ginko, yet. kindly, michael Re: throw in two bits - for Michael From: Judy Kuster Date: 10/17/99 Time: 2:52:28 PM Remote Name: 22.214.171.124 Comments >ISAD'99 has been very coool! -Professors, thank you for your active >participation in the Internet Conference. I look forward in a couple >of years to an Oct.22nd video Internet conference to every >university class on fluency disorders and sites for consumers around >the world. Yikes!! What are you saying here, Michael?? That the ISAD online conference become a *video* conference in a couple of years? Or am misunderstanding you? From my perpective a video ISAD would be very problemmatic. Full videoconferencing is still difficult even in highly sophisticated and technologically very savvy places! I suspect that good and cheap videoconferencing technology is still about ten years away. And that is from a US perspective. What about participants from less technologically-advanced countries? Such a format would shut them out of participation. There are other problems beyond just technology. First of all, half of the world is sound asleep when you are awake. There would have to be at least two "videoconferences" running twelve hours apart to have any chance of truly including the whole world. Second, for over half of the presenters, English is a second language. Unless we have the same type of translation services that are available at the United Nations, effective real-time video communication would be almost impossible. Third, in most non-US countries people pay for internet access by the minute through their home phone lines. If the conference were a video conference, they would have to hang on the telephone line for a LONG time, either to download the video clip or to stay online for the video streaming. It would cost much to much. Michael, the great thing about this conference in its present format is that time and location don't matter much. The format is simple enough to be accessible by almost anyone who has a computer and a modem, without added costs. The people who need this conference most are the ones for whom a video conference would be the most difficult to pull off. It's nice to aim high, but unless some miracles happen in the next couple years, a video conference is technologically impossible and unforgiveably exclusive. Let's keep this conference as simple and as accessible as we can for people all over the world, not just those who are lucky enough to live in the cradles of modern Internet technology. Re: throw in two bits - for Judy From: Michael Sugarman Date: 10/19/99 Time: 10:52:46 AM Remote Name: 126.96.36.199 Comments On technology, I do not feel the techniques that are used will continue to be expensive. I feel the virtual classroom/conference will become a standard online format and will become a relatively inexpensive commodity sold by various companies. I feel we can expect in the next few years the following service in the United States and International: an online service that supports streaming Internet audio/video broadcast of a panel of speakers in different locations. The viewers of the broadcast will interact with the panel by 1) online chat or 2) phone call-in. The speakers will need access to high end video conferencing equipment with high speed, low latency connectivity (like ISDN). Currently, in the United States, you can access such equipment at any kinkos. The viewers will need a standard Internet connection and a PC. There is no intentions to replace ISAD Internet "threaded discussions" Conference. The ISAD online conference is a valuable resource. The videoconference was for one day Oct. 22nd to bring consumers, professionals and students together at a speech clinic, someone's house or classroom to discuss fluency disorder-stuttering. Re: throw in two bits- From: Bob Quesal Date: 10/18/99 Time: 8:15:17 AM Remote Name: 188.8.131.52 Comments Michael: Regarding why the name is "fluency and fluency disorders," there are other fluency disorders besides stuttering. BQ Re: throw in two bits- From: Woody Date: 10/18/99 Time: 5:14:13 PM Remote Name: 184.108.40.206 Comments And one of the "interests" of the Special Interest Division is the nature and development of normal fluency, although this interest expresses itself but rarely. Woody Differences in Stuttering Behaviors From: Tara James (Graduate Student at Southern University) Date: 10/18/99 Time: 2:47:13 PM Remote Name: 220.127.116.11 Comments In the literature stuttering behaviors have been defined as including repetitions, hesitations and blocks. I would like to ask if there has been any research to find out if differences in stuttering behaviors differ among ethnic groups? Do African Americans tend to have different stuttering behaviors than do Caucasians, Asians or other ethnic groups? Also, is