The Professor is IN — 2000

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Self image development

From: Gunars K. Neiders, Ph.D.


Dr. Wendell Johnson, a General Semanticist, was aware that we frequently developed our self image, as children, according to a label which was attached to us. He, and his mentor in General Semantics, Korzybski, knew the danger of defining ourselves solely by a label. They argued that we are neither a butcher, baker, nor a candlestick maker, but a complex person of many varied talents, potentialities, characteristics, and things that we do. They tried to say, Joe is a person who bakes bread, who has a wife, who has a talent for playing piano, who might become a hero if fate called upon him, who loves his wife and children...

The danger they saw of defining a person by a label as "stutter" or "Person Who Stutters" (which is still a label) is that it promotes a negative image of self, since, stuttering is nothing to cheer about. 😄

This concept is hard enough for adults to understand, when stated in this abstract form. Thus, most probably, cannot be directly used with children. Have any of you found a way to instill in a child the understanding, the feeling that he/she is more than his/her fluency/disfluency? Especially if his/her parents have started to overfocus on his/her speech and are constantly reminding him/her to "take a deep breath", "now speak slowly, dear" etc. that only calls attention to what he/she already perceives to be his/her inadequacy and the defining aspect of himself/herself.

From: Ken St. Louis

Hi Gunars, I don't think there is any set of rules that will always tell us what to do regarding labels or parental corrections and reminders. Clearly Johnson was aware that when we label anyone, there is always the possibility that either we might not see them fully for what they are or that they might begin to see themselves for less than what they are. But, in a conversation I had a few years ago with the late Einer Bogerg, he told me that Johnson had stated that he was sure that speech-language pathologists were intuitively aware of this danger and were able to see beyond the label.

Of course, we must be cognizant of the potential problem of parents overdoing reminders and corrections. The Lidcombe Program after all recommends 10 times as many praises as corrections as parents begin to deal with their children's stuttering. It seems to me the best thing to communicate to parents is that they should always be the child's parent first and do what they believe would be best. Beyond that, they can learn to interact in different ways for short, circumscribed periods of time that hopefully will result in the child learning to speak in a new way. But it is important to communicate to parents that, other than these periods, they should interact with the child in their usual way.

I don't think this is any different from a parent dealing with a sick child. Yes, the child may be at risk of acquiring the self-concept of a sick child, but parents typically know how to minimize this through constant assurance of love, caring, and optimism for the best possible outcome. Kids generally know when parents' attention is in their best interest, even if they don't like it very much. And, as a result, when the child's problem resolves, the self-esteem scars you suggest may either never occurred or have healed up.

As you might surmise from my JFD article on labeling, I don't think the words that are used to label someone are nearly as important as the spirit in which they are used. I would hold the same position here: the parental love and care will likely determine the long-term effect of any temporary changes in their about their child's speech.

This is not meant to be an answer but another hopefully realistic perspective. It may not work in every case, but at least can provide a good place to start.

Best wishes,


From: Steve Hood

I think the tone of the message is more important to children than the actual words. The so-called suprasegmental features of melody, inflection, pitch and loudness are key elements. I think you partly answered youw own question, Gunars, but what you wrote in your second paragraph. Above and beyond the "lable" -- When people over-focus on the speech, with constand reminders to take a breath, speak slowly, etc, then this is giving the messsage that stuttering is bad, wrong, dirty, nasty, terrible, awful, etc. Then when this happens and the child is older, we need to work as Bill Murphy says, to "de-awfulize" and "de-terriblise" it. I think it would be better if the child realizes that "some bumpy speech is o-k."

We also need to be cautious of the "conspiracy of silence." If we make such a big deal out of not using the terms "stutter" or "stuttering," then the child is apt to conclude that stuttering is pretty bad, so it should not be discussed.


From: Judy Butler

As an SLP, I struggle with this issue in lesson planning. I am called in by parents to fix a stutter. So, the stage is set when I walk in the door (I make house calls). When the child and parent look at me, they think "stutter." In fact, I am seduced into the role of "stutter-fixer". Sometimes I feel like a plumber. To break out of this, I usually leave time to talk about other interests/issues about the child and family. But I always get the feeling, whether it is coming from inside of myself or from the family, that I am not doing my job if I stray from the topic of stuttering. I have to actively affirm to myself, during the session, that moving the topic away from stuttering is the right thing to do. It is in my job description to broaden the focus of therapy. But its not easy.

Still learning, Judy Butler

From: Gunars


I agree with you whole heartedly. There are a number of parents who, in my experience, a) do black and white thinking about stuttering (either a child is perfect speaker or not, instead that stuttering therapy can lead to management of stuttering and not necessarily a "cure") and b) overgeneralization, because a child may experience some rejection or difficulty in communication due to stuttering, stuttering must doom the "tyke" to a miserable life experience, instead of understanding that stuttering is only one of the many areas of a childs (and for that matter, adults) life. And from my own experience I know how obsessed a child can get with his "inadequacy", his thoughts of "If I don't cure myself of stuttering, I will be no damn good."

I wish that during my childhood somebody would have placed stuttering in the proper context, de-awfulized it, de-devilified it, and have given me hope that I can lead a full productive life all the while as I learn to manage my attitudes about stuttering, my forcing and my struggling with my speech.

I thank you in behalf of the children whose parents may have to be taught to handle the problem of stuttering and the child's psyche in an accepting, non-demanding way.


From: Dana McCluskey

When treating a patient, self-image is definitely of major importance to me. When, as sppech pathologists, do we determined that an individual has problems that are too difficult or out of our scope of practice? I tend to think that a therapist would have more experience and expertise in this area. How often do speech pathologists work with other alternative medicine providers (holistic medicine) to facilitate improvement in this area?

From: Steve Hood

Hi, Dana

I have no idea how often speech-language pathologists make referrals to holistic providers. I also am not sure precisely what you mean by holistic medicine. In cases where it seems appropriate, I discuss the possible values in referral to a psychologist who is knowledgeable about stuttering, although the majority of psychologists know relatively little about stuttering.

In the meantime, I do what I can to help build the person's morale, self-image, ego-strength, or whatever it is you wish to call it, and I try to find ways to help people feel good about themselves. I think it is also helpful and important to work with the child's family so that they can also help do things to boost the child's morale and feelings of positive self-worth.

Hope this at least partially answers your question.

From: Woody

To answer first your question about how we determine what we are qualified to work with, it is simple a matter of how we were trained. My students, for example, are well trained to work on the psychological aspects of stuttering as well as on speech motor aspects. But if a SLP were trained only in fluency shaping, or some other of the control therapies so that he/she only knew how to deal with speech motor aspects of stuttering, than that is all she can ethically work on.

Self image is a more general psychological problem, but in a stutterer it may be very focused on the way the person presents him/herself via speech. Some speech pathologists will be equipped by virtue of their training to work on this aspect of the problem.


From: Walt Manning

How much a therapist might focus on self-image (or self-esteem, self-efficacy, assertiveness, risk-taking, etc.) and whether or not the therapist may refer the speaker for other professional services depends entirely on the needs of the client. I think that all professional clinicians operate from some philosophical approach and overall strategy, the client really determines what is necessary for change. Some clients require amazingly little in the way of direction and information. Others, of course, need so much more and usually over a long time. In such cases the change process is much more complex and, I suppose, has as much to do with how these people have reacted to their lives to date - not just the fact that they stutter. It's not often necessary, but we have referred clients to several other professionals as needed. I think we can all benefit from changes or improvements in our self-image but it's probably not necessary in all cases in order to come out from under the handicap of stuttering. And that's all I have to say about that!

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anger in children who stutter

From: Judy Butler


I would like your on how children who stutter express their anger. I imagine it takes many forms since speech is not so easy. How can parents and SLPs help children with this issue?

From: Steve Hood

Hi, Judy-- I am not sure if you are asking how DO children who stutter express anger, or how can we help children express anger in a more socially acceptable way. I'll try to give you some thoughts on this, but hope you realize that since I don't know any of the details (e.g., ages of the children, etc) I can not be overly specific.

First, I think it is important to try to determine whether the anger is related to anger regarding stuttering, or generalized anger about other things. In order to help children deal with anger, it is important to know the source(s) of the anger. It is also important to realize that feelings of anger are normal. We all have them. The crucial issues are such things as how **often** we get angry, the **duration** of how long the langer lasts, and the degree of **intensity** with which we experience the anger. If the anger is frequent, long duration and intense, then additional services from a child psychologist may be in order.

With respect to stuttering, it has been my experience that most children who stutter develop some degree of anger, but not to a marked extent. Indeed, there are some children who go to great lengths to keep the anger inward, and attempt to deny and hide it. These are highly individual issues, and I feel unformfortabe dealing with specifics.

I can, however, give some guidelines that may be helpful: First, help the child realize that some degrees of anger are normal and natural, and that it is ok to feel angry. If a behavioral outlet is required, there are acceptable ways to blow of steam such as hitting a punching bag. It is helpful to help the children realize that stuttering is not their fault, and that they are not bad, worthless, stupid, or unworthy because of stuttering. Do as much as you possibly can to help build such things as self-confidence, ego-strength, morale, and feelings of positive self-worth. In addition to helping the child have a happier childhood, it will help the child enter the next stage of adolescence with less emotionally negative baggage.

My response has only scratched the surface, and I hope others will respond.

Good luck,

Steve Hood

From: Ellen-Marie Silverman

Jason's Secret, a middle reader novel I authored addresses anger associated with stuttering (two chapters are accessible via this converence. See: Panel - Children's Books). Jason, age 10, struggles to keep his stuttering secret from his classmates. His development of an enlarging world view with the assistance of his father, homeroom teacher, and school speech pathologist, allows him to modify those feelings as he increases his speech fluency. I hope reading "Jason" helps you meet challenges you are facing. Ellen-Marie Silverman

From: Judy Butler

Thanks so much for your reply. I immediately read the two chapters of your book. You did such a fabulous job of capturing the turmoil going on inside children that the world does not see. When I ask children about their feelings, they seldom admit that this is going on. I learned about these emotions from adult support groups, especially during open mike sessions when adult PWS sometimes recall horrendous childhood memories. And, when I try to inform parents and teachers about how children can get so twisted up inside, they are skeptical because what they see on the outside is a child who is somehow not appropriately engaged in what is going on. A child who they assume is distracted, lazy, lost, or whatever. So, I think your chapters would be excellent reading material for the adults in a child's life.

Thanks again, Judy Butler

From: Ellen-Marie Silverman

Thank you, Judy! In other chapters of Jason's Secret (not available) interactions with parents and an older stepbrother further highlight the turmoil a child with a stuttering problem can feel at home when he feels isolated and alienated from his family members.

From: Woody

This is such an important question. Children are, I think, first of all frustrated in their attempts to speak, and frustration is a form of anger, usually turned inward, that is, one is angry with oneself. In addition, children typically turn their anger inwards anyway, maybe because they lack power in an adult world. So the clinician does not see anger expressed very much even though the children are angry, and when it is expressed it takes child-like forms. What I look for in a clinical situations is displacement of the anger toward objects -- hitting and banging things, breaking things. All children like to express feelings of anger and power, but really angry children do it with more intensity. So, for example, any child will want to knock down a tower that he or she has made. The angry child might really smash it down. Sometimes, too, angry children make gestures that are hitting types of gestures, but made near or next to the person they are angry at. They hit the air off to one side of the (usually) parent. Another way to see it is in the pictures they draw. Children who draw monsters and evil looking characters are often identifying with the power these characters seem to have. When the child is extremely angry, they will talk about violent things, maybe hurt animals, or show some other pre-occupation with violence. I have seen very few stuttering children with this much rage, but I can remember a few. One of them threw a chair at me. I thought that was pretty direct.

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DAF for young children?

From: Gert Reunes

At what age you can give therapy with DAF?

From: Ken St. Louis

My opinion is that you could use DAF with very young children if (1) they can tolerate the headset (2) they have a cursory understanding that this will help them learn to talk in a different way, and (3) DAF has been shown to have the salutory effect on their speech that was expected. Basically, if one lets DAF control the rate of one's speech, he/she will end up prolonging syllables (along with talking louder [Lombard Effect] and--sometimes--slurring speech, repeating syllables in multisyllabic words, etc.) The primary benefit seems to come from prolonging the speech, resulting in a slower, more deliberate pattern. This speech pattern, like many that are taught in fluency shaping programs is quite incompatible with the usual stuttering; hence, stuttering often drops out. Adults typically concentrate more on their speech under the influence of DAF. This may not occur consciously with children, but it may not be necessary, so long as the resulting speech is more prolonged and more fluent.

From: Vikram

I wish to comment on the response made with regards to the use of DAF or similar feedback mechanisms with children who stutter. Our research group at East Carolina University has investigated the issue "Does fluency enhancement under DAF results due to the resultant slowed speech". The results indicate that under fast rates of speech, the person is still fluent. I would think that these effects do indicate something very different from that observed when contemporary therapy techniques are used. Not to forget the usual unnatural sounding speech that results from this form of therapy.

From: Gert Reunes

Unnatural sounding is something more in the ear of the stutterer than for the listener. Is it possible to learn the stutterer that this unnatural sounding is natural sounding for the listener? Which techniques can we use for this change in thinking?

From: Walt Manning

As Ken has already mentioned, the fluency enhancing effects of DAF may be due to several factors, especially the slowing of speech. I don't think that it is necessary to use DAF in most cases with younger children in order to slow the speech. One other effect of disorting auditory feedback in some manner is that it helps (forces really)the speaker to pay attention to their motor planning and proprioception. This can be an important part of achieving fluent speech and is especially important for making fluency stable in the long term. Performers (athletes, speakers, singers,etc)tend to relay on that type of feedback to monitor performance. I suspect that people who achieve success in treatment(or out of treatment)do so in large part by learning to monitor proprioceptively.

From: Gunars

Walt, How do you teach clients to proprioceptively monitor if they chronically experience/report "Petit Mort" during their blocks? [Those who go into panic mode, "space out", and report that they do not know what they are doing during the severe blocks.]

From: Bob Quesal

Clearly, we have to get our clients to deal with the panic (if panic is something they experiece) before we can get them to self-monitor. It's not cut-and-dried--different clients have different needs and respond to different techniques differently at different times.

I have worked with stutterers who have been able to proprioceptively monitor nearly from the first session--others take years to reach the point where they can do it.


From: Nan Ratner

Just a fast note to say that our experimental work on this subject (and the literature on speech development) suggest that very young children (around age 3-4) are not affected much by DAF because they haven't fully developed auditory self-monitoring strategies, thus they wouldn't profit from the use of DAF as a therapeutic adjunct.

From: Vikram Dayalu

Could you tell me the differences in stuttering frequencies for young children who stutter on the DAF condition as compared to the NAF condition? If possible, I would be interested in knowing the nature of delays used? Any information would be truly appreciated.

From: Tim Saltuklaroglu

Could you please tell me what you mean by 'auditory self-monitoring strategies' and how they are necessary for DAF to be effective as a fluency generator? Thank you tim

From: Nan Ratner

In our work, we were asking whether or not young children, whether they stutter or not, hear themselves under DAF, since an older literature suggests that children are better at monitoring the speech of others than their own at a very young age. The task we used was simply labeling single words from picture cards, thus no child stuttered, to answer the first question. Auditory self-monitoring is the process by which we monitor what we are saying as we say it. Because adults do this actively, changing the relationship between what they are doing (talking) and what they are hearing (DAF) creates a mismatch that must be dealt with somehow, either by slowing, prolonging speech, etc etc. If you aren't listening to yourself much when you talk, which is more typical of very little children, no adaptive changes to speech production occur, and therefore, you would not expect any facilitating effects of the DAF, because it is not the DAF that produces the fluency, it is the REACTIONS to the DAF that does the "trick" insofar as it works in some cases (but not all). Nan

From: Joe Kalinowski

This "assumes" that we "know" the agent of fluency enhancement under DAF or any fluency enhancement strategy. We have no idea --only speculations! I suggest that we do have behavioral, auditory, gestural and other phenomena that induce fluency, but we have no idea what "the agent of fluency is" --although we all speak with such certainty. . Propioceptive monitoring is nothing more than a "guess" (an educated guess--but not much more) as the agent of change in children or adults who stutter. We do not know what causes stuttering or fluency enhancement and that is why we are in the bind that we are today. How do you definitively treat something that you do not know "what is broken" or what to fix?

