Click on the title in this index to go directly to the discussion below.
From:
Murray Braha
I'm a 45 yr old man who's been stuttering since early childhood. I've recently lost my business & have been looking for a job. I've interviewed for quite a few positions I am very qualified for but have been turned down each time. I have had "therapy" ie(CRC institute/Schwartz program, as well as private sessions).None really gave any real world or lasting results. I tried the Fluency Master recently & it worked very well on my reading aloud but not on my speaking. I'm considering trying the Speakeasy device & was wondering if someone had any experience with it's results.
From:
Judy Kuster
I hope others "profs" will respond as well, but I'd like to refer you to another article on this conference by Greg Snyder that talks about this technology.
From:
Larry Molt, Auburn University
Hi Mr. Braha
I'm desperately searching for the proverbial 10 foot pole for handling this question - and it's a question we all knew would be coming. Thanks to it's very public release and publicity splash, questions about the SpeechEasy devices have dominated the stuttering internet list-serves, self-help group discussions, and the phone lines and e-mail of speech-language pathologists for the last two months. Our clinic does not currently dispense the devices. I can only pass along anecdotal information. I would encourage you to subscribe to the Stutt-L internet discussion list-serve, if you're not already a member, and check the archives, as much discussion has already taken place that might help answer your question. (BTW, if you're not a member, instructions for subscribing to the various internet list-serves dealing with stuttering are available at the "Stuttering Home Page").
I've copied the most recent Stutt-L posting concerning feedback on the SpeechEasy device that appeared yesterday (30 September, 2002) and pasted it below. In my opinion it's fairly representative of the feedback that has been coming in:
" . . . . . . I've had the SpeechEasy (completely-in-the-canal model) for about nine months. A little history -- I had tried a DAF device before I tried the SpeechEasy and was just blown away. My speech had never been so effortless. Of course the idea of taking that comfort inconspicuously out into the world was an attraction.
My experience with the SpeechEasy has been mixed. I should tell you that I've got a moderate stutter, though most of the time I've got a handle on it (whatever that means). Anyway, you'll notice a couple of things initially. First, the signal is not as clear, despite what Janus claims, as a more elaborate machine. There is also quite a deal of residual noise - making places like malls and gymnasiums a little unbearable. That said, the Speecheasy is helpful. Though there is some adaptation, which can be quite frightening if you aren't prepared for it. Ultimately, you've got to use the device -- the device won't use you. That is, it's only a tool. On bad days, or times when you just want to get it over with and blast your way through a sentence, the Speecheasy is rather useless. But if you can remain aware of it, and expect only assistance, not a cure, it's helpful. And, as I'm sure you're aware, the price is steep. I wouldn't sell anything important, like your soul, to get it. But if you've got the resources, it may be worth it . . . . . "
From:
John Tetnowski
Murray,
I'm like Larry, and will answer this question very carefully. I would ask you (and other interested PWS) what your goals for therapy are, or what "success" means to you. If "success" is measured by "stutter-free" speech, then you may gain some degree of success with this (and other similar) devices. If your goals for success are measured with aspects other than just "stutter-free speech", such as eliminating avoidances, learning coping strategies, etc., then an alternative method of therapy may be best for you.
From:
Gunars
John,
I was a little disappointed in your answer. The modern philosophy of science (postmodernism, social constructivism) emphasizes the BOTH AND instead of the EITHER OR approach. But, I guess the field of stuttering therapy has always been adversarial: a) first thing I recall about stuttering therapy was the great Wendell Johnson vs. Charles Gage Van Riper feud, b) next was the Fluency Shaping versus Stuttering Modification feud, c) now there appear to be camps forming to start a Device versus Stuttering therapy feud, and, d) when I get out of graduate school in psychology, I can see the emergence of Stuttering Therapy versus Psychology feud.
These feuds appear to be very entertaining and occupying for those individuals who participate and those who observe. Otherwise, they would have died natural deaths.
I am very involved with stuttering therapy, having undergone at least 15 or 16 or 17 by the last count. I am also very involved in desensitization via Rational Emotive Behavior Therapy techniques. Finally, I understand that collaborative, competency-based constructivist therapy may be the best way to handle the Post Traumatic Stress Syndrome effects of stuttering. This empowerment and encouragement of people to be their own therapists by merely providing them with information, but not forcing them through structured therapy, may well work for a lot of people who are turned off by one size fits all therapy.