the stuttering behavior of African Americans characterized more by one behavior than another behavior (is the stuttering behavior defined more by blocks than hesitations or repetitions)? Thank you and I look forward to reading your response. Re: Differences in Stuttering Behaviors From: Woody Date: 10/18/99 Time: 5:10:11 PM Remote Name: 18.104.22.168 Comments There is only one study that I know of that bears on your question, and that was done by Leith and Mims back, I believe, in the 60's. They found no difference between African-Americans and European Americans in the overall frequency of their stut- tering, but they did find a tendency for the Afri- can Americans to use more avoidance behaviors or secondaries. They attributed this difference to the historically strong value placed on good communication among African Americans, as reflected particularly in the great Black orators and rhetoricians. Where there is a tradition placing a high value on excellence of speech there must be a corresponding stigma placed on its apparent opposite. That, at least, was the interpretation that Leith and Mims made of their results, and it seems to make sense. Woody Re: Differences in Stuttering Behaviors From: Ken St. Louis Date: 10/19/99 Time: 7:56:06 AM Remote Name: 22.214.171.124 Comments Dear Tara, Good question. I second what Woody wrote. Definitely take a look at Leith's work. There are also a number of other articles that have appeared over the years in the Journal of Fluency Disorders about stuttering in other languages around the world. I have been looking at cross-cultural research on attitudes toward stuttering and ran across a chapter in a 1977 book entitled "The Problem of Stuttering :Theory and Therapy" that was edited by R. W. Rieber and published by Elsevier. The chapter is by Lorraine Kirk, who is apparently an anthropologist, reporting an ethnographic study of of "Stuttering and Quasi-Stuttering in Ga." Ga, she says is a tonal language and a member of the Kwa branch of the Niger-Congo language family. About 700k Ga people live near Accra, Ghana. Kirk describes a sort of "normal stuttering" that is very common in Ga as well as an abnormal form. Very interesting study! Good luck in your search. Ken fluent speakers becoming dysfluent when speaking to folks who stutter and about the topic of stuttering From: Joan Morris Date: 10/18/99 Time: 5:48:58 PM Remote Name: 126.96.36.199 Comments I've been a practicing SLP for a number of years and have noticed a "phenomenon" that I find curious and wonder if anyone has any info/research concerning it. I've noticed that very fluent people often become quite dysfluent when talking with people who stutter and sometimes when even discussing the topic of stuttering. I know that a friend and I became extremely dysfluent during our summer Stuttering Seminar. Is this a symptom of our discomfort with/for the speaker? Are we unconsciously trying to put the speaker at ease by attempting to replicate their speech patterns? Or are demonstrating our own inadequacies on the topic regarding treatment. Would appreciate any comments you might be willing to share. Would also appreciate your cc:ing a copy of this to Dr. Joe Kalinowski at firstname.lastname@example.org thanks, Joan Morris Re: becoming dysfluent From: Walt Manning Date: 10/18/99 Time: 8:48:56 PM Remote Name: 188.8.131.52 Comments Hello Joan- I don't know all the reasons why but it's very common for my students who are taking my course in fluency disorders as well as those who are working with clients who stutter to notice that they are producing stuttering-like symptoms. It's something that occurs when we pay close attendtion to normally unnoticed fluency breaks. Sometimes they tell me that it sounds as though everyone in their environment is stuttering. It reminds me buying a particular of a particular color (or an article of clothing)and then begin to notice how there are so many of them around. When speaking to a person who stutters (or has a unique dialect) it's also common to begin to take on the characteristics of the other speaker. I don't know that I've actually answered your question but I regard it as a good sign (of involvement) when my students begin to have those kind of experiences. Thanks for the question. Re: fluent speakers becoming dysfluent when speaking to folks who... From: Ken St. Louis Date: 10/19/99 Time: 8:04:30 AM Remote Name: 184.108.40.206 Comments Hi Joan, Fascinating phenomenon, isn't it? I can't say I have seen the dramatic changes you mentioned in one person in the summer program, but I have frequently had students indicate to me that they are starting to "stutter" since they started my course. [I don't think it's the stress of the course, but that's only *my* opinion ;-)]. One assignment I give the