My colleagues and I suggest that stuttering isn't the problem but the ANSWER, much like a fever is the answer to an infectious disease state. You can treat the fever, BUT that just masks the problem. That is the cases with stuttering therapy at the current time--we are treating the symptoms and confusing it for the pathology.

I refer you to:

Kalinowski, J., Dayalu, V., Stuart, A., Rastatter, M.P, & Rami, M.. (2000). Stutter-free and Stutter-filled Speech Signals and Their Role In Stuttering Amelioration. Neuroscience Letters, 293/2, 115-118.

From: vikram dayalu & tim saltuklaroglu

We are both doctoral students researching stuttering at ECU. We first wish to thanking you for your response as a great deal of our research has dealt with the effects of DAF. We would appreciate it if you could comment on some further issues about the effects of DAF?

Thank your for your time. Any information regarding the following questions would be greatly appreciated

1. As the task you mentioned was picture naming and did not elicit continuous or stuttered speech, how have tested that DAF had any effect at all? (It is our understanding that for DAF to be effective, both these criteria must be met)

2. Could you tell us about the delay time used in your DAF studies?

3. How do we know that young children are not paying attention to their own speech (auditory self-monitoring)? It appears that evidence exists to support the notion that children are sensitive to their own stuttering even at young ages.

4. Could you give us some more information on why the effects of DAF are considered a 'reaction' to the stimulus?

From: Nan Ratner

I was testing auditory self-monitoring, not DAF per se. Thus, I went from the speech production/perception literature that used it to test self-monitoring in children, not fluency enhancement. Simply put, if a child does not change speech, does not perturb speech in any way, such as lengthening of segments, the conclusion that has been reached in earlier literature (see my chapter in Curlee & Siegel, 1997) is that the child does not perceive the feedback. The children in our study did not really make many adjustments in their speech when their normal side-tone (simultaneous feedback) condition was compared to DAF. However, the stuttering children did respond slightly more, suggesting that they were somewhat more hyperattentive. My only caution is that people need to understand that DAF might not be appropriate for VERY YOUNG children because of differences between toddler and older people's auditory feedback propensities. See the references in the Curlee & Siegel (1997) chapter for those references, of which there are a few, mostly generated by people asking why children did not automatically self-correct articulatory errors.

best regards, Nan

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DAF in the ear device

From: Gert Reunes

Hello Dr. Kalinowskij, When can we expect a DAF in the ear device? Best regards, Gert

From: Stuttering Research Lab

We should have the device for field trail soon.

From: Gert Reunes

Can you give us the size and also perhaps the price such a device will cost?

From: Stuttering Research Lab

Its an In-the-ear device. I am sorry but I have no idea of its cost. Our aim is to first investigate its efficacy.

From: Gert Reunes

Testing the results on fluency...??? or testing the device?

From: Joe Kalinowski

Didn't you talk about getting Bill Gates to donate a million dollars to a stuttering charity and then that organization would give these fluency aids away? I hoped that you had contacted him by now (no kidding — money moves the world — or at least that what it seems like in this situation. WE would be glad to help, I want so badly to have two or three hundred of these in the ear aids to all the people who have contacted us over the years The problem is that we are academics, not businesspeople, engineers, nor bureaucrats, so our progress is slow . We realize that people are waiting for our help and a different therapeutic alternative.

Drs. Troy Nagle and John William Ledbetter of NC State University are working on the device. You might want to contact them for more information.

From: Gert Reunes

Hello Dr.Kalinowdki. I am now working at the university of Antwerp. On a project on cochlear implants. There are more stutterers then deaf people and if you see how much such an implant costs...25000 US $ And they are giving it for free to the deaf people... ok I am happy for this people but why is it so difficult for us stutterers. In fact I know people who will invest in certain projects but if there are still people who are saying that stuttering is a psychological problem...

From: Bill GATES

OK Dr. Kalinowskij I will give you a grant of 100000000000000000000000000000000 million US dollars for your device. 😄

From: Joe Kalinowski

You can build your own device in Europe and the rest of the world. The best way is to stay in the analog domain an stay with DAF. All rights for analog DAF expired long ago.

From: Gert Reunes

Why only analog? Digital is the only way to make the device smaller. I am not interested to be the first for making the device smaller, but I am certainly not the only one who is waiting for such a device not only for me but also for my fellow stutterers.

From: Joe Kalinowski

Just because it is easier! I'm tired of waiting too!! I thought someone else would do this by now, but the only thing our there is Casa Futura's bulky devices and the "fluency Master" which provides a questionable signal. You can be that person!!

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The right hemisphere

From: Gert Reunes

As a stutterer and speech therapist I use often the Hausdorfer-methode what is best known in the Netherlands and Belgium. We use a technique that is almost similar with singing but it isn't. We pronounce our vowels and consonants with enormous variety of intonation, and we speak also more slowly (cfr DAF). With a lot of attention to the listening of the sounds. When you practice this a lot you become almost 100% fluent! Can it be that we trigger our RIGHT HEMISPHERE more than the left, and that the synchronization of our speaking has now a dominant hemisphere (the right one, or maybe the left one because now the right has a lot of work to do...)??? Is the fighting of the two sides of the brain not the answer to our stuttering??? After doing this for a long time, you are speaking naturally but it takes time... about 2 tot 5 years practicing with in our mind that we have to work on our speaking for the rest of our lives.

From: Dale Williams

Gert, Why some speech is fluency-enhancing is another of those topics in stuttering for which there has been much speculation. As you suggested, the right hemispher's role in processing longer durations and transitions is one proposal. Potentially related to this is the observation that speech involving longer phonatory durations and decreased rate reduces stuttering. But others have advanced the notion that any speech that is less variable in its production is easier to produce fluently. There are other theories as well. So as for your question about hemispheric asynchronization being the answer to stuttering; all I can say is that it's speculative at this point.

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Child stuttering

From: Lisa Webb

My four-year-old daughter has had a slight stutter for over a year now. It was a rare occurrence. But for the past month, the stutter has gotten much worse. Sometimes she has trouble getting through a sentence the stutter is so bad. My question is this: Do we wait until next year when she goes to kindergarten and let her go to speech therapy at school or is this something that needs to be treated now? Will it be harder to correct if we do not treat it now?

From: Ken St. Louis

Hi Lisa,

I'd like to try to answer your question about your 4 year-old daughter who has been stuttering mildly for about a year but noticably more in the past months. I would advise you definitely not to wait to arrange for an evaluation of her speech by a qualified speech-language pathologist (SLP). You will need to interview the SLP to be sure that he/she agrees that it is a good idea to intervene and treat young stutterers. (You see, for more than a generation, the conventional wisdom was to "wait and see" because it was believed that anything the parents did to draw attention to their child's stuttering would make it worse. We know that is not true now. In fact, the evidence in becoming very clear that the earlier we treat children who stutter, the better the outcome is likely to be.)

You may decide you would like to try to seek out a specialist. There is a specialty recognition program underway, but it is not far enough along to provide you with a list at this point. Your best resource for now would be to visit the Stuttering Foundation of America Referral List to see who in your area has indicated a willingness to be listed as a clinician or resourse person for those who stutter. The website is:

I must tell you with utmost seriousness that nobody can guarantee a particular outcome for your daughter. I must also tell you that there might be extenuating circumstances that would make her case unusual. But given those caveats, you should be aware that your daughter has a fairly good chance of "outgrowing" her stuttering. Since she has been stuttering for more than a year and since her stuttering was probably mild, her chances for what we call "spontaneous recovery" is probably around 40-50%. Even so, there is very, very little evidence that having her evaluated and treated will increase her risk of getting worse. If she is a good candidate for therapy, I would guess that her chances for an excellent outcome are probably above 80% (a complete "cure," i.e., no stuttering at all, is also a realistic possibility). If you wait and your daughter does not recover spontaneously, she would still stand to benefit a great deal from therapy, but the likelihood for a complete cure will be lower. The longer she waits, even with a successful therapeutic outcome, the less likely she will grow up not stuttering at all or even remembering that she stuttered.

My daughter stuttered at that age and, thankfully, completely recovered. Girls do seem to be more resilient than boys in this area. That is no doubt part of the reason there are more males than females who stutter.

I wish you the best. There is good reason for hope!


From: Steve Hood

The advice Ken gave you is excellent, and I hope you follow it.

Let me add that if you go to the host site for this ISAD on line conference, you can also get some good ideas. Go to: You will find a tremendous amount of information. In particular, I would suggest you go to the link on INFORMATION ABOUT STUTTERING. Scroll down, and you will see a section with INFORMATION FOR PARENTS. This includes suggestions of things that you and the family can do to be helpful, and to create a "talking environment" that may prove helpful to your daught. Most of these suggestions are the kinds of things that will be helpful to ALL chldren, not only those who are at risk for stuttering, or actually beginning to stutter. Suggestions include such things as: allowing pause-time and "turn taking" between speaker and listener during conversation, minimizing times where there is verbal competition, reducing interruptions and contradictions, speaking in a way where you model a slighly slower speaking rate-- with a little added inflection and melody.

Without knowing your precise situation it is difficult to be overly detailled, but I think you will find some of these suggestions helpful.

From: Dale Williams

Lisa, The issues of spontaneous recovery and early intervention are controversial ones (see last year's conference). Allow me to wade in with some thoughts.

A common misconception is that all children go through periods of stuttering and, thus, the best plan of treatment is to wait it out. Stuttering is, by definition, a communication disorder and therefore not part of normal development. Furthermore, abnormal fluency may be a symptom of a disorder other than stuttering.

Parents may also be hesitant to seek help because some children stop stuttering on their own. But while estimates of spontaneous recovery vary greatly, it is clearly not a universal phenomenon. More to the point, there is presently no way to identify which children will recover. Thus, even if spontaneous recovery is as high as 80%, as the most optimistic reports have suggested, there is no guarantee that your daughter will not be the unlucky 1 in 5 whose stuttering persists.

It has been my experience, generally speaking, that the earlier the stuttering is treated (relative to its onset), the easier it is to manage. I am not necessarily referring to regular sessions with an SLP. Early stuttering can sometimes be ameliorated via adjustments in the home and other environments.

My suggestion is to first get an evaluation by a speech-language pathologist. Then you can determine whether direct treatment is indicated at this time, if there are adjustments you can make in the home that will help your daughter, or both (or neither). At the very least you will have more information than you have now.

From: R. Saavedra

First of all, what is stuttering? My son is 5 years old and he is in pre-k. Last week his teacher told me that he might need some speech therapy becuase he stutters. For about a year now, I've noticed my son having dificulty communicating. I will give you an example of what he says: If he is going to say "I want to go outside." He'll say,"I I I I I I I want to go outside." Is this stuttering? I might also add, that we speak both English and Spanish at home and he does this in both languages. Do you think he needs professional help? Is it true that it's hard for a child to learn two languages at the same time?

From: Steve Hood

Hello, R.S.

It is not appropriate to try to make a diagnosis over the internet, but from what you have observed over the past year, and from the fact that your child's teacher is concerned, I certainly feel that it would be wise for your son to receive a complete speech and language evaluation. This evaluation will also be helpful in terms of making recommendations regarding the pros and cons of having him learn two languages simultaneously. With respect to stuttering, we tend to look at four speech factors in determining whether or not the child is beginning to stutter. We look at the frequency of the disfluency, and when we find that the child is disfluent on about 5% of the words spoken we feel he is borderline with respect to a problem. When we get up to 10% we have more serious concerns. The second thing is the degree of effort/tension/struggle associated with disfluencies. Disfluencies which are easy and effortless and rhythmic are not of particular concern, but when they are disrhythmic and uneven, and showing signs of tension, then we are concerned. Thirdly we look at duration. Short duration and brief disfluencies are not usually a sign of trouble, but when they reach or exceed one full second then we become concerned. Finally, we look at the types of disfluencies. Disfluencies involving the repetition of a whole rode or part of a phrase are not as much of a danger sign as repetition of just a sound or even syllable. Examples like-like-like this or like-or like-or-like this are not as serious as d-d-d-d-doint this. Sound prolongations lllllike this are also among the danger signs. Another danger sign is when the child is becomming aware, and reacting negatively to his disfluencies. If he is showing awareness, surprise, frustration, feeling that he is "not talking correctly" would be danger signs.

I believe your child should receive a complete evaluation. I also encourage you to go to: and read the sections dealing with stuttering in children. Also, under the link to Information About Stuttering there is a nice section with information for parents.

From: Nan Ratner

It is hard to tell from your example whether he is prolonging or repeating the first sounds in words, and how often he does this. I know that others will respond to your first question, so I will respond to your last question: whether being bilingual has any effect on a child's fluency. As far as we can tell, it does not. Being bilingual is not "dangerous" for children's speech and language development.

From: Ken St. Louis

Dear Ms. (or Mr.) Saavedra,

I’m sorry I can’t tell for sure if you are the mother or father from your message. It doesn’t matter; my answer is the same. Actually this is the second answer I have drafted; the first one got lost in cyberspace last Friday before I posted it.

From you description, it appears that your son is manifesting whole-word repetitions. Are these "normal disfluencies" or are they instances of real "stuttering?" Whole-word repetitions, especially those that are single syllable words at the beginning of sentences, indeed are an ambiguous case—often they are normal but sometimes they are stuttering. My best guess is that your son is in the beginning stages of stuttering. I say this for three reasons: (1) you are concerned and have noticed that he has "difficulty communicating" (2) his teacher has noticed a problem as well (and teachers hear enough normal children to realize when these disfluencies seem to cross the line to constitute a problem), and (3) he has been doing this for at least a year.

My recommendation is to take him to see a qualified speech-language pathologist for an evaluation. May I suggest you take a look at my response to Lisa Webb for some tips on finding such al person? This way, you will have a professional opinion and not be obliged to guess on your own.

I wholeheartedly agree with Nan Ratner’s response to you regarding the "unlikelihood" that your son’s bilingualism has any important role in the cause of his difficulty speaking.

From: Nick Ingram

Our 2 and a half year old daughter just started what looks like mild stuttering. She stayed with her grandparents for 4 nights without my wife and I for the first time last week. Whle there she started having trouble saying her "w's". So, on the phone she said to me "Wh..wh..what are you doing, daddy?" (She was doing this with the grandparents when we weren't on the phone as well.) Since coming back to our place and resuming her normal routine the stuttering has remained. She is saying things like: "I can't say it". It's obviously frustrating her. She has been a very good speaker compared to her peers till this point,but now we are noticing that she is using shorter sentences and one or two words only, where previously she would have used a longer sentence. She obviously avoiding words she has trouble with, particularly questions she used to ask all the time like "Where is ...". This change has made my wife and I think about two of her other speech patterns. Firstly, she has always lengthened the middle syllable in some words. She says "mooon" instead of "moon", for example. Secondly, she often says words twice, especially adjectives. For example, she says "special special treat", and "I want another nother one" or "I put it up high high". What's really got us worried is this sudden back step in her speaking, particularly her reluctance now to speak sentences that she would have handled easily until a week ago. Her obvious concern about this is also worrying. (By the way we have tried really hard not to make a big thing about this in front of her). I've looked on the net and there seem to be normal "speech disfluencies" at her age. Is it likely that this is all it is? Should we go to see an SLP? And is the Lidcombe programme based in Lidcombe in Sydney Australia? If so should we get in touch with them, given we live only 10 minutes away. Also, what can we do at home? I noticed on the net one suggestion to talk in shorter sentences to your child. I've always talked to her in the same way and using the same vocabulary as I might to an adult. Is this not a good idea?

Many thanks Nick

From: Dale Williams


As your daughter just started these unusual speech patterns a week ago I wouldn't rush to an SLP just yet. I know I stated elsewhere that the earlier the child is treated, the better and generally speaking, this is true. In my opinion, however, waiting 2-3 months will not change the prognosis should the disfluencies continue. In the meantime, there are some things you can do to make speech easier for your daughter. See Steve Hood's post on this same list for some readily accessible resources. Also, your point about normal disfluencies is an important one. In my experience, parents are quite good at identifying abnormal fluency in their children. Once the parents know it's there, however, they often start to classify every disfluency as aberrant. Excessive prolonged sounds and sound/syllable repetitions are consistent with the onset of stuttering in a 2 y/o. Other disfluencies (e.g., "special special" or "another nother") are not. The sites noted in Steve's post should help you sort these out as well.

From: Ken St. Louis

Dear Nick,

I can really empathize with what you write about your 2 1/2 year old daughter. At that age, my daughter began to stutter as well. Fortunately, she overcame the problem completely.

I believe you are looking at a beginning case of stuttering rather than normal disfluency, especially since she has expressed that she cannot talk as well and since she is experimenting with ways of avoiding stuttering (e.g., simplifying her sentences).

Since you live in Sydney, I would definitely suggest you contact Mark Onslow or Elisabeth Harrison at Lidcombe. Mark is at the Australian Stuttering Research Centre, Univ. of Sydney and Elisabeth is at the Stuttering Unit, Bankstown Health Service, Bankstown.

From: Lyn Detwiler

I have a 2 1/2 year old boy that has been stuttering for approximately 3 months. At first it was generally the first word in a sentence - for example Mom Mom Mom Mom I want drink. Now it is any word and several words in a sentence. At first I thought it was excitement or frustration at not knowing the right word but that doesn't seem to be the case. I spoke to my pediatrician about it and he feels that he will grow out of it. He feels that by my son seeing a speech therapist , it will only draw attention to the problem and hurt his speech more. I am torn on what is the right thing to do. Is early intervention the right thing for him?

From: Nan Ratner

As some of the other discussions on spontaneous remission indicate, there is a high degree of recovery from early stuttering in the first year after symptoms show up. So, a child who has been demonstrating the symptoms you describe for about three months, without undue stress, tension or struggle, would not seem to be a child highly at risk to continue. Roughly 80% of children who start to stutter do stop. As the notes here and elsewhere point out, though, if the behavior continues beyond a year OR the child begins to demonstrate struggle or concern about his own speech, then it is time to consult a professional, who can help the child manuever through frustrating stutter events, and who can begin to teach the child ways of speaking that make it less likely that the child will stutter. A professional can also help you problem solve conditions under which fluency is maximized for your child. There is widespread belief that bringing in a child or calling his attention to the stuttering is bad, but there is actually no evidence to support this, and the reported success of the Lidcombe programme (also reported at this conference) flies directly in the face of arguments like this. Quibbling over the relative merits of Lidcombe aside, if paying attention to stuttering were harmful, Lidcombe children should get worse, not better, and that is clearly not the case. Hope this helps. Nan

From: Dale Williams


Just one thing to add to Nan's note. The Stuttering Foundation of America web site is compiling a listing of SLPs with an interest and/or a specialization in stuttering. Should you decide to seek help, this is a good place to start. Good luck.


From: Marie

I am 17 and from the Czech Republic. I`ve been stuttering for 11 years now. What an awful number! I hate it. Now it is very bad. It`s never been so bad before. I can`t say a sentence without stupid sounds coming out of my mouth. I cannot stop them. Sometimes I feel like suffociating. My granparents told me to stop those embrassing sounds and stutter freely. I couldn`t say a word, somehow managed to squeeze my lips into a polite smile and quickly walked away, bursting into tears. Other people tell me to arrange the words in my mind before I start to say something. That really annoyes me. For goodness sake - I know EXACTLY what I want to say. They also say: ,,Take a deep breath." That doesn`t help either. I breathe in deeply - and the lot of air gets stuck and can`t go out with the words. Well, people surely don`t mean it badly. It`s my fault, that I don`t (and can`t) explain them, how things are.

Do you have any advice for me?


From: Nan Ratner

I would try to obtain some of the publications from the Stuttering Foundation of America (go to their website); they include advice for adolescents and a number of good self-help booklets.

From: Judy Kuster

There is an announcement about International Stuttering Awareness Day from someone in the Czech Republic at you can track down this person for some help and information.

Judy Kuster

From: Patrick

Hello, I'm a 14-year-old who stutters. I want to get rid of this problem, and I don't know how. Can you help me?

From: Woody

Hi Patrick:

You have already taken the first step in asking for help. I guess it is possible to improve your fluency, among other communication skills, on your own, but it is really hard. Most people need help, and there are a number of places to find it. I would say that the first step is to hook up with some other kids your age who stutter. You can do that through the National Stuttering Association or through Friends. Both organizations have websites and active programs for teenagers. Even this Stuttering Home Page has some specific items for teenagers. If you can find a local chapter of NSA and go to meetings regularly you will surely find some support there. These sources of support will build up your confidence in yourself and help you realize that you are not the only stutterer in the world, although it really feels as though you are in the beginning. Then, with the support of your fellow stutterers, you can begin looking for professional help if you want to. Again, I think you can do a lot on your own, but I think that it will be easier for you if you find a professional helper. Here you have to be careful. There are a lot of professionals, both speech-language pathologists and psychologists, who are not very helpful, and the work to find one that is right for you falls squarely on your shoulders. But persist. They are out there. Find someone who will listen to you. That's the first thing because then, if they don't know as much as they should about your problem, you can educate them. Ask for their credentials. They should be very willing to tell you about their education, certifications, and licensure. If they balk at these questions, or suggest to you that the formal credentials are not really important, run fast. If you can, find someone who is a specialist in the treatment of fluency disorders, recognized by the Commission on Specialty Recognition in Fluency Disorders. There are not yet very many of these folks because the program is new, but more are being commission-recognized every day. Finally, find someone that you feel comfortable with, that seems to understand the problem, and stay away from people who act as if they have The Answer. No one does, and those who act that way are trying to convince themselves.

Stay in touch with people too. Join the stuttering community. That probably sounds wierd and unpleasant, and the first step is pretty scary, but you will not be disappointed. Support is the answer and you want to get it wherever you can. It can be discouraging at times because the typical road to recovery, from stuttering as from everything else, is characterized by two steps forward one step back.

Trust your own instincts. Stuttering may make it difficult to talk to people, but it often seems to make it easier to listen, and you probably have excellent listening skills. When you hear something that doesn't sound right, coming from your therapist, try to help them understand. If they can change the way they think, that is a very good sign.

I wish you luck Patrick. It may be a difficult journey at times, but it is exciting and wonderful too, as many journeys are.

From: Jamie

I am currently a speech therapist in a public school district and in the first year of my masters program. I have come across a kindergarten child who has difficulty catching her breath and at times seems to talk when inhaling. I have spoken with her quite a few times and she seems to prolong vowels, but does not display any hesitations or prolongations on consonant sounds. This is not consistent, however, is evident in the classroom and at home. She has seasonal allergies, but has not been diagnosed with any type of respiratory problem. I was wondering if someone could give me some insight about this child. Would stuttering therapy possibly help this child to use more rythmic breathing? and is this considered "stuttering"?

From: Ken St. Louis

Dear Jamie,

This youngster sounds like she might be stuttering, but there also might be some serious respiratory problem going on. If I were in your situation, I would refer her to a good medical center that has all the usual specialties for a complete diagnostic workup before I did anything with her. As in voice therapy, I would want to have medical clearance to proceed with therapy.

If it turned out that the young girl was stuttering only, then I believe I would start with some relaxation exercises, breathing (perhaps lying supine and then progressing to the sitting position), easy vocalizations on exhalation, and finally to easy words. Then I would choose an approach to stuttering therapy that would hopefully address the symptoms that hopefully would emerge once the breathing and speaking on exhalation were somewhat normalized in highly selected speaking tasks.

It could be a long haul. Good luck.


From: Elizabeth Gormley

I know that many children go through a "stuttering phase." A year ago, my four year old niece occasionally stuttered. It seemed it usually occurred when she was excited and had a lot to say. How should you handle the situation with a child going through this phase?

From: Judy Kuster


There is a lot of very good information about how to handle this situation on the Stuttering Home Page at

Two of the professors that were a part of this Prof is In section have written some excellent information linked at the above URL. The direct URLs to their suggestions are by Steve Hood and by Woody Starkweather,

Judy Kuster

From: patti kenney

has any research been done to see how siblings interact and treat their siblings who stutter? Do they usually they point it out to the stutterer or do they accept them no matter what?

From: Woody

Siblings react in all different ways. Some are wonderfully supportive in the therapeutic effort. Others are angry at the attention that the stutterer gets and do everything they can to sabotage the clinician's efforts. And there is a full range of other possibilities between these two extremes. Generally, I have found siblings to be more helpful than not, and on a few occasions they have been the key to a successful outcome.

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The Lidcombe Program

From: Andy Floyd

Recently, I've been hearing a lot about the Lidcombe program. Dr. Guitar mentioned some positives during a talk he gave at NSA 2000 and Dr. Ann Cordes Bothe's positive decription of an adapted Lidcombe approach in her article in this conference. I am really interested in everyone's opinion on this approach. When I first read about it, I was shocked because I thought it was everything I was told not to do or tell parents to do. But, I've only heard positives and as Dr. Bothe wrote in an answer to a question of mine in this conference, she corrects the kids "as positively as possible." Have I been telling parents the wrong things for the past year or is the Lidcombe program just another possibility in the ever widening whirlpool that is fluency therapy?

From: Ken St. Louis

Hi Andy,

I assume you are a speech-language pathologist or an active leader in the stuttering self-help movement. It sounds like the advice you have been giving stems from the Wendell Johnson diagnosogenic theory of stuttering. (See my letter to Lisa Webb.)

I have not used the Lidcombe Program much yet, but I have been impressed with the data I have seen on its effectiveness. Young children are malleable in lots of ways, so it does not surprise me at all that they can learn new ways of approaching speech that are incompatible with stuttering and struggle and that become "the way they talk" thereafter. It also does not surprise me that many parents can be taught effectively to administer much of the treatment.

Of course, there will always be extenuating circumstances wherein the Lidcombe Program would not be the best choice, e.g., in cases where family members cannot be counted on to carry out the carefully supervised interactions.

From: Nan Ratner

As someone who has done some data analysis of Lidcombe with Onslow and his colleagues, I think it is important to understand that what the parents do in this program can be labeled differently by different people. While it is easy to see the program as operant, it is also easy to see the program as one that brings stuttering out into the open for family discussion and problem solving, as well as Rogerian, since many parents on the tapes I have seen appear to "reflect" what the child is saying when they provide feedback. An article we just published in Clinical Linguistics and Phonetics also suggests that the positive reinforcement of the child's short and fluent utterances APPEARS to produce an effect of the child using more short, simple utterances in their speech, which can lead to increased fluency.

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monitoring / panic / petite mort

From: J. Scott Yaruss

Hi all... wow - finally found something I can post on that my friends didn't beat me to ;=)

It's not much, but I wanted to add in a comment in response to Gunars's post...many adults who stutter do report an experience of "losing touch" during a hard block, which Van Riper termed the "petit(e) mort"...In fact, Lou Heite is currently completing a thesis on this topic, and may have something to add...

In any case, I wanted to suggest that we do work directly on minimizing the intensity of the "loss of control" feeling during the block, in part through education and desensitization of the stuttering moment. My impression is that people are better able to engage in active proprioceptive monitoring -- and even speech modification -- once they have made some progress in the desensitization process.

During an intense block, it may be very difficult if not impossible to engage in active monitoring or modification if the speaker is experiencing the petite the speaker becomes better able to tolerate the unpleasant experiences and feelings that accompany the block, their ability to manage the block through proprioception and other methods increases...

That process of desensitization has been discussed previously by my friend Bob Quesal as helping the client learn to "stay inside a burning house..." In other words, rather than experiencing the panic and the NEED to get out of that block immediately, we help the speaker learn to tolerate staying in that block (though activities like holding on to blocks and pseudostuttering)...once they can stay in that burning house and look around, then they are better able to engage their modifications, whatever they may be.

Hope this contributes a little...TFL (thanks for listening...)

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Spontaneous recovery

From: Jennifer Smith

I have three questions.

1. Is there any neurological basis for the occurence of spontaneous recovery in children who stutter?

2. Does anything specifically increase the chances of spontaneous recovery?

3. Exactly why don't adults spontaneously recover?

From: Ken St. Louis

Dear Jennifer,

I'll take a stab at your first question. First of all, there is a neurological basis for anything any animal does. I'm sure you know this, so there is no need to elaborate that point further.

I may be wrong, but I assume you mean, "Is there any known relationship between a neurological etiology and spontaneous recovery in stuttering?" I am sure there is, but I don't know what the necessary parameters and interactions are. Others may be aware of specific data on this issue, but my experience is that the more likely there is other evidence of neurological involvement (e.g., oral-motor impairments, fine motor incoordination, sensory-perceptual difficulties), the less likely the young stuttering child is to recover without therapy--or even with therapy for that matter. By contrast, if a child has no other symptoms but stuttering and the onset and early course were what Van Riper would call Track I stuttering (accounting for about half of all stutterers), then the likelihood of spontaneous recovery seems to be better.

I must hasten to add two things. First, as Roger Ingham pointed out years ago, there is probably no such thing as "spontaneous" recovery alone. Nearly everyone who stutters has been given advice, has tried various things on his/her own, and so on. What "spontaneous recovery" means really is that the child recovers without formal therapy. Second, the etiology of most stuttering (even for those in Track I) is most likely related to some sort of subtle discoordination in the mechanisms of breathing, phonating, and articulating as they function in speech. If one were to oversimplify, this would suggest more of a physiological (e.g., "neurological") basis for the stuttering than psychological or learning. So from this perspective, there will always be a neurological basis for spontaneous recovery.

Tough question that really cannot be answered with certainty at this time in my opinion.

From: Gunars


I agree that we can view spontaneous recovery as a result of something that the subject does. I believe that the operant factor in spontaneous recovery is the change in attitudes that the child undergoes either a) due to his own observation of reality, b) due to rethinking of reality as a result of the stimuli from the environment, such as casual advice from adults or friends or the provision of a less demanding environment for the child with less pressures, and c) due to therapy and therapist induced changes, such as demonstration that a child does have some control over his speech, that he can cope with his problem, and that he is unconditionally acceptable whether he stutters or not (Rogerian unconditional positive regard). When the therapist de-awfulizes and de-catastrophhizes stuttering, I hypothesize, he demonstrates to the parents and the child that does not make the "tyke" is some type of deviant, but a lovable, warm human being who is able to cope with stuttering and calmly work himself out of his problem. The recovery, thus, is not "spontaneous" but "evolutionary" and often "indirectly" directed.

I think that the study of these "evolutionary" and "indirectly directed" recovery examples would yield some very, very interesting data. My hypothesis is that the self talk of the child would be something like, "I like me. I can learn to cope with many things. Stuttering is just one of these, that although bewildering at times, does not make me a bad person. The degree of struggling and forcing can be minimized."

What do you think?

From: Ken St. Louis

Hi Gunars,

You described many of the reasons that people do get better as a result of therapy (and certainly you mention therapy in one of the possibilities). Occasionally these occur without therapy. But I think most of these factors never reach a conscious level of attention in what we typically regard as spontaneous recovery. In most such cases, the stuttering just goes away as mysteriously as it appeared. This happens often in young children and occasionally in adults. We had a college student here years ago who stuttered mildly all her life. She had some therapy, but never worked very hard at it or felt much need for it. After one Christmas break, she came back to school not stuttering anymore. I asked her what happened, and she had no idea. "It just went away."

That's what I was talking about more than therapy-induced recovery or self-therapy-induced recovery.

From: Beth LaRosa


I'm a first year graduate student and just recently began working with clients. I'm wondering how and/or if the topic of Spontaneous Recovery should be discusses with parents of children who stutter? If so how would you go about explaining this? Is there a particular cut-off age where it is mostly likely that the child will remain a PWS?