undergraduates is to go out and stutter on purpose in a realistic situation to three different people and report their reactions. This seems to trigger some additional disfluencies in some individuals and/or, like Walt mentions, make them more aware of those that they previously did not notice. Ken Re: fluent speakers becoming dysfluent when speaking to folks who... From: Steve Hood Date: 10/19/99 Time: 9:10:39 AM Remote Name: 220.127.116.11 Comments Although I don't think Wendell Johnson's diagnosogenic theory of stuttering necessarily answers your question, I do think it is relevant. Johnson was concerned that "stuttering is what you do when you try not to stutter again." He was talking about what people do in an attempt to avoid normal nonfluencies. The parallel I see here is that when "normally fluent" students take a course in stuttering, they learn about "normal" disfluencies and "stuttered disfluencies" and become more alert to their occurrence. Many students did not realize that "normally fluent speech" is disfluent about 4%-6% of words spoken. (Of course, stuttered diisfluencies are more fragmented, more discontinuous, of longer duration and accompanied by more effort/tension/struggle. Normally fluent talkers, become aware of the fillers, pauses, interjections, bobbles related to language formulation, revisions and false starts, easy word repetitions, etc, and become concerned about this. I think we should take heart in the fact that this happens in other areas as well. For example, students in psychology have been known to suspect themselves of being paranoid, obsessive-compulsive, victims of "learned helplessness" and a host of other conditions. Students in medical school sometimes diagnose themselves as having multiple sclerosis, sub-clinical seizures, reflux, and a host of other medical conditions. I have a number of stuttering assignments that I have my undergraduate and graduate students perform. It is common for students to become concerned about the disfluencies they have in their speech. My belief is that this ends up being a valuable learning experience for them. Steve Hood Re: fluent speakers becoming dysfluent when speaking to folks... From: Woody Starkweather Date: 10/19/99 Time: 12:06:05 PM Remote Name: 18.104.22.168 Comments My experiences are pretty much the same as the rest of the group. Something that is ordinarily in the background becomes figural. As a child, I use to be able to get myself into a "set" to find a particular kind of very small shell on the beach. By manipulating my attention in this way, I could find hundreds of these little shells. Later in life, I found it useful to give them to girlfriends, something like wampum, I guess. Anyway, the interesting part of this phenomenon to me is the fact that dysfluencies, along with most other aspects of speech production are typically in the background. The speaker's attention is on the ideas he or she is trying to convey unless, of course, something unusual happens -- an embarassing spoonerism, or an unsually long dysfluency. Then, for a moment, speech production becomes figural. It is a fortunate feature of speech communication that has evolved this capacity to put the process on automatic pilot so that we can focus our attention on the ideas we want to communicate. I don't think it could have evolved as an effective method of communicating without this automatic pilot feature. Stuttering (the disorder) disrupts this naturally automatic process. Speech production becomes figural. Attention shifts away from the ideas, at least until the moment has passed, hijacking the speaker's attention. Maybe stuttering IS a failure of this important mechanism to develop. Woody Re: fluent speakers becoming dysfluent when speaking to folks who... From: Bob Quesal Date: 10/19/99 Time: 9:21:58 AM Remote Name: 22.214.171.124 Comments I've always attributed this to the germs that cause stuttering. ;-)>> Seriously, I tend to go along with what the others say. People become more aware of their own disfluencies (not dysfluencies) when in the presence of people who stutter. And, perhaps, they do something similar to what many of us stutterers do: in an attempt to "not be disfluent" or "not stutter" they do things that interfere with their normal way of talking. BQ Cluttering From: Rachel Thomas/SECD 560 Southern University Date: 10/19/99 Time: 8:29:23 PM Remote Name: 126.96.36.199 Comments What percentage of clutterers are misdiagnosed in the school system? Is cluttering more prevalent in particular regions of the country? Re: Cluttering From: Ken St. Louis Date: 10/20/99 Time: 8:01:54 AM Remote Name: 188.8.131.52 Comments Dear Rachael, Good questions on cluttering. Unfortunately, there is no specific research data that bears on either question. We'll have to speculate. How many clutterers are misdiagnosed in the schools? In my limited hand-on experience with those who clutter, reading on the subject, and participation in surveys of SLPs in the USA, Great Britain, Bulgaria, and Greece, it seems that many if not most clutterers are diagnosed originally as articulation disordered, language disordered, LD, ADHD, etc. These really are not misdiagnoses so much as *incomplete* diagnoses, similar to a case with coexisting disorders wherein all the disorders are not completely diagnosed. Cluttering is hard to pin down. My opinion is that a clutterer must have a fluency disorder that is not stuttering and also must have either a rapid or an irregular speaking rate. The disfluencies are often suspected to be "language based," that is, the result of pushing the limits of their ability to produce speech fluently rather than struggles to get specific words out. Are there regions where cluttering is more prevalent? Again, there is no solid data on this. I would be hesitant to even speculate here. It's good to see that cluttering is beginning to be recognized in this country. Ken Spontaneous recovery From: Peter Louw Date: 10/20/99 Time: 3:46:45 AM Remote Name: 184.108.40.206 Comments Dear Panel Yes, it's me again! I know that I have asked many questions at this conference, and hope that you will bear with me. In the latest (Summer 1999) issue of Speaking Out, the British Stammering Association's magazine, there is a letter on page 18 regarding spontaneous recovery which I found rather interesting. The writer of the letter, "John", from Clevedon, Somerset, mentions that he was a stammerer, but now talks freely after falling in love about 5 years ago. It has given him tremendous confidence and he now believes in himself again after years of negative thinking and low esteem. He is now 58 years old. Cases of spontaneous recovery, as you are aware, are mentioned in the literature. In particular I remember the one mentioned by Van Riper (probably in The Nature of Stuttering?) of the boy who was apparently cured after his father, in a moment of extreme irritation with his son's stutter, threw a bucket of fish on the boy's head. In my own book, Coping with Stuttering (Delta Books, Jonathan Ball Publishers, Johannesburg, South Africa, 1996) other such cases are mentioned, among them that of an elderly gentleman who was apparently cured after watching a TV programme in which other stutterers told of their experiences. This gentleman later said that he identified to such an extent with the individuals on the programme that he himself was cured. In my book I suggested that these people (provided of course that their accounts can be verified) may have been cured due to a sudden and lasting drop in their baseline tension, i.e. a lasting and significant decrease in their total combined stress level (not just anxiety levels - stress is a wider concept than just anxiety). Their baseline tension has fallen far below their threshhold tension level, so that the stuttering response is no longer activated. (In the discussion "Stuttering and stress" in this conference I refer to the concept of "threshhold".) I know that Van Riper's case seems, on the surface, not to support such a position, and I admit that it may throw a spanner in the theory. After all one would expect the boy's stress level to increase significantly after a nasty experience such as having a bucket of fish thrown over you! But again: the response to a stressor is subjective. What is stressful for one individual may not be stressful to another. An event which can be traumatic for Mr A, may result in a psychological catharsis for Mr B and a resultant release from anxiety, leading to lower stress levels. Perhaps this is how Van Riper's case can be explained. I hope that this makes sense. I know the argument is not "scientific", but there may be some truth in it. Anyway, I guess I will have to formulate all this into some kind of question, so here it is: assuming that "John's case" above has been verified, how would you explain it? Many thanks. Re: Spontaneous recovery From: Larry Molt Date: 10/20/99 Time: 9:18:31 AM Remote Name: 220.127.116.11 Comments Hi Peter! I've been enjoying your postings. This time, you asked: assuming that "John's case" (of spontaneous recovery) above has been verified, how would you explain it? Alien abduction. A miracle. A sign from God that the apocalypse is almost upon us. Verification that stuttering is indeed a psychological disorder. Proof that low self esteem is a critical factor in maintaining stuttering. John suffered a subclinical stroke of which he�s unaware that altered bloodflow patterns or impacted on neuronal activity in a critical site. Evidence of the limbic system's role in disrupting complex motor activity such as speaking. Proof