From: Bob Quesal

Hello Beth:

This is an extremely difficult question to answer--I wonder why I'm even doing this, but I'll give it a stab....

There is a reasonable amount of controversy about the whole idea of "Spontaneous Recovery." (It's probably one of those terms that, over the years, has lost whatever usefulness it may have once had.) Depending on who/what you read and how you interpret findings, there may be as many as 80% (that's probably a very high estimate) of DISFLUENT children who go on to have normally fluent speech. Whether those children ever "stuttered," in the sense that I would use the term, is questionable.

By the time most SLPs see disfluent children, something has been going on long enough that the parents are concerned about the child's fluency. In some cases, parents may be overly concerned about normal disfluency (but that typically is not the case--the parents' concerns about their children's fluency are valid ones). I suppose (am I going out a limb here?) that for those parents whose children are truly showing normal disfluency, we could talk about the 80% who recover "spontaneously."

However, I see the issue of spontaneous recovery as being a dangerous one in that parents (and people who stutter) often hold out hope that their child (or they) will be one of those who "outgrow" stuttering. In last year's ISAD conference, there was a spirited debate about whether we should withhold treatment until we are sure that a child is showing signs that s/he is a "stutterer." The arguments on both sides are compelling (and made by folks a lot smarter than I am) but the notion that I kind of like is that if we provide intervention and the child spontaneously recovers, we haven't hurt the child by intervening. If we withhold treatment in the child who truly is at risk to stutter, we may be delaying valuable intervention.

I'm all over the place with this answer (I told you it was a tough question), but let me try to summarize:

Some disfluent kids will spontaneously recover--whether those kids represent a subgroup of "stutterers" is subject to question.

If we see any signs of possible stuttering in kids, I think it's a good idea to intervene. We may do very minimal or peripheral intervention, but I think we should do SOMETHING.

To tell parents that their child could spontaneously recover is dangerous, in my humble opinion, because it has the potential to delay treatment and set the parents up for disappointment.

So, my considered opinion would be that it's best not to talk about spontaneous recovery with parents. If they bring it up, I think we need to discuss it with then rationally, but make them aware of the many unresolved questions that surround the concept.

I sure hope someone else will help me out on this one! ;-)>

I hope this helps, at least a little bit.

Bob Q.

From: Nan Ratner

There has been discussion on this topic in other places during this conference, but,briefly, about 80% of children diagnosed with stuttering appear to get better, apparently without intervention. Work done by Ehud Yairi and his colleagues (look him up on pubMed or EBSCO) suggests that stuttering has its highest rate of recovery within 12-15 months of onset, and that after that, recovery rates drop, although it still happens. Ramig noted that when stuttering has persisted for a number of years, even in a young child, recovery is somewhat unlikely without intervention. Yairi also noted that, for children who would recover, tracking disfluency showed a fluctuating but declining profile across time, rather than abrupt disappearance, while chronic children showed a flat or worsening profile. Other factors identified by this team as negative prognostic indicators of recovery were: sex (boys recover less often than girls), language ability (poorer language skills yield poorer recovery rates), duration of the problem, and age of onset of symtptoms (late onset was a somewhat negative prognostic indicator.) As a recent discussion in AJSLP noted (see articles by Curlee & Yairi, and by me), these are not absolute markers, but rather factors that can be used to help parents decide whether they wish to continue to monitor a problem, using help from a clinician to palliate symptoms and prevent secondary problems from developing), or seek active intervention.


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prognosis and severity

<From: tlcmd

Is there any research to compare "cure" rates to severity of fluency disorder? Assuming a child responds well to treatment what is the likelyhood of recurrence of disfluency? Is ongoing or intermittent therapy required after successful treatment in order to maintain fluency? Is there a predictable pattern or outcome of severity for children who do not spontaneously improve who have or have not undergone therapy?

Thank you for your responses and .

From: Nan Ratner

You posed a lot of questions, so I think that is why no one jumped in right away. Let me try to lump your questions into a few areas for a fast answer and then we can continue to discuss. Severity of stuttering in young children is not easily related to prognosis, according to relatively recent data collected by Ehud Yairi and his colleagues (one source: Journal of Communication Disorders, 1996). In general, prognosis can be affected by a number of variables (see discussion in American Journal of Speech-Language Pathology, Vol 6, No. 2, 1997 for a round-table discussion). Factors such as age of onset, family history, language functioning and specific trends in the nature and frequency of behaviors over the first year post onset are potential factors in predicting chronicity, as is gender (boys do not recover as well as girls). Severity, as measured by pure frequency or presence of secondary symptoms, has not yet been shown to have strong prognostic value. You may want to hunt up the collection of articles in the AJSLP volume for more detailed musings on this. Hope this is OK for starters.

From: Woody

There is a known relationship between prognosis and severity. IN an article Sheryl Gottwald and I published some years ago, we found a significant, but rather modest, correlation between severity and the speed of recovery in therapy. But, as Nan said, there are many different variables at play. IN our article, the largest correlation was between the amount of time between the onset of the disorder and the time needed for the therapy to remove it. Our main conclusion was of course that clinicians and parents should try to treat stuttering as soon as possible. We felt that the correlation between severity and the time needed to remove the problem with treatment was a derivative. That is, the longer the disorder went on untreated, the more severe it became. I hope this answers your question.

From: tlcmd

Thanks to all for the info and .

Any thoughts as to the need for intermittent therapy after succesful threatment? Does dysfluency return to any significant degree after succesful therapy?

From: J. Scott Yaruss

Keeping in mind what Woody said about a finding that there is a correlation between severity and recovery in therapy, I want to throw in one thing that I have learned from the research of Yairi and colleagues referenced by Nan Ratner...

Specifically, this is that some children can exhibit significant initial severity -- often associated with a rather sudden onset of stuttering -- yet still show a complete, seemingly natural recovery from stuttering. Many of these children may not have been studied in prior research because the resolution of the stuttering may have occurred within the first few months -- or even weeks -- of onset, before parents and others had time to get sufficiently concerned to contact a speech-language pathologist. So, these high-severity but high-recovery children may may have been underrepresented.

Some evidence in favor of this interpretation comes from a retrospective study conducted by Ed Conture, Lisa LaSalle, and myself, in which we examined the reported time since onset of stuttering for 100 3-6 year-old children who were referred to a University clinic because of their parents concerns that they might be stuttering. The average time since onset of stuttering reported prior to the first evaluation of stuttering for the 85 children for whom such data were available was 18 months -- this is a VERY long time, in my opinion, that parents waited to determine whether their child was at risk for stuttering.

We know from Yairi's data, and other sources, that many children exhibit a seemingly natural recovery from stuttering within the first 6 months, so some children may have shown significant initial severity but still recovered, as Yairi's data show.

So, I've rambled a bit, but the bottom line in my book is that the correlation between initial severity and recovery is far from perfect...we still need more research to identify the risk factors that contribute to the likelihood that a young child exhibiting early stuttering will continue to do so.

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From: Jamie

What is the best way to find out about future training in Stuttering therapy for SLP's? Are you aware of any conferences or workshops in the Philadelphia area?

From: Woody Starkweather

The Birch Tree Foundation offers periodic workshops designed to help train clinicians in working on the psychological aspects of stuttering. Our next work- shop, however, is going to be in Albany and is, I believe, already full. Watch STUTT-L for an announcement of when the next one will be in Philadelphia.

From: Karen Gordon

I am currently a graduate student majoring in speech-language pathology and have found that the area of fluency is extremely complicated. I attended a different undergraduate university than my current graduate school. The two universities presented different standpoints as to the assessment and intervention for people who stutter. For example, the professors had conflicting opionions as to spontaneous recovery. In your opionion, how do you sort through the various approaches toward stuttering?

From: Ellen-Marie

You ask a very good question: How do we decide for ourselves what we believe. The answer, as such. is: Through knowledge and experience, weighting experience more highly. While accumulating both knowledge and experience, maintain an analytical mind, practicing discernment. Eventually based on reading, listening to colleagues express their points-of-view, and consolidating your own experiential base, you will discover your own approach to prevention and remediation of stuttering problems. I don't know any other way to develop a point-of-view with conviction. Note that your point-of-view will evolve over time as you enlarge your world perspective. And remember no one point-of-view works equally well with all clients. Once you have established yours, I think you may find that you tend to attract people who can benefit most from it as well as some who don't. They will provide you with the challenges to keep evaluating what you believe. Good Luck! Ellen-Marie Silverman

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Book Reviews on

From: Gunars

Ladies & Gentlemen, provides a means for people to review books. Why is it that the experts in stuttering therapy have not felt it worth while to write some short book reviews on the books that they have read and found indeed helpful and accurate.

Do you, as professionals, understand that when you abdicate your duty, the intelligent lay person is left without any guidance and may well choose the wrong book to buy?

Do you agree that the book that is at this time the best selling book on is the most worthwhile book for the people who stutter to buy?


p.s. Just a little kid poking his stick in a hornets nest. :-)

From: Woody

Oh Gunars, you're such a cut up.

It is of course lots of fun to hear someone else tell me what my duty is.

Seriously, to spontaneously review a colleague's work strikes me as extremely arrogant, and I guess that is why it has never even occurred to me to do what you suggest.

When asked, of course, I have often reviewed other professionals work, and in this case, the review has a certain context that supports the process of careful consideration and thoughtful expression. That works a lot better than simply sharing what you think about a book that you just read.

I believe also that Amazon intended those "reviews" to be from lay readers, not professionals, and I would for this reason be particularly careful not to contribute to this forum.

From: Gunars


In the spirit of gentlemanly debate as in the case of Lieberman versus Cheney, not Gore versus Bush we will dispense with the ad hominem such as "cutup". :-) My intent is serious.

I respectfully, but vigorously disagree on various points:

a) It was not my intent to specifically single you out to review all of the books. Nor was I ascribing it as a duty, just a wise suggestion.

b) My bookshelf contains many books on stuttering that have been out for considerable time, are in their second editions, etc. These books on stuttering have been used in many universities both in graduate and undergraduate courses. These books have been reviewed elsewhere. An abridged version of a book review would serve the same purpose as provided on the books back cover. My understanding of the English language is such that if a person wrote the "blurb" this week, passed it by his collegues, etc. there would be nothing spontaneous about it. But, of course, English is not my first language. :-) And my unabridged Random House dictionary may lie. :-)

c) As for asking you, or your esteemed colleagues, would you like a personal e-mail from Bezos himself?:-) Or would a policy statement on letterhead from one of his top lieutenants be enough? :-)

d) I heartily agree with your last point that the books best be reviewed by peers of those who are likely to buy the books. What I am puzzled about is that I thought many books on my shelf which I bought through were meant for professionals and, therefore, should be reviewed by professionals: Manning, Shapiro, Bloodstein, Starkweather and Givens-Ackerman, Van Riper, Sheehan, Guitar, Curlee and Siegel, Bloom and Cooperman, Culatta and Goldberg, etc. etc. For example, a very good book by Starkweather and Givens-Ackerman to me appeared to be geared both to the professional SLP and maybe, associated audiences like school counselors. Was I wrong? :-) Would you, really, like me to be the first, and, maybe the only reviewer of this book? :-)

Respectfully yours,


From: Woody

I continue to believe that it would be inappropriate of me to write a review of a colleague's book on


From: Steve Hood

Hi, Gunars-- I have read your post, and Woody's response, and your counter comment, and I am having trouble understanding where you are coming from, and where you are going with this.

I think you still have the stick in the hornet's next, or somewhere else......

I would certainly think twice before reviewing a book for a source such as Amazon. Although not recently, I have written book reviews for professional sources such as Asha magazine. And I am proud that something I wrote was selected to be printed on the back jacket of Marty Jeser's autobiographical book on stuttering. But I would be concerned that writing for a "profit" company like Amazon might be a form of commercialism.

I'll not tempt any further the stick that might be near the hornet's next.

From: Ellen-Marie Silverman

It is curious that experts take the role of paid critics in book review journals and newspapers as well as on television and radio to provide considered recomendations about plays, books, movies, videos, recordings, concerts, dance, musicals, painting exhibits, and restaurants. But academics, even those who profess to care about the welfare of the people, shy away from using their expertise to advise the general public about the soundness of advice contained in books written for them. Yet these same professionals critique materials written for each other in their own professional journals. Maybe, academics unwilling to publicly comment on books within their area of expertise written for the general public are concerned about conflict of interest issues that may be raised should they make favorable or even unfavorable about the available works. If so, they may do well to consider that professional critics have found solutions to these concerns that seem to satisfy all concerned. Thank you for bringing this issue into the light of discussion.

From: Walt Manning

I think that Woody's answer to Gunners' question was great. The books Gunners refers to are primarly written for undergraduate/graduate students and, to a lesser degree, professionals in the field. They are not generally intended for the lay person. Students and professionals can generally find thoughtful reviews in the professional literature. Assuming an "intelligent lay person" wants to purchase one of these books, they can do a little research on the web or contact a professional to find out which book(s) they may want to purchase. I don't know what you mean by saying they "may well choose the wrong book to buy". I don't think there are any "wrong books", only different approaches and different styles of presenting much the same thing. By the way, what is the best selling Amazon book on stuttering?

From: Gunars

Stuttering : Science, Therapy, & Practice: The Most Complete Book About Stuttering by Thomas David Kehoe

From: Walt Manning

Kehoe's book eh. That is a surprise. Or maybe not. There are a couple of reviews by Venkatagiri and Cordes-Bothe in The Journal of Fluency Disorders, 23, 3 (1998) about another "book" by this author that are worth reading.

From: Gunars


I know. That is what prompted this posting.


From: Woody


I wish you had stated your motivation in your first posting, although I can see why you might not have, but I would have been much less likely to have replied in such a flip manner. Kehoe is not a colleague. He has no training in stuttering at all and actually knows little about it. He often makes errors that betray this ignorance, as we have all seen in his posts to STUTT-L. Knowing this, I never read his book. So of course I couldn't comment on it. But I do think he is dangerous in that he doesn't seem to realize that he is ignorant of many aspects of the disorder. For this reason, I have little interest in reading the book.

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Son with ADD

From: Alejandra Cotte

I have a 7 year old boy, with A.D.D, and he stutters on certain situations. I would like to know if you have any suggestions on how to work with his therapist and his first grade teacher so we can help him overcome his difficulties. Thank you Alejandra Cotte (Venezuela)

From: Nan Ratner

I am not aware of any specific strategies for working with the stuttering and ADD, if that is your question. If your question is broader, it would help to know more about your son and what his therapist is currently doing. It is not only tough but also poor practice, to give therapeutic counseling on a case over the web like this.

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Research proving that stuttering is located in pre-motor brain by Ingham, Fox, et al

From: Gunars

In October 3, 2000 issue of ASHA Leader Ellen Uffen wrote an article titled "Research Confirms Pre-Motor Brain Location for Stuttering". It is about a research report to be published in Brain and Language "Is Overt Stuttering a Prerequisite for the Neural Activations Associated With Chronic Developmental Stuttering?" by Ingham, Fox et al. This replicative study using positron emission tomography (PET) established that "...the brain regions that were activated and deactivated during stuttered speech were the same as those activated when the participants simply imagined they were stuttering." "This work put into doubt the common belief that stuttering is essentially a speech-motor disorder."

My questions to you are:

1) Isn't this a marvelous breakthough!?! Finally we can start to trace something physical as to what happens during stuttering inside the nervous system!!

2) Should we not now try to find a marker indicator from polygraph, biofeedback, or brainwave measurements which would track the activity in the given specific area of the brain so that we can develop a cheaper measurement apparatus to scientifically study stuttering?

3) Would not this type of apparatus be useful to study covert stuttering?

4) Could we not then prove or disprove the effectiveness of certain cognitive psychology techniques?

5) Doesn't this give us a window to possibly objectively measure the attitudes and emotions during stuttering including anxiety, shame, and guilt?

6) Borrowing a page from sports psychology will we not now be able to find out if we are in a "Zone", a mind set where we can talk flowingly?

7) Could not these types of measurements be used to discriminate children who have normal dysfluencies from those who are at risk of developing chronic stuttering?