that the St. John's Wort (or any other herbal remedy/food supplement) he was taking to control depression is the real answer to curing stuttering. John's realization that he could make big money by selling his new "improve your self-esteem and cure your stuttering" therapy program over the internet was such a positive factor that he was able to maintain fluency gains he had achieved . . . . . We could play the game and go on and on with possible explanations. My point is that such speculations are a fun game, but bad science. Anecdotal reports are interesting. But we�re missing any data to make the speculations meaningful in any way. Exactly how did John�s stuttering begin; did it follow the typical developmental pattern; is there a familial history in John�s case; were any other disorders or abnormalities also present; what type of therapy/treatment experience has he had in the past; what would be the results of a comprehensive neuropsychological battery if performed premorbid to the recovery (and results of one performed afterward); does John truly represent the typical stutterer; were there any other changes going on in John�s life at that time � a change in diet, sleep patterns, job stress, etc. � we could and should go on and on with questions that might somehow give us a basis for making speculations before making any speculation. Otherwise, you�re doing bad science � only looking at data that fit your models/theories. "Post hoc" paradigms are not good science, but one could then test use the theories developed to set up a priori experimental paradigms with a better chance of finding an answer. Don�t get me wrong, I personally like the theory you propose of "critical stress levels/baseline tension levels" as playing a role in the maintenance of stuttering. It�s been around a long time, and all kinds of different etiological models have employed it. I think it�s useful in explaining the waxing and waning patterns of the disorder we see in many people. As a stutterer myself, I tell my students and clients that my fluency (and disfluency) is a pretty good barometer of how things are functioning in my life. Few stressors - good fluency levels; hectic periods, lots of deadlines, money worries, etc. - I really have to work hard to hang onto fluency. But in the question you pose � we don�t know anything to help us make a decision about why John experienced spontaneous recovery. Warmest Regards, Larry Molt Re: Spontaneous recovery From: Peter Louw Date: 10/21/99 Time: 4:00:16 AM Remote Name: 18.104.22.168 Comments Dear Larry Many thanks for your thorough answer. I agree with most of what you are saying. The point is that I never intended my question to be "scientific". I was talking about my hunch. Maybe I did not formulate the question clearly enough, but the issue still seems to be valid. I would not agree that speculations are just a fun game. Naturally they are not science, but they may well become science, once studied and proven. Pure science has its place and role, but so does speculation, lateral thinking and intuition. Kind regards. Re: Spontaneous recovery From: Woody Starkweather Date: 10/21/99 Time: 11:37:38 AM Remote Name: 22.214.171.124 Comments I agree that anecdotal evidence has its place, but I think it is important that we keep in mind what that place is. Because I work in a university setting, I have seen many stutterers in their 20's, a time when falling in love is common and frequent. I can't tell you how many stutterers I have heard tell me that their stuttering seemed to have miraculously disappeared during this curious emotional time. And of course, there are known behavioral differences during this time, as well as less well known, but surely equivalent brain chemical changes, which must mediate the form of insanity that we call being in love. Another thing to consider is an old idea, which has some basis in the literature, but certainly not conclusive evidence, that the original cause, the reason the young child produces repetitious speech may well disappear with development, while the struggles to talk remain like a precipitate in a chemical experiment. Such a mechanism could explain why at a certain age, it may take only a little nudge to push someone over the edge into a cessation of stuttering symptoms. Woody Re: Spontaneous recovery From: Peter Louw, Cape Town, South Africa Date: 10/22/99 Time: 4:06:11 AM Remote Name: 126.96.36.199 Comments My own speech is very much stress-related, so I have become very aware of my stress levels, and stress management is very important for me. It is a continuous monitoring and meant much work for me in the past, but with age I seem to have become a more relaxed person, with a concomitant improvement in speech. I well remember the time when I fell in love for