8) As for the results of stuttering therapy, we might discover which stuttering therapies actually deal with the root cause and which ones just superimpose a discipline in the motor area of the brain to override the stuttering causing stimuli?

9) Above all can't we now start to build models of what makes a person be fluent and what causes him to stutter in a given situations? Although we might yet be very far in establishing what processes take place during stuttering onset, aren't we, with this seminal paper, a lot closer to finding out what propagates stuttering?

I, personally, have not been as excited about any research in stuttering as about this. This is a study that replicates the early findings (see P.T. Fox et al, 1996, "A PET study of the neural systems of stuttering," Nature, 382, 158-162)!!


From: Woody

I think, Gunars, that your reaction is exactly the kind of reaction that the authors would decry. I haven't read the article, of course, since it hasn't appeared yet, but I was somewhat alarmed by the headline saying that the authors had found the "location" of stuttering. It sounds as though brain surgery could cure the problem. What they found was the location in the brain that is active during stuttering behavior and also during imagined stuttering behavior. I see the results as valuable additional information in describing the disorder because they have shown what areas of the brain are active. They are the areas that one would expect to be active during stuttering and during imagined stuttering, so I don't see it as any kind of a "breakthrough," just a valuable addition to knowledge. It has been known for some time that imagined behavior produces brain activity that is very similar, and similarly located, to the brain activity that occurs during the actual performance of the behavior. Sports psychologists have been using that to teach divers and gymnasts that imagined practice is nearly as beneficial as real practice. I am hopeful that the authors have used the kinds of controls that will enable us to make some important distinctions. For example, I am hoping that they have asked nonstutterers to pretend to stutter, and also that they have asked stutterers to pretend to stutter because the differences between the real and the pretend event would greatly enhance our understanding. Of course, there are always practical constraints on a piece of research, and it may be that the authors were unable to address this question. Another crucial control would be to monitor muscle activity levels in the speech and voice mechanism during imagined stuttering. Several decades ago it was shown that imagining oneself perform a behavior produced muscle activity in the related muscles, even though no overt activity occurred. Finally, I don't understand the conclusion, if it is really one the authors reached, that stuttering cannot be a speech motor disorder. It seems to me that their data demonstrate even more clearly that it IS a speech motor disorder, since the speech motor system was so clearly involved. Perhaps they define the term "speech motor disorder" differently than I do.

When a person performs an act, whether overtly or in imagination, the brain is active as part of the performance. I think that what they have shown is that stuttering is no different in this respect than any other behavior.

From: Gunars

Firstly, thank you for the prompt reply. In reading your response I found out that we do not differ that greatly in our opinions except for my exuberance, enthusiasm, optimism and persistence.:-)

I have promised myself never to outgrow these characteristics of optimism, enthusiasm etc. Without these I would not have tried sixteen different stuttering therapies before I found Rational Emotive Behavior Therapy which helped me to manage my stuttering and my attitude toward stuttering to the point that it has no impact, whatsoever, on my daily life. Although I do have some disfluencies from time to time they do not impede my communication either in person or on the telephone. This I contrast to the many members of National Stuttering Association who a) either have given up on improving their severity and struggle associated with their stuttering or b), more sadly, are persisting on doing the same therapeutically suggested things but expecting different results, i.e. they swear by some stuttering therapy techniques and yet show no improvement over a long period of time either in terms of forward moving, less struggling, less forced speech or improvement in how they feel about themselves and their feelings of anxiety, shame and guilt.

Another example of visionary optimism, enthusiasm, and persistence was the German rocket scientist Dr. von Braun who was instrumental in putting the man on the moon. He started dreaming and working toward this goal while he was still a youth and succeeded only after decades of dedicated effort (and luck).

What we are talking here is about misplaced optimism and enthusiasm. The next couple decades will either bear me out or prove me wrong. No arguments or debates will influence the future, they can only either inspire others to pursue this area of study or discourage them. I am 100% for vigorously following this avenue of research.

Dr. Nan Bernstein-Ratner reminded me yesterday, when talking about scientific hypothesis, I should make sure that they are falsifiable. The other statements I make are purely speculative and, probably, I should indicate from the context, at least, which are which. She made a very good point, so in the following discussion I will try to follow it.

1) By no means do the authors or I imply that brain surgery is an option. (Maybe we should include a little bit on the nature of brain in our books on stuttering so as to inform the students, practicing SLPs, and professors how the brain is organized and why surgical cure is total absurdity.)

2) I agree with you whole heartedly that we can learn a lot from sports psychologists, cognitive psycholgists who, for example, use Rational Emotive Imagery. It is exactly the point that I wanted to emphasize, that we now have hard evidence that the same areas of brain are used during stuttering and during imagined stuttering. Whole new protocols of stuttering therapy could be evolved around this, but, again, I have not read about any of them in the textbooks that were published through 1999. In fact, I know of no stuttering therapists except the ones practicing REBT that use imagery as part of the stuttering therapy protocol. Neither have I read any papers that deal with "What can stuttering therapy learn from sports psychology." I call this a breakthrough, because now we can have some scientific justification for using the imagery exercises during therapy process.

When we get down to the meat of what this paper means, we agree completely. If the authors did not follow through and do a good job, you have suggested the topics for at least a half a dozen good Ph.D. thesis. The scientific (falsifiable) hypotheses that are open to PET type of investigation include:

A) Stuttering causing anxiety exists (possibly, due to our sizing up a speaking situation) before we start to talk, carries through the speech process waxing and waning (even if this in a virtual space, i.e. vividly imagined stuttering).

Thus, it is indeed independent albeit at some times coexistent with the "speech motor disorder". Possibly it is an anticipatory anxiety syndrome that interferes with the speech motor disorder. (Nan, how am I doing so far?)

B) Before a non-stuttering person has done voluntary stuttering exercises in public there is no anticipatory anxiety syndrome invocation. This can be falsified by PET studies when a subject is voluntarily stuttering for the first time when hooked up to the PET.

C) In a non-stuttering person the anticipatory anxiety syndrome, if it was proved to exist for people who are not stutterers, does not interfere with "speech motor functioning".

D) The voluntary stuttering in by a stutterer minimizes the strength of the anticipatory anxiety syndrome.

E) Given sufficient voluntary stuttering in public by a non-stuttering person the anticipatory anxiety syndrome is invoked. Or the converse, no amount of voluntary stuttering invokes this response.

F) The reduction of overt stuttering symptoms is inversely proportional to the anticipatory anxiety syndrome.

etc. etc. (including some of Sheehan's hypotheses).

If we can establish the existence of anticipatory anxiety syndrome and in time can quantify it, I suggest we call the units of measurements "woodies" :-), since, he was instrumental in the definition of this concept. Then, at some future time we might be able to say, "Before the treatment client X had a measure of 5 woodies :-). At the end of the treatment regimen the client only had had 1.2 woodies :-).

All kidding aside, you have asked some very good questions about the quality of the research. I hope that all of us get a hold of the paper and do some detailed analysis of both the methodology and the conclusions.

My real concern, however, is the question of finding some type of marker indicator for this phenomena to reduce the cost of the research, such as combination of brainwaves when the biofeedback electrodes are placed in the right position on the head. Otherwise, the replication of Ingham's research will be prohibitively expensive and new directions based on his research will be few and far between.



From: J. Scott Yaruss

Hi Gunars --

While I agree that this is an important piece of research, I would be VERY cautious about reading too much into the little blurb you read in the ASHA Leader until we have the actual research report. The author of the article in the Leader did a fine job of summarizing some of the key points about this line of research, but the tone was a little too sensational for me...I understand why she needed to do this in a publication such as the ASHA Leader, but such sensationalism in reporting (e.g., the leading dramatic question at the beginning of the blurb that doesn't actually relate to the content of the study) leads to exactly the type of enthusiasm you exhibited. This is not a bad thing; still, it is not the type of thing we want to build our research and theoretical plans around.

Let's, as Woody suggested, add this piece of knowledge to our slowly-growing body of knowledge about stuttering, and proceed cautiously from there.

In terms of whether this indicates that stuttering is a speech motor disorder...Roger Ingham wrote a very interesting paper that appeared in the book by Cordes & Ingham (1998) on whether we should be viewing stuttering as a speech motor disorder...some valuable questions are raised, and this research may be interpreted differently based on that chapter.

Finally, although I will reserve complete judgment until I have a chance to read the article (and even then, will reserve complete judgment pending further study...), I find it VERY interesting that the patterns of activation during imagined stuttering were similar to that during real stuttering. To me, this says that people USE the same areas associate with stuttering, not that these same areas CAUSE stuttering -- this is a critical difference, and depending upon the interpretation, can lend support for the notion that stuttering is not a motor DISORDER, but rather a disorder that INVOLVES the motor system in rather unique ways. We always knew that the second statement is true; I think it is valid to question whether the first statement is true.

I personally will look forward to reading the actual research report, and will try not to get caught up in media hype until that time.

My 1/2 a cent... S

From: Lou Heite

If I might add another ha'penny worth, the idea that stuttering involves the premotor cortex is far from new. Other studies than the one described in the ASHA leader, both studies that use brain imaging, and studies that depend on more traditional, less expensive, and less spectacular research methods, have drawn conclusions that are very similar to the ones described in the article. So be careful of "discoveries." Sometimes a discovery is new only to the discoverer.

Lou Heite

From: Gunars


The novelty is not my issue. My hope is that the stuttering therapies are starting to be based on models that take into account anticipatory anxiety, etc.

If you can direct me to the other studies, I would be very, very appreciative, because I would want to find a cheaper way to measure the effectiveness of stuttering therapy, to differentiate between children who are at risk and who are not.


From: Gunars

Hi Scott,

Thanks for pointing me to Roger Ingham's article in Cordes and Ingham (1998). One advantage of having a good home library of the modern books on stuttering research and stuttering therapy is that one can be induced to waste a perfectly good evening reading a paper on stuttering. :-)

I can now see where Woody was coming from. On page 89 Ingham has a header TMS: Not Yet Time to Worry about What's Flying Over the Cuckoo's Nest, and then proceeds to scare the crap out of me. As much as I respect his research in the area, his breadth of scholastic knowledge, when in the application he suggests messing around with the brain by using repeated transcranial magnetic stimulation (rTMS) I get the visions of poor Murphy being given electro-shocks (reference One Flew Over the Cuckoo's Nest). I am totally opposed to experiments where "A brief electrical pulse through a wire coil placed on the scalp provides a magnetic field. The field passes unimpeded through the tissues of the head and induces an electrical current in the brain." My repulsion to this is extreme as I have studied the zombies produced by electro-shock therapy. Before I get myself into trouble with intemperate language and comparisons, let me stop.

If you have read Ingham's treatise recently (Chapter 4 in Treatment Efficacy for Stuttering Cordes & Ingham) you will have seen that Fox's et al 1996 study (referred to in the ASHA Leader) appears to have been rather well thought out. I expect Ingham's et al paper to be just as strong.

My uses for Ingham's study are totally different than his. With experiential and cognitive exercises and "overlearning" I propose to alter the "structure" of the brain. On page 83 Ingham states, "There is certainly considerable evidence that behavior change (i.e. therapy or fluency induction) may produce lasting neural reorganization." My suggestion is that we go this way! Not electro-magnetic manipulation.

The model I was proposing was much simpler and to me more elegant. There is a "path" or "activity center" in the brain that controls the speech production. The basic speech production mechanism areas are the same in both normal speakers and stutterers during choral reading where no anxiety is invoked. During stuttering other areas of activity are observed. These areas of activity are then correlated with stuttering. The question then arises what type of therapy cognitive and/or other can be used to desensitize these areas.

Other variations of my hypotheses can be found in my reply to Woody. The key, as Ingham indicates on page 85 in footnote is overlearning. This is one of the basic concepts in preparing an athlete for championship form (as a former All-American in soccer when it was a minor, minor sport I can have an appreciation for this). The overlearning can be done also using imagery exercises.

Another interesting point is Ingham's preoccupation, probably wise, with the auditory component of stuttering. See specifically pages 78 "(3) the lace of auditory factors in treatment", page 79 "auditory factors in stuttering" and "Numerous studies have suggested that stutterers do display unusual central auditory processing," and page 86 "However, the most surprising finding was that the primary auditory area (left and right superior temporal cortex) activations, so prominent in controls, was literally nonactivated during stuttering, while the associated auditory area (BA 22) was actually deactivated, mainly on the right. In many respects the latter finding is especially interesting because it might mean that stutterers simply do not self-monitor their speech to the same extent as nonstutterers during oral reading. That finding is also of added interest because it seems to be in conflict with theories that claim that stutterers monitor their speech excessively (e.g., Postma & Kolk) 1993)". Lou Heite and I independently observed that over a couple years ago when she chose her topic of Van Riper's petit mort. My conclusion, after introspection, as suggested by another "man without letters" :-) i.e. self taught scholar Leonardo da Vince (no I do NOT consider me being in his class :-) ) was that even a half-wit would try to adjust his body so as not to hear his stuttering voice for which he has caught so much heck :-) . It is just a survival mechanism, Dr. Ingham, that all of us who have been ultra severe stutterers space out, i.e. shut out our auditory feedback. On the other hand without the auditory, proprioceptive and other feedback we cannot get better. So we need to learn how to "stay in the moment."

Scott, enough for tonight. You and your suggestions to read Ingham's article have kept me from eating, walking the dogs, and talking to my wife. :-) With friends like you, who needs enemies. :-)

All kidding aside, I wish you could suggest to me some other good reading. I hope that the Human Subject Review Committee is alive and well at UCSB and UT. :-)



p.s. Would I pass your undergraduate course in stuttering therapy? :-)

From: J. Scott Yaruss

Hi Gunars - I can't remember for sure if Ingham has tried the TMS on people who stutter or not...his main point in the presentation (it's been a while since I read the chapter) was that he was questionning the widely presumed motoric base for be sure, the motor system is involved, but the role of the motor system is far from clear, imho.


From: Woody


Those were very well put, Scott, and I completely agree.

After I sent me comment in a few days ago, I went away for the weekend, and I was driving through Virginia when I suddenly realized what was wrong with the article in the ASHA Leader. They said that the article helped elucidate where "stuttering" was located in the brain. What the article seems to show is, as Scott described, where the brain activity associated with stuttering behavior is located in the brain. Thus, it could be said that the authors have helped us understand where stuttering **behavior** is "located." My fear is that people will read that as meaning that the authors have discovered where stuttering **the disorder** is located in the brain. So, it was just a piece of somewhat sloppy journalism.

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Stuttering does not wait for tenure; the pain is constant, real, and often unbearable

From: Joe Kalinowski

Scott: I must disagree with you on two issues. First we do not have to act out a behavior for a typical physiological response to that "imagined behavior" to occur". I don't know about you, but when I go to sleep at night I have a wide and varied range of physiological responses to a number of "supposedly imagined" environmental stimuli. My brain can not tell the difference between its self-generation of dreams and "my supposed reality"--in my brain all stimuli are created equal. Isn't all we experience virtual reality anyway? There is plenty of speech data to support that notion both empirically and rationally. See Motor Theory... Second, Roger Ingham's work is being published in THE TOP TIER scientific journals in the world! He, like our research group, has apparently left the exclusive domain of the ASHA "speech community". It may be, like our research group, that Dr. Ingham is tired of the dogged and vested interests of those gatekeepers in power at JSHR and AJSLP. (What great science has come out of JSHR in awhile?) When we find something compelling we go to bigger and better journals. That isn't our fault that is the fault of those at ASHA.) When we go to journals with much higher standards in science, please DO not be harsh on us!! We only want to find answers and play the game of science with those who have little vested interest-except to find answers to compelling questions. Finally, we go to other mediums because we challenge the "establishment (e.g., see WWW, Napster, psychopharmacology (Listening to Prozac--remember when we thought we could talk ourselves out of everything--ala Freud), etc.) Our group at ECU has had between 4- 6 papers queued up at JSHR and AJSLP for the last 2 years --none have been published! But---we have had 2 published by Neuroscience Letters and--- one by my doc students just sent one for review at Nature! We can't wait for the ASHA, JSHR, AJSLP, to change--we will go to better journals to ensure our duty to those who stutter. However, we must "tell those in speech who may be interested where to find our work! This--the need to promote peer-reviewed scientific articles. These are not to be confused with chapters or textbooks, which pontificate answers. These are a higher order of work and should never be confused with the opinion pieces... I get E-mail all the time saying that people need help, they are tired of waiting and can't take blaming themselves any more for stuttering. I'm with them! But with the caution of using scientific peer-reviewed articles as a foundation and always having the a series of checks and balances to ensure that our enthusiasm to find an answer with procedures that are adherent to the scientific methods---Patience is for those like us with a good job, a family, and plenty of security. Those who suffer so badly under the yoke of stuttering just can't wait for slow journals and dogma. Stuttering does not wait for tenure; the pain is constant, real, and often unbearable, PS Check out our new article in Neuroscience Letters _uids=11027847&dopt=Abstract Stutter-free and stutter-filled speech signals and their role in stuttering amelioration for English speaking adults. Kalinowski J, Dayalu VN, Stuart A, Rastatter MP, Rami MK Department of Communication Sciences and Disorders, School of Allied Health Sciences, East Carolina University, NC 27858-4353, Greenville, USA

From: J. Scott Yaruss

Hi Joe Afraid, I'm not clear on exactly what it is that you are disagreeing with in my post. I don't recall saying that we have to act out behaviors for responses to happen (thought I said the opposite, as the research seems to show), and I don't recall criticizing Ingham's article or the journal...or your own work, for that matter.

Perhaps I have inadvertently tapped into something that has absolutely nothing to do with the topic at hand...?

From: Joe Kalinowski


You can get Ingahm's article for free on

This is the future of journal publication!!!!

Welcome to Neuroscion ™

Neuroscion is a an exciting web-based resource designed to facilitate the transmission of information among members of the global neuroscience research community. As dynamic as the field of neuroscience itself, this rich environment is structured to accommodate both formal and informal communication - “a meeting of minds.”


From: From: Ellen-Marie Silverman

I appreciate your concern for people with stuttering problems and those who care about them when you refer to the disappointing results of research directed toward their needs.

Empirical research conducted in the USA during the past 80 years or so certainly has yielded precious little information easily transported into therapuetic strategies for children and adults. From my perspective, the problem rests with the underlying model. The assumptions underlying the statistical model usually can't be met, while the data collection procedures stemming from application of the model, i.e., selecting individual variables to study, are at odds with the fairly well accepted view that what makes humans human is a fairly complex interaction of behavior, cognition, and emotion. Essential human behavior can not be described accurately let alone understood by a reductioinist approach.

What we need more of is clinical research, naturalistic research, revealing the on-going problem solving efforts involved in focused change as well as an in depth account of the consequences of the described interactions. In the meantime, given that there is some reasonable information fairly readily available to parents, children, teens, and adults concerned about stuttering and some equally substantiated information about the varieties of human learning and how to best structure new learning, clinicians in partnership with those seeking their help should be able to establish helpful programs of change for those who want to do that without waiting for empirical researchers to tell them how.

Our journals need to be much more responsive to the writing of clinicians. They need encouragement to present programs of intervention in a descriptive, thorough manner ala writings of Piaget, Jung, Einstein, and others. And our training programs need to recognize that their objective is train effective clinicians, which they can do more effectively if they stress and reward clinical problem-solving to the same extent they admire empirical research conducted by individuals with limited, and sometimes no, clinical experience.

Perhaps, I should not hang out SLP's dirty laundry in this forum. Then maybe I should. At any rate, there is no reason that, given the nature of some reliable information currently available about the nature of stuttering, language development, communication skills development, and human learning, that dedicated clinicians working closely with people seeking their help can not provide amelioration of stuttering to some extent and do no harm in the process.

From: Joe Kalinowski

Though provoking --I applaud you!!

From: Woody


It is a pleasure to read such an articulate expression of an opinion with which I concur.

From: Ellen-Marie Silverman

Thank you, Woody. It's nice to know I have at least one kindred spirit!

Let's see what we can do to try to turns things around, i.e., put the emphasis in clinical training on "clinical."

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Scholarships for students who stutter

From: Dakota Johnson

I NEED HELP!! If anyone would happen to know if there are any scholarships for people who stutter, could you please send me an e-mail of how i might be able to apply.

Thank you very much Dakota Johnson

From: Ken St. louis

Dear Dakota,

I'm sorry. I don't understand your question. Scholarships for what? If you would care to explain, perhaps one or more of us could respond.


From: Dakota

Scholarships for attending college. I was just wondering if there were any for students who stutter.

From: Ken St. Louis

Dear Dakota,

I am not aware of any scholarships for college that are exclusively targeted to people who stutter. Perhaps others might be aware of some. Sorry.


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large vocabulary and stuttering in 2 1/2 year old

From: Betty

Hi My daughter is 2 and 1/2 years old and she is starting to stutter (I think). How do I know if this is a potential problem for her and how can I help it. She has had a very big vocabulary since she was about 1.5. Could this be from not being able to think of the word she wants to say right away?

From: Dale Williams


Your post struck a chord with me because I have a 2 yr, 4 mo old son who is also quite verbal (actually, he never shuts up). And I hear occasional disfluencies that make me nervous, e.g., yesterday he told me, "My my my my my my basketball is in the potty" (Don't ask). This is a multiple unit syllable repetition, a behavior consistent with incipient stuttering. Yet when I watch him do this, I can see the wheels turning in his little head as he tries to formulate the utterance as he speaks (not an easy task for a 2 y/o). In other words, I see the repetitions as a linguistic behavior. Still, while I do not think he is stuttering, I certainly intend to continue monitoring his speech.

So the bright side is that your daughter's behavior could be linguistic, as you suggest ("not being able to think of the word she wants to say right of way"). The other side is that moms are usually right when they suspect they hear something unusual. In order to help determine whether your daughter's behavior places her at-risk for stuttering, and whether you should seek help, it is really necessary to know what she is doing and how long it has been going on.


From: Betty Lou

Thank you for your reply. But i was wondering is there a way to help her motor skills catch up? Since I posted the question on 10/13 her stuttering has seemed to slow down or should I say get better. Is the television not good for her. She doesn't watch it much and I sit with her and we laugh together and talk about whats going on. I also notice she is trying to use sentences like: Mommy/Daddy wh,wh,wh,wh, are we going? to the store? or I,I,I,I,I,I, love to go to the store. or H,h,h,h,h,h, how about some bubble gum. It just seems to be at the beginning of a sentence. The reply's I received were very helpful and let me know I am not to blame. Is there anything else I could do? I feel bad to even repramand her now, I am afraid she might stutter! Boy, if she finds this out she is really going to take me for a ride!

From: Dale Williams

Betty Lou,

To help your daughter's speech motor skills catch up to her advanced language, make speaking an easy & relaxed task for her. If she really is susceptible to stuttering, you don't want to overload the system (i.e., ask her to perform verbally in ways that are beyond her present skills).

Re. the TV, occasionally that's a factor in that some shows may excite a child which leads to long strings of rushed (& usually loud) speech. If you're not noticing that, I wouldn't worry about the TV.

Re. what else you can do, anything that keeps communication stress low, e.g., use a relaxed rate yourself with plenty of pauses, don't fire multiple questions at her, etc. The Stuttering Home Page (linked to this conference) & Stuttering Foundation of America web sites have a lot of parental advice. It sounds as if you're doing a lot of the right things already, given your description of how you talk and laugh about TV shows.

I don't see any reason to change the way you discipline her, assuming your present method doesn't involve putting pressure on her speech.

How long have the speech behaviors been going on?


From: Betty Lou

Dale, I do not put pressure on her due to her speech. This weekend was very good I didn't hear her stutter very much at all! Its really always been there (very,very slight) but the past 2-3 weeks seem to have been when it got noticeable. But now its tapering off. ??? I don't ask her allot of questions at once, I pause between each word, Maybe I am reading too much into this. I am just a concerned (first time mother). Shhhh. Anyway I thank you for your input. Any other tips please send my way!

Thanks again.

From: Steve Hood

Hi, Betty

Without actually interacting with your child it is hard to be specific. I do not know the frequency of her disfluencies or the types of disfluencies she has. But, I do have some reactions to what you have written.

When children are under various types of pressure or stress, they are more apt to be disfluent. We think often of stresses as being things like hurried, and interrupted. Another type of pressure is linguistic pressure. Children between the ages of 2 and 5 are learning a lot of language, increasing their vocabulary, generating longer and more complex sentences, and generally sounding more and more like little adults.

For children who are delayed or disorders in language development, they are sometimes more disfluent because they are having problems communicating **AT** their age level. For children who are precosious and advanced in developing language, they are sometimes more disfluent because of the stresses they face talking **above** their age level. I wonder if your child might be in this second group.

We once worked with a child who was in about the third grade. He was stuttering quite severely. At age 8, he stuttered on words such as: indigenous, imminent, catestrophic and surpurfluous. We later found out that his dad was an English professor, and wanted his son to develop the best language and vocabulary possible, so every night there was about 25 minutes of intense vocabulary drill.

If you think some of this might be happening in your situation, see if you can back off on language and vocabulary expectations, and encourage your child to do the same. Talk with the correct grammar and vocabulary (don't "baby-talk" with you child, but back off and try to reduce the lenngth and complexity of your sentences. If the problem persists, if your child's disfluencies occur on more than about 8% of the words spoken, and if you see signs where she is prolonging sounds, showing any tension and struggle, or repeating primarily sounds and syllables rather than whole words and phrases, then attannge for a complete diagnostic evaluation by a speech-language pathologist who has a good background in childhood disfluencies and childhood stuttering.

Steve Hood

From: Woody


As others have noted, it is difficult to form an accurate clinical opinion over the internet, but I have seen quite a large number of children whose stuttering (or disfluency -- it may not yet involve enough struggle to be stuttering) has come about as a by-product of advanced language. INdeed, it seems to be one of the "tracks" by which stuttering develops. Unfortunately, you can't undo what language she has learned. But it may be possible to slow the pace of future language acquisition and give the child's motor system a chance to catch up. None of this is to say that you have created the problem in any way. Some children simply learn language very quickly, and although we have little clear information about it, it seems that in some cases the motor system is behind the language system, that is, the child can think of and accurately construct long complex sentences containing multisyllabic words, but is nonetheless able to utter these sentences with the same dexterity that an older child, more advanced motorically, might be able to do. So, perhaps, the answer is to try to slow the rate at which language is being acquired, giving the motor system time to catch up. We have had some success using this approach with this type of child. IN any event, it would be helpful to consult with a speech clinician who is specialized in treating stuttering and particularly interested in the treatment of very young children. There are also a number of useful materials to be found on the Stuttering Home Page.

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If stuttering only occurs in real world

From: Tse-Hsuan Cheng

I had a client who is 18-year-old rarely showed stuttering in clinic but frequently in daily life. And once he has stuttering, it is very severely and will not stop until we took a break and changed the topic. How could I help those who did not stuttering frequently in clinic but in daily life through clinic training?

From: Walt Manning

Your question and the problem is a commone one. Transferring desired performance from the treatment room is the usual situation and especially so for some speakers. Even maintaining some reasonable level of performance when moving from the treatment room to a lobby or a group treatment setting is a big step for many people. I have always felt that the best clinicians were those who did relatively little therapy in a treatment room. The speaker may demonstrate greater fluency because they have adapted to the clinical setting and their role in the treatment process. Experienced clincians should be doing treatment - to the degree possible at least - in the client's world. I know that this may be difficult for logistic, time, or insurance constraints. However, at the very least, the clinician can accompany the client to several locations and conduct "walking and talking" therapy. There are some measures that have been developed for assessing extra-treatment confidence and performance that provide some information about real world behavior. But, of course, there is no substitue for actually doing it with the client. At last that has been my experience both as a client and a clinician.

From: Woody


I may be wrong, but I still see this problem as one of stimulus generalization. That is, the client learns new responses -- either behaviors or thoughts or feelings -- in a particular setting, namely, the clinic or therapy room. Then, when they are in a different setting, the new stimuli either do not evoke the new response or they re-evoke the old response because it was learned in those external settings.

The behavior modification literature offers several suggestions for increasing stimulus generalization. First, vary the setting in which therapy takes place, making it as much like the outside world as possible. This can be done partially through role playing and other ways of making the therapy more closely resemble the real world. Second, you can, as Walt has suggested, do some therapy IN the real world. I have found this to be very helpful, when it can be done, but it is often quite time-consuming and awkward to accomplish. Third, and this is the solution that is often overlooked, if you keep on working IN the clinical setting, and by doing this strengthen the strength of the response in the clinical setting, the range of stimulus situations in which the response will occur broadens to include situations that are more and more different from the one in which the learning has taken place. The stimulus generalization gradient is like a bell curve with habit strength on the vertical axis and difference from the clinical setting on the horizontal axis. The positive and negative tails of the distribution can be considered identical in this application. As the central habit strength increases and the curve gets higher in the middle, the two tails spread out, and the gradient becomes broader, thus including situations that are more and more different from the setting in which the learning takes place. So one solution, is just to keep developing the strength of the new response, overlearning it in the clinical setting, and you will find that it is easier and easier for the client to use the new response in external situations.

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where are the stutterers?

From: Gert Reunes

About 1 % of the population are stutterers, but only 0,1% of the 1% is joining a selfhelpgroup. In chicago at the congress there were about 500 PWS... where are the stutterers???

From: From: Walt Manning

The vast majority of people who stutter are not members of support groups or attend treatment programs or are participants in clinical research. I think that what we know about stuttering is based on the very few people who come through the doors of clinics and, for whatever reason, ask for help. Most people who stutter are able to more or less adapt to the situations brought about by their condition. Many of these people don't know that help is available or their handicap is not great enough to take steps toward seeking treatment, or they feel that whetever help they might receive is not worth the effort or money. I suspect that the nature of stuttering and the ability of people to deal with it is much greater than we realize.

From: Grt

I think you are on target. I have been blessed with a number of chronic pathologies (e.g., PKD, substance abuse, obesity). I have only sought help when the pain was unbearable to handle. (When I was sick and tired of being sick and tired.) If after several attempts at help, I failed ; the therapy failed; or the clinicians failed; I moved to my protective cocoon. I was not any better--probably worse because my hopes were smashed. But I was as safe as I was going to be--at least in my mind. I was coping, but I was miserable and terribly isolated. I suspect there are many how stutter who stay hidden and are in constant pain and unending pain.

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Stutterer who is outgoing

From: Theresa Dobransky

While in high school, I had a friend who stuttered. He was involved in many extracurricular activities and was extremely smart. He was a member of the newspaper staff, where he had to interview people. He also was on the academic challenge team, where he had to debate against other schools. I think he would be considered a pretty severe stutterer, but he seemed to never let that stand in his way. He gave excellent speeches in class (and yes, he did stutter during them.) I can not ever remember a time when I heard someone make fun of him for his stuttering. It seemed that since he did not act embarrassed to stutter, people accepted it. It also seemed to me that he was involved in so much that stuttering was only one very small aspect of him. My question is this: Is this extremely atypical of someone who stutters or is it that we just do not hear much about these people? (I think I should also mention he had wonderful parents, who I am sure fostered his great self-esteem.)

From: Steve Hood

Hi, Theresa You raised an interesting point, and I'll take a stab at it. I am an SLP, so I can comment on two fronts: as a child growing up, and as an SLP professionally.

As a kid growing up I had a number of good friends, and acquaintenances who stuttered -- in some cases severely. I remember one kid who was sometimes teased and kidded, but really not because of the stuttering, but because he was a kid who would have been teased anyway.... He was the kid who dropped the pop fly, who goofed off, and who always reaced to being teased. I don't think stuttering was much of a factor in his being teased. I had other friends growing up, and in college, who stuttered-- and for these kids, stuttering really was not much of an issue. They were spunky, outgoing, friendly, good in sports, and involved in activities.... They had lots of morale, a good self concept, and were fun to be around.