the first time. I felt that I was completely at peace with the rest of the world. I had no more cares and worries (for a while at least ... until she dumped me ...) and it was a wonderful time. I was very fluent at the time, and my stress levels must have been at an all-time low. As this is the last day of the conference, I guess it's time to say goodbye. Many thanks to all the members of the panel for patiently listening and responding, and for Judy for taking the initiative with this wonderful new medium - the electronic conference. It is a fantastic idea, with enormous potential. The "global village" has really become a reality! For next year, the goal must be to involve even more people. But surely this will happen, as more and more people get PCs and get connected. All the best and keep well until next year. Peter Stammering vs.Stuttering From: Andrea Jones Date: 10/21/99 Time: 8:16:59 AM Remote Name: 188.8.131.52 Comments Does the European classification of stammering differ from the American classification of stuttering? If so, how? Re: Stammering vs.Stuttering From: Ken St. Louis Date: 10/21/99 Time: 10:37:27 AM Remote Name: 184.108.40.206 Comments Dear Andrea, No, there is no difference. British infuence is evident in the use of the words "stammering/stammerer" and American influence is seen in the use of "stuttering/stutterer." In the past, there were identifiable differences between these words, but not now. Even so, there are still those who will insist that they "stammer" but not "stutter" in the USA, even though the dichotomy has nearly faded away. Good question. Ken THANKS -- THANKS FOR PARTICIPATING From: Steve Hood Date: 10/22/99 Time: 12:30:08 PM Remote Name: 220.127.116.11 Comments This may be my last opportunity to post anything before the 5:00-PM hour when the interactive portion of ASAD comes to a close. I wish to thank those who asked questions, and the other professor who responded to the questions and comments that have been posted. I believe that this, the second ISAD, has been a remarkable success. I have enjoyed participating, have learned much, and have again come to realize how much more there is to be learned. Good luck and best wishes to all. Steve Hood Re: THANKS -- THANKS FOR PARTICIPATING From: Walt Manning Date: 10/22/99 Time: 1:56:06 PM Remote Name: 18.104.22.168 Comments Goodby and thanks to all. Like Steve, I've enjoyed the interactive nature of the conference and loved many of the papers. I hate to see it end but I tend to get hooked on reading all the comments. I really need to be getting on to other stuff that the taxpayers think they are paying me to do. Judy did an incredible job again this year...but, knowing her, what would you expect.! Hope to meet many of you before too long or at least see you back here again in the future. Re: THANKS -- THANKS FOR PARTICIPATING From: Ken St. Louis Date: 10/22/99 Time: 2:06:48 PM Remote Name: 22.214.171.124 Comments I'd like to add my thanks to everyone, along with those eloquent statements by Steve, Walt, and the others. Yes, it has been fun, but challenging, trying to write sensible replies to all sorts of interesting queries and comments. It feels a little bit like leaving a message on an answering machine. You're tempted to try to be funny or cute, but if you screw up, your errors are there for posterity. I've "left a few messages" that I wish I could erase. But, isn't this like calling and doing the real thing as a person who stutters? You gotta trust that the person you called will understand that the stutters are unimportant to the real message. Peace! Ken Re: THANKS -- THANKS FOR PARTICIPATING From: Bob Quesal Date: 10/22/99 Time: 2:35:14 PM Remote Name: 126.96.36.199 Comments I, too, need to jump on the bandwagon here (although I hope to be around for a few more hours to answer questions). This has been a great experience, and it's been a true honor for me to be in the company of Drs. Hood, Manning, Molt, Bernstein Ratner, St. Louis, Starkweather, and Yaruss. In many cases, their responses were much better than mine, and in others, they gave a better response before I had a chance to reply. This forum has really been an interesting one, and I thank everyone who posted some truly outstanding questions, and thank my colleagues for their thoughtful answers. I hope we can do this again next year. And many thanks to Judy Kuster and Michael Sugarman for all their efforts related to this online conference. Great work! Bob Q. Re: THANKS -- THANKS FOR PARTICIPATING From: Woody Starkweather Date: 10/22/99 Time: 4:16:56 PM Remote Name: 188.8.131.52 Comments I have probably missed the opportunity to add my words of appreciation. But it has indeed been a pleasure. I am always astonished at how much we agree about such a complicated phenomenon. Woody