Professionally, I have observed the same things.... What you are describing maybe atypical, but not as much as we might think. The folks who are doing well, coping, living life and achieving may not be known to us because they no longer seek therapy. They are being successful, in spite of stuttering. For them, stuttering is not a "handicap" and they do not let it become a "disability." They make decisions independent of the fact that they might stutter.

Stuttering, per se, need not be this aweful and terrible monster. Most listeners react not so much to the stuttering, but to the severity of the stuttering. Most listeners react not just to the stuttering, but to the stutterer's (PWS's) way of reacting to, and handling, and coping with the stuttering.

You asked a good question, and one that is not easily answered in an e-mail forum of interactions like we have here on ISAD. I hope others will also respond.

From: Ken St. Louis

Dear Theresa,

I second what Steve Hood has said to you. There are lots of stutterers and former stutterers "out there" for whom speech therapy was never sought or, in some cases, never needed. Many of these individuals, as Steve pointed out, have made good adjustments such that stuttering is just one more of the big or little misfortunes that happen to people which can be overcome. It's too bad there are not more books, television shows, or films that portray stuttering as merely a uniqueness-- something that could be used to describe the person--but not become the usual fearsome, unhappy circumstance that so often is portrayed.

VERY IMPORTANTLY, none of my should be construed to imply that if a person IS fearful of, overwhelmed by, and/or highly affected by his or her stuttering, then there is something wrong with this person. Stuttering can be absolutely devastating and can handicap a person as much as all but the most dreaded diseases. It is simply the case that some people, by virtue of the values imparted by their families, friends, or societies or by their own unique abilities to adapt, or even by luckily stumbling upon effective self-management techniques are able to overcome on their own that for which other need help. It is really no different than adjustments some people have to chronic pain. Some manage well on their own; some do not. There is nothing wrong with either.

Let me take this opportunity to mention some research I have been doing for the past three years. My students and I have been asking stutterers, former stutterers, and parents of current or former stutterers to simply "tell their stories." The interviews are fascinating! I am working on a number of qualitative means of analyzing the enormous amount of information I have collected (e.g., from 100 adults who stutter or used to stutter). Many of these individuals never sought nor had any speech therapy and yet recovered fully. Others were just like the person you described: well adjusted with stuttering. As I look at the data, one thing is becoming increasingly clear to me. The somewhat negative picture we have of adult stuttering from our clinical research and textbook accounts is probably skewed toward the group who is not able to manage the problem on their own. Any why not? This is the group that seeks our services.

What we need to remember is that there is more to stuttering than the common clinical experience of SLPs. I hope to shed more light on that in the next year or two.

Good question, Theresa! Please pass my "tip of the hat" to your friend who clearly knows something about learning to live with stuttering that I did not know as stutterer in high school.


From: James Griffin

Dear Theresa,

I am an outgoing person who stutters and I read you account of your friend with interest. I was struck by your observation that he seemed to cheerfully incorporate stuttering into his life.

I could never quite do that. While I did not let stuttering stop me from talking, and while most listeners were patient and suportive, my goal was to speak without stuttering.

I would also agree with the other responses to your question who suggest that for some, it's more 'just a part of life' than it is for others.



P.S. If my experiences would shed any more light on your questions you can find my autobiographical paper in this site as 'James Griffin & Stuttering.

From: Gunars Neiders neiders

Very good question. The individual adjustment or maladjustment to the problem of stuttering is amazingly varied. Take, for instance, my case.

a) One of my problems was the severity of my stuttering, so I tried sixteen stuttering therapies. Always optimistic that the next one would do the trick.

b) I understood that my shyness and introversion was also an independent problem. So I tried Rational Emotive Behavior Therapy. And I started to work on that. Now there is nobody who could call me introverted.

c) Perfectionism was another problem of mine, which I worked on with the tools provided by the above mentioned psychology. When I stopped demanding being perfectly fluent, I was able to gain what I consider marvelous ease in speaking, although not total fluency.

d) Lack of a sense of humor about stuttering was the next thing I worked on. Now my irreverent sense of humor gets me into trouble. :-)

e) Self-discipline is the thing I am going to work on now.

I guess my current spontaneity in daily situations, where I talk to everyone I come in contact with, where people are completely at ease to tease me a little about my speech, my not internalizing what others say if they have malice in their heart, was evolved due to my own hard work. It was not given to me free.

I think your friend earned his spurs. He, just like I, probably saw that life is both a moveable feast and at times a pain. Stuttering, when managed properly, both working on one's own attitudes and speech techniques, is nothing more nor less that one of the many, many characteristics that are part of the total human.

When a human loses optimism that he can cope with stuttering, when he lets life slide by, it is time for that person to see a good cognitive psychologist. This is not a dress rehearsal, this is it. :-)


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Software package for at home help?

From: Judy Butler

Someone has asked me if there is a software package available for speech-motor control practice at home. Would someone please comment on what is available in terms of features, cost, and effectiveness?

From: Gunars K. Neiders


I came across the following article. The website is below. I have had zero experience with this software. Maybe some of the professors would like to comment on it.

"The Jerusalem Post" - Tuesday, March 30, 1999 13 Nisan 5759 SO TO SPEAK By NICKY BLACKBURN

(March 28) - Until the age of 23 Arie Friedman was a so severely affected by a heavy stutter that, in an attempt to avoid speaking situations, he pursued a career in physics.

That was seven years ago.

Today, as president, CEO and founder of education and medical technologies specialist Speech Therapy Systems (STS), Friedman talks confidently and, as a result of his experiences, has developed a unique software program to help people with similar problems learn to speak fluently.

The software program, called Dr. Fluency, is now being sold in clinics, hospitals and schools in six countries; in Sweden it is a recognized treatment for stuttering.

This month it received special recognition when it was awarded the Prime Minister's Prize for Computer Software in the field of medicine and education.

This year the tiny eight-man start-up, based in Kiryat Arba, anticipates sales of $1 million; by 2002 Friedman expects to see that figure rise to $20m.

Overall, there are about 50 million stutterers in the world, says Friedman. In the US alone some three million people stutter.

Despite decades of research the cause of stuttering is not known, though - contrary to popular opinion - it is not thought to be caused by emotional distress. Some believe it might be caused genetically but scientists have been unable to pinpoint the actual reason.

What is known, however, is that it affects four times more men than women, and that 25% of all children go through a stage of development during which they stutter.

Stuttering can be extremely debilitating.

"It's very hard not to be able to say what you want," says Friedman. "You can't speak to people, can't teach, can't even ask a simple question in the supermarket. In many cases you just keep quiet. You learn to cope, but it's very hard. It restricts your life."

Friedman arrived in Israel from Riga, Latvia, in 1991 at the age of 23. He had been stuttering badly since the age of six and despite a range of treatments was unable to achieve speaking fluency.

While he was studying for his Ph.D. in physics at Beersheba's Ben-Gurion University, Friedman's tutor encouraged him to attend a three-week fluency-shaping course at the Hadassah-University Hospital Speech and Hearing Center in Jerusalem.

By the end of this period Friedman had lost his stutter.

"It changed my life," he says simply.

Having recognized that the treatment could be far more economical and effective if it were computerized, he approached the industrial-incubator program in Kiryat Arba, and by the end of 1992 STS was founded with a two-year grant of $250,000. Two years later, with the help of specialists at Hadassah, the software was completed.

The program, which is based on Hadassah's therapy and is designed for clinical and home use, combines all aspects of fluency-shaping therapy.

It uses multimedia technology combined with animated graphics to create an attractive and user-friendly package. A main feature of the program, which is accredited by the American Speech and Hearing Association (ASHA), is the patented breathing monitor, which features linear measurement of chest and abdominal breathing; there's also an oscilloscope, feedback devices and a microphone headset.

Dr. Fluency should be used in conjunction with clinical therapy. At present, stutterers who become fluent after a course often relapse a few months later. The software prevents this from happening by maximizing the effectiveness of fluency shaping. This cuts patient costs enormously.

THE FIRST version of Dr. Fluency was presented at the Congress for Fluency Disorders in Munich in 1994 and proved a great success. A number of leading fluency treatment specialists joined STS's board of advisers.

After leaving the incubator the company received another $80,000 from the Chief Scientist's Office and a further $100,000 from the K.K. Newton investment fund. It also financed its activities by selling Internet products. Friedman doesn't want to discuss these, however, explaining that they are trade secrets.

The software first came out in Hebrew, followed by English, German and Swedish versions. The program has undergone testing at leading clinics around the world; sales to hospitals, clinics and school districts in the US, England, Sweden, Canada and Germany began last year.

Hadassah has been using the software for the last three years and Haya Levi, director of the speech and hearing center, is full of praise.

"It helps patients a great deal and they really like it. They get direct feedback from the computer so they can see by themselves whether what they are doing is right or wrong. Patients need to practice a great deal and this software helps them do just that," she says.

The hospital now uses the software as part of its therapy and Levi believes it's an ideal tool for other clinics involved in similar fields.

In October of last year, Robert Kroll and Tina Gasee from the University of Toronto's Speech Foundation of Ontario conducted a study on Friedman software. Eighty-six percent of subjects claimed their accuracy in achieving specific speech results was helped by using it.

"I view Dr. Fluency as an excellent supplement to fluency-shaping therapy and as an invaluable and practical tool for home practice and fluency maintenance," Kroll says.

As far as competition goes, there appears to be none. Both Friedman and Levi believe Dr. Fluency is unique.

At present STS markets its products through independent sales representatives around the world. Though Friedman is not a businessman by profession, he understands that the company needs to invest heavily in marketing. STS is now hunting for a large investor or marketing partner that can help the company reach its markets.

A recent breakthrough for STS is the decision by the Swedish health authorities to use the software as a recognized treatment for stutterers. Since health care in Sweden is fully state funded, Friedman believes it will become one of the company's best markets.

"There are 80,000 stutterers in Sweden so we expect several million dollars worth of sales from Sweden alone in the next few years," says Friedman.

The company, which is currently developing Danish, Latvian and Russian versions, also aims to develop a children's version.

STS also plans to use the technology to create a new Aphasia program for stroke victims and a multi-channel EMG device based on the breathing monitor.

Friedman says he feels optimistic about the future.

"We've started selling and there's a large potential market. Now we just have to find an investor to help us bring it to the market," he says.

For Friedman, however, STS is more than just a company.

"Dr. Fluency helps people. It offers people who can't speak properly the chance to be fluent. That's a wonderful thing."

The website is

I really would be interested on what the experts think.


From: Nan Ratner

This is not a comment on the program you describe per se, but rather an observation on what any software program can really accomplish. As an aid to concepts in fluency shaping, it probably has its uses. However, fluency shaping alone or practice of speech targets alone, can only do so much, in my opinion. For many people who stutter, it is not mastery of the targets that is the problem, it is being able to use them in real-life situations, particularly because issues such as their fear of stuttering, or fear of speaking, impeded their ability to utilize these skills when they matter most. I sometimes think it is like performance anxiety: it is easy to shoot hoops well when no one is watching, but very difficult if an audience of thousands of playoff fans are watching. Or, as my colleague Vivian Sisskin nicely notes, it is easy to walk on a 2X4 board if it is on the ground, but impossible if I stretch it between two tall buildings. I think that many of us recognize that the challenge is not the mastery of certain speech goals, but helping the person understand the complex interaction among factors such as tolerance of their own speech and fluency, fear of stuttering and speaking, etc. that makes the largest difference between successful and less successful treatment, and I just don't know how much software is going to make a dent in this.

From: Gunars


Thank you for your insightful comment on the topic.


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Effect of ADD medications on childhood dysfluencies

From: Adriana DiGrande

I have evaluated several children for fluency, whose parents reported that their children's dysfluency worsened after taking medications for ADD. Parents have also reported that during the summer months, when their children were off their meds, the fluency improved. These children were all at risk for stuttering or had a history of stuttering prior to taking the meds. Any research to support these observations?

From: Nan Ratner

Past discussions on Stutt-L suggest that many children do react more disfluently under these meds, but others seem to do better, if I recall. It seems to be very ideosyncratic.

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Counseling parents of children who stutter

From: D. Hawkins

I am a graduate student in Speech Pathology. I am writing a paper on counseling parents of children who stutter. I am looking more at helping them cope with the stuttering disorder rather than researching strategies to teach parents how to communicate with their child. I have found limited research on this topic. I was wondering if you could share some of your ideas with me on how to counsel parents of children who stutter?

From: Woody

There are several good books on counseling the parents of stutterers. I think you could find all of the titles right here on the Stuttering Home Page, or in any library.

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Which Speech Therapy?

From: Ubaldo Martinez

I've been given a great opportunity, my employer has let me know that he would pay for any speech therapy and/or devices I might need to help me with my stuttering.

I need the help of all you guys. What are my best options, money is no obstacle. I've been thinking of an electronic device combined with a real good extensive therapy. Example: Fluency Master combined with the Hollins program.

Two years ago I went through the Hollins program, it did help me a lot but I still have times of severe stuttering. Would it be wise to go through the program again?

Please, I need advice from all you.

Thanks, Ubaldo Martinez

From: Ken St. Louis

Dear Ubaldo,

Your question is a hard one. Should you recycle through the Hollins program? Should you purchase a speech aid device? I honestly do not think there is a clear answer to your question. You asked for advice from all of us. If everyone were to respond, I'm sure there would be contradictions. But here are my thoughts.

Did you find the Hollins Fluency System to your liking? In other words, do you like striving for speech free of stuttering, even if your speech pattern sounds more or less unnatural and feels more or less artificial. If so, then I think you might find it useful to try the program again.

If you don't like to monitor and might prefer a more fluent form of your stuttering, then you might want to consider a stuttering modification approach to therapy. More and more clinicians are getting back to this traditional approach that was perhaps best perfected by Charles Van Riper. One big difference in this approach is that you will spend far less effort focusing on everything you say and more effort studying, intercepting, and changing your stutters than you did in the Hollins fluency shaping program.

Should you purchase a speech aid? Others will certainly disagree, but I would advise you to try to achieve and maintain fluency without one. If that fails, repeatedly, then you might wish to pursue such an aid.

In any case, regardless of what approach to further therapy you take, I think you might benefit from a more comprehensive maintenance program that will help you retain the gains that you are capable of making. Sometimes the plus of becoming fluent quickly in an intensive program like the Hollins program becomes a minus in terms of maintaining the gains once the program is over. Ultimately, recovering from severe stuttering involves some very basic changes in the way you live day to day. Starting or joining a stuttering self-help group might provide some of the motivation to keep monitoring, practice your targets, etc.

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Parental guilt

From: Judy Butler

Can someone please address the tremendous guilt that parents who stutter feel about stuttering being a problem for a son or daughter. As an SLP, how should I address this issue?

From: Bob Quesal

This is one of those (many) cases where our counseling skills come into play. I think it would be a good idea to find out why the parents feel guilty, since that could come from many sources: we did something wrong during pregnancy, we raised our child wrong, we "made" our child stutter, etc. You need to reassure the parents that the stuttering is not their fault--it's nobody's fault! (that idea is stolen from Bill Murphy). ;-)>

You can try some "what if?" types of things with them: What if your child didn't stutter? Would you love them more? Less?

To what extent do you feel that your child's stuttering reflects poorly on you? (This is an extremely tough question to ask, but often it needs to be asked.)

Parents who are guilty need two primary things, IMHO: some education to show that they are not at fault, and some help in putting their child's stuttering in some context: what does your child do well? What are his/her strengths? How big of a role does stutttering play in who your child is and/or what s/he will become?

Examples of stutterers who have become successful might help.

Like most other things, "parental guilt" can have many underpinnings and I think it's important to determine where the guilt arises and tackle it from those points.

From: Ken St. Louis

Dear Judy,

Bob Quesal has given you a wonderful answer!

Let me add one thing. I have found that jointly watching then discussing the SFA "Stuttering and Your Child" video and the Bondarenko "Speaking of Courage" videos offer a wonderful opportunity to bring up the problem of parental guilt. Be sure to have lots of tissues available for the tears (even yours)! There is a wonderful segment in the latter video where a neuropsychologist talks about a father who scared his son with a Halloween mask whereupon the boy started to stutter. He talks about the guilt the father felt for years but points out that if that had not triggered the stuttering, something else very likely would have. This would be a great place to start a conversation on feeling responsible for the child's stuttering.

From: J. Scott Yaruss

Hi Judy -- Very good question, and I agree with the answers provided by Bob and Ken...

One thing that I would add...something that I stress in both my stuttering class (where this was the topic of discussion just last week) and my counseling class is that we cannot CONVINCE parents to not feel guilty.

Guilt seems to just come with the territory of being a parent, and we can't take it away through persuasion...Education is one key to helping parents overcome their guilt, but we need to provide that education in such a way that we're not trying to persuade the parent.

Rather, I try to first validate their feelings, acknowledging that I understand why they feel the way they do, and letting them know that their feelings are not unusual or out of the ordinary. Then, I try to give them information so that they can come, on their own, to the realization that their child's stuttering is not their fault.

I find that this makes a difference for helping parents take appropriate ownership of what they can do to help, rather than being stuck in what they might have done wrong in the past.

Finally, one thing we need to keep in mind is that many of the recommendations we make about ways parents can help their children may increase guilt if we don't present them in the right way. In other words, if we tell a parent to reduce their speaking rate, they might become concerned that the fast speaking rate might have caused the stuttering. This is delicate, for we need to help them understand (not convince them, but help them understand) that they have power to help the child, but this does not necessarily mean that their prior behavior was what caused the problem in the first place.

One analogy I've used, and I've heard it lots of places, is that of a cast...a child may need a cast if he breaks his is not the lack of a cast that caused the child to break the arm, but the presence of a cast can help it heal. The parents are like the cast - their slow rate can help the child improve his fluency, but the lack of a slow rate is not to blame for the onset of the stuttering.

Just some thoughts on a very important topic...Thanks for raising it! Scott

From: Woody

You have received some wonderful answers already, and I don't have too much to add to what the others have said. But two ideas come to mind. First, we used to have a parents' group therapy session as part of our program in dealing with preschool stutterers, and it was very helpful in a number of ways, including the guilt issue. It is certainly a very common part of the parents' experience, and it is quite relieving to meet and talk with other parents who feel the same way. As with many of life's problems it is important, but not easy, to come to realize that the problem is not your fault. As Scott said, this is necessary but often not sufficient to alleviate guilt. The group process can be additionally helpful.

The second thing I want to mention is very difficult to even bring up, but it needs to be said. The percentage of families in which there is another problem, usually a dark secret problem, is very high. There may have been physical or sexual abuse, alcoholism or addiction, or some form of mental illness. The presence of any **other** serious problem in a family, greatly increases the feelings of guilt that the parents have, and not just the parent with the other problem. The spouse too feels guilty for having allowed the problem to influence the child. These additional serious problems probably don't actually cause stuttering, but they may trigger it and they certainly can exacerbate it. The SLP's role is delicate and constrained by the law. Of course, if you have any real evidence that a child is in danger you must report the facts to legal authorities. But in most cases you simply suspect that there is another problem and the case takes longer than it should. Sometimes, with good counseling skills and/or a good referral, it is possible to bring the other problem out in the open. I have seen this happen only a few times, but the child's stuttering has been greatly improved by the shedding of guilty secrets. Most of the time it remains a background concern that never gets addressed. These problems are very common, and yet we as SLP's receive little or no training on how to recognize them or what to do about them, which I think is a kind of educational scandal. People still want to pretend that these problems don't exist. Sometimes, there is something that the SLP can do. We had one case where there was an alcoholic parent. It was obvious when she brought her son to therapy that she was inebriated. We refused to treat the child until the mother began to address the alcoholism. I am not sure how this case turned out, and we may very well have scared her off, if she wasn't ready to face her addiction, but we wouldn't have been able to do much for the boy anyway, and often, when a parent is faced with a decision like this, it will be the thing that gets him or her to start taking the addiction seriously, maybe not immediately, but eventually. So, it will still be my policy not to treat a child when the parents are actively addicted. Most of these situations have no good outcome, but we can at least try to be part of the solution.

From: Ellen-Marie Silverman

You have received some good suggestions. I have one thought to consider: A SLP, untrained as a counselor, probably would be well-advised to help parents transform guilt into positive action rather than trying to directly help them process their guilt. Of course, empathetically responding to their message "I feel so guilty . . ." would be expected of any sensitive clinician. But the primary interaction between the clinician untrained as a counselor and the parent(s) needs to be focused on what can be facilitated in the present to bring about improved speaking behavior in their child and in their manner of interacting with their child.

If the parent(s) cannot release their guilt about their child's stuttering, then, in my opinion, a referral should be made to someone, e.g., clergy person, professional counselor, who can help them find relief. In the meantime, the clinician would be well-advised to continue treatment, carefully considering how to include the parents in formulating and establishing new communication patterns. The clinician's mantra in working with such parents could be "That was then, and this is now" in the sense that now is where change can be brought about.

From: Judy Butler

Thank you very much everyone for your thoughtful answers.

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Ritmika Ortofonica

From:Flor Suarez

Please I would like to study about "ritmica ortofonica" (I can not translate) of Mme Borel -Maisonny. I would like to know Jose Farellada felliu. I have his books of stuttering and I have questions of his method. Thank you.

From: Woody

I am sorry to say that I have never heard of either the person or the method, so I can't really comment. If you could identify the country you are in, someone else may know something about where you could go to get an opinion.

From: Judy Kuster

From what I can gather (my French is not very good and altavista translation service helps, but isn't perfect) Suzanne Borel-Maisonny was instrumental in starting the French association of speech therapists back in 1959. She also developed a method to teach language through gestures with each letter of the alphabet and each sound being represented by a gesture or a hand position. When the child pronounces the words he cannot reverse the letters of the word or the syllables "because he unconsciously memorized through gesture the order of appearance of the letters and syllables." I believe it is used for speech and also for children with reading difficulties. I do not know how it relates to stuttering therapy.

I cannot find anything about Jose Farellada.

Perhaps the French F�d�ration nationale des orthophonistes (their website is could help answer your questions or give you some information where you can get additional help.

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Child who has dramatic increase in stuttering at age 7

From: pam b.

My son just turned 7 and is a very bright articulate perfectionist who has always had a large vocabulary. As a preschooler he would occassionally stutter- mostly first words of a sentence but it was never consistent. I mentioned it to his kindergarten teacher who said that he did not do it in the school setting. This summer (between K and 1st grade) he had a dramatic increase in his stuttering- again almost always the first word to a sentence. Upon entering the first grade I asked his teacher about the stuttering and she again told me they did not notice it at school. 2 weeks ago the teacher did note an occ. stutter and had the school SLP do a brief (10 min) eval- in which she told me that he did not stutter but he does speak very quickly and seemed "stressed and nervous" and that could put him at risk for stuttering. She wants to wait a month to see if this "gets better" Since that time (about 1 1/2wks) he has had a dramatic increase in his stuttering- blocking on words (still mostly beginning words of sentences),using some eye twitching/closing and widening his mouth during extreme episodes of stuttering. He still has times of perfectly normal fluency and his worse time seems to be the end of the day. I am panicking at the rapid progression of the stuttering and we are seeing his pediatrician on monday for his well child check-up. Am I correct in asking for a full speech and language evaluation at a specialist (locally Mass General?) Could there be any correlation with his school work (phonetically sounding out words to write on their own) as it seems as if he is repeating each word When,when,when did we go.... till it sounds perfect??? any further suggestions would be greatly appreciated- we are trying to slow our lives as well as speech down to decrease stressors -and have been reading all these excellent reference articles. Thanks for your time, pam

From: Ken St. Louis

Dear Pam,

I would definitely recommend a speech and language evaluation at Mass General for your son. It appears that he is getting worse and beginning to react strongly to his own stuttering. I don't know if the phonetic approach to reading is a contributing factor or not.

In any case, it is generally agreed now that young children who stutter should be enrolled in therapy as soon as possible. Look at the previous posts in this session about finding a competent clinician who in interested in fluency disorders. I know there are a number of good people in the Boston area.

I wish you and your son success.

From: Woody

Hi Pam:

I completely agree with Ken. I can even recommend a particular person in the Boston area. If you will write me out of the public limelight, I will give you her number.

Just a few notes too. Stuttering most often occurs at the beginning of sentences, so that fact in your son's pattern doesn't mean anything special. That he talks rapidly and is sometimes hard to understand is helpful information. This is a different problem from stuttering, called cluttering, which can be a part of stuttering in some cases. That is the kind of information that a full evaluation would get at. Ken St. Louis might want to comment on that, since he knows much more about it than I do.

Seven is a little older than average for stuttering onset, but not unusual, and the pattern you describe of a milder problem at an earlier age which gets worse as school, or some other stressor, kicks in is also a common pattern of onset. I too am not sure if the phonics instruction played a role, but it would not do much harm to his eventual ability to read, if you were to remove him from that form of instruction, if it is possible to do so. If it is a major factor in his stuttering, you should see a quick change in the stuttering for the better.

I hope these help. Call (215-222-4559) or email ( me offline, and I will give you the name of the clinician.

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stuttering in preschool children

From: Kathlyn McNeal

I am the mother of a three-and-one-half year girl who is exhibiting atypical dysfluencies for her age. I am also a speech/language pathologist (with limited experience with people who stutter). We have been following guidelines for indirectly dealing with her dysfluency. The characteristics that trouble me the most are phonatory and respiratory compensations she sometimes appears to make to deal with dysfluent periods (there is also a paternal familial history of stuttering). What I would like to know is if you might be able to give me any suggestions for directly dealing with someone this age. I would appreciate any concrete examples of what I could say to her during times of dysfluency. I realize that you have not heard this child, but as a practicing speech language pathologist, I could read through the suggestions and see what would be most helpful for her. Although I am an SLP, I am obviously emotionally clouded by this, and would truly appreciate any suggestions that that I could read through.

From: Nan Ratner

For me, one of the most important things I have seen in working with the parents of the little ones who come here is that it is OK and probably necessary to acknowledge when she seems to be having difficulty, rather than ignoring the behavior. We have seen the severity of stuttering moments alleviated by parental that reassure the child, such as, "that seemed hard to say. Sometimes I have trouble with words too. You did a good job." The very hardest thing, perhaps especially for a parent who is an SLP, is not to convey the thought that the stuttering is bad or something you really want gone, because that conveys the impression that stuttering is something bad, something to fear, and that parents don't like it if you talk and stutter. Such thoughts only complicate everything if the problem persists and doesn't spontaneously disappear, which we know will unfortunately happen in about 20% of cases. This is just a start, and I know that others can do a fine job of saying more on this topic.

From: Ken St. Louis

Dear Kathlyn,

I give an enthusiastic "second" to what Nan Ratner has advised. I believe the more something is not mentioned the more unmentionable it becomes. Stuttering is no exception.

I wanted to add that my daughter began to stutter severely as a 2-3 year-old. We also had the family history connection. (Me!) And that was back at the time when we were just beginning to consider treating youngsters, but the conventional wisdom still more strongly favored the "ignore it and it will go away" diagnosogenic thinking. We tried to ignore her stuttering, but after several months of watching it get worse, we sought an evaluation and started some semi-direct therapy. Maybe she would have spontaneously recovered, but my daughter completely recovered. Until her grandmother mentioned it when she was a teenager, she did not even know that she had ever stuttered. I can't say that all outcomes are like this, but I have had several cases where young preschoolers completely recover.

If you think you are having a hard time being objective, seek out a specialist in stuttering to guide you. It seems to me your main job is being the mom. It's fine to let someone else be the clinician.

From: Woody

I firmly believe that preschool children do best when both direct and indirect treatment is provided, and I second the opinions of Ken and Nan about bringing it out in the open. ONe of the best ways to do this, in my opinion, is to stutter a little yourself in front of the child. Not too often, and certainly not with struggle and tension, but light, easy whole word repetitions that are brief, say one or two extra syllables. This will show the child that some disfluency, of the type that she started struggling with, are acceptable behavior. So you have to be careful, as the Mom, to model an accepting attitude toward these disfluencies that you are producing.

I sometimes think that having children who stutter, even if briefly, is an occupational hazard of being an SLP. Someone should actually gather the data, but when I give a workshop to SLP's, I ask how many have kids who have stuttered, and I usually get a 10-15 per cent positive response. I know, I know, that could be why they came to the workshop. Still, I would like to see someone get the real data.

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Left handed female stutterers

From: Jim Clarkson Australia

Hi. In researching our family tree and through my own observations of stutterers and others in our family and conferring with elder members in the past [observant academic types]. Of the many people in there hundreds dating back to the 1800s' I have come up with 10 stutterers 9 of which I have had personal contact with one being me. Of these three are females, one female did not learn to speak until age 8 and now speaks with excellent fluency. stutterer? Of the other 2 one being my daughter age 27 the other age 8. Of all these hundreds of people the only definite left handed persons in the family are these two females. According to recent research in Australia, definite L.H. persons are actually survivors of a twin pregnancy ie' one has died as early as the first few weeks of pregnancy. Could you please briefly relate to me how this may fit in with past research into different types of stuttering twins, male female etc. Is there a pattern of female stutters. In non stuttering twins are there more females than males. A hypothetical question which you dont have to answer. With our family history when and if I ever become a grandparent and I reach into my son our daughters babies basinet if the baby is a female and it reaches out with a little left hand. Do you think a little more care in its upbringing may be in order especially by the parents. Don’t get too serious about this I am not. Kind regards Jim Clarkson.

From: Judy Kuster

Very interesting research you have done on your family history!

Questions about handedness and stuttering have been around for awhile. At one time there was even a theory that changing handedness would cause stuttering. But I don't know of any research that has been done on handedness in females who stutter. All I remember was my instructor at the University of Wisconsin, Dr. Lois Nelson telling our class that from her clinical experience, if we ever saw a preschool girl with signs of stuttering, if she was left-handed, we should not take a "wait and see" approach, but get her and her family involved in therapy right away. Lois Nelson is a person who stutters. She is also left-handed. She is now retired and was the teacher for many who are especially interested in stuttering therapy - Barry Guitar, Judith Eckhardt, Steve Hood, Peter Ramig, and others. Lois Nelson.

From: Jessica Hunyady, USA

The information on your family history sounds really interesting. I'm a speech pathology student working on my masters right now. Although I'm not too familiar with any types of studies done with left handed females who stutter, I do know that there are many left handed females who don't stutter. If you had a grand daughter who's left handed, I think there's a good chance she won't stutter. Of course, if she would begin to stutter, I would seek treatment as early as possible, but until then, don't jump to any conclusions. However, you have proposed a very interesting idea that's made me think.

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It has been a privilege to be a part of this!

From: Ken St. Louis

As this 3rd on-line conference comes to a close, I want to express my thanks to all of the people who participated in these discussions. I'd like to think of my comments not as "professing" but as offering another (hopefully) informed opinion. I firmly believe that nobody has a corner on the truth, but I am sure that seeking the opinions of competent people of good will is the best way to get as close to it as possible.

There is hope for those who live with stuttering. Especially to the parents who are struggling for direction and answers to the heartbreaking circumstance of a son or daughter who is beginning to stutter, I want to say again that many of these children recover completely. Yet even for those who don't, or for older stutterers who are not seeking that elusive goal of complete fluency, there is hope as well. Therapies can be effective in most cases. Self-help groups are continuing sources of support and guidance. Information is increasingly available for those who seek it. We have begun the process of recognizing specialist in treating fluency disorders.

For three years, I have been collecting stories from adults who stutter or used to stutter and from parents whose children either stutter or used to stutter. These stories, like the discussions here, often mention the pain and suffering that stuttering can cause, but in nearly every case they also highlight the courage and triumphs of real people overcoming adversity. I plan to continue to communicate those positive messages to those who stutter and their relatives as well as students and practitioners who seek to help and guide them.

Thanks to Judy and Michael for their efforts in making this conference a success. It has been a privilege to be a part of it.


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