I think that was a long enough of an introduction. I really think that there is nothing wrong, except the price, with experimenting with an adjunct to therapy as SpeakEasy or Casa Futura version of it.
I see no disadvantage to wearing a bulkier device if the price is right. Of course, if it is uncomfortable I would opt for SpeakEasy. I do see that people who stutter have a very well developed feeling of shame: a) they are ashamed of their stuttering and b) they are ashamed of wearing a device. I think reading some recent Rational Emotive Behavior Therapy (REBT) literature, such as the third edition of The Guide For Rational Living by Albert Ellis and Robert Harper may well reduce the shame to manageable proportions. If that does not work, I would suggest some good REBT therapist.
My experience is that Wendell Johnson�s approach to stuttering using General Semantics helped me not to define myself as merely a stutterer. Charles Van Riper gave me some tools to form sounds. Joseph Sheehan taught me a good desensitization technique, voluntary pseudo stuttering. Fluency shaping, taught me to follow my sound formations via proprioceptive feedback (feedback of the motion of my sound forming muscles) and overlearning the concept of easy onset. Stuttering modification got me out being stuck. Somewhere along the path I lost all secondary stuttering symptoms. REBT taught me to accept myself unconditionally and to take risks, like going back to university to earn my Psy.D.. REBT taught me also how silly it is to spend time AWFULIZING AND CATASTROPHIZING ABOUT MY STUTTERING. Constructivist collaborative competency-based psychology is teaching me that as a psychologist, I best understand that each of us arw different. But, moreover, each of us wants to be the Pygmalion of our selves. Above all we want to be empowered and respected.
What will the SpeakEasy or Casa Futura device do for me? I don�t yet know because I have been too busy with my studies to order one, but I am sure I will experiment and find out. Will it turn me into a perfect speaker? Probably not. But say it takes out another 30% of dysfluencies of the already rather fluent speech, it may make my communication process 30% better. Not a bad deal.
My questions to you, John, is: Why can�t the stuttering profession see the symbiotic nature of various approaches? Why is there such a strong feeling of "us" against "them"? Is it because the academic environment does not propagate integrative therapies whose ultimate goal is to serve the client, instead to publish more papers?
Respectfully,
Gunars
From:
Mike Hughes
Murray,
You mentioned that you have tried the Fluency Master. Unfortunately, I can not use that for comparison since I have never used the Fluency Master. I have, however, used the Edinburgh Masker, Kehoe's Pocket Fluency Device, and the new SpeechEasy Device.
As is mentioned elsewhere in this discussion, to be most effective the user must *work WITH* these devices. They won't work alone. My testing of the SpeechEasy Device found it to be an option, although I would have liked the volume of the feedback to be louder. The biggest drawback of the SpeechEasy device is its cost: $4,000 USD is simply too much. But to be honest, my experience has shown that expenditures for such equipment might be repayed by qualifying for a better job or a higher salary.
I would recommend that you investigate Kehoe's Pocket Fluency System (www.casafuturatech.com). Although it is much move visible, its cost of about $600 USD is much more reasonable. Should you find this Delayed Auditory Feedback technique works for you -- when you work with it -- you may then want to consider the SpeechEasy device (www.janusdevelopmen.com). CasaFutura's system has a 3-month trial period with a 100% satsifaction moneyback guarantee. I believe that the SpeechEasy device has a 90% limited refund policy.
From:
Russ Hicks
Hi guys,
What an impressive panel of experts!! Even your pictures are good! I hope that many people will be able to post questions on stuttering to this panel. It's an honor to know most of you. You are making a difference in this world!
People, ask away! You've got the best people in the entire world here!
Best wishes for the success of this panel!
From:
chris marshall
Do PWS tend to be harder on themselves than people with other kinds of speech disorders? We PWS often have strong feelings like shame, lack of self-worth, or deficiency; we often feel it limits us in important ways. Are these attitudes typically as strong among people who are dysfluent in other ways?
From:
Judy Duchan
Yes--adults with aphasia (language problems resulting from a stroke), children with language and literacy problems, those with voice problems, all talk about the stigma and embarrassment that their speech, voice, or language problems cause them. It affects their sense of identity and self worth as well as their ability or willingness to do what they want to do. Indeed, many feel that the lack of acceptance and understanding of others is more of a problem than the communication problem itself!
From:
Ken St. Louis
Hi Chris,
I just thought of some data I published in a book called "Living With Stuttering: Stories, Basics, Resources, and Hope" last year that relates to your question. It involves one aspect of a "taking stock" exercise, specifically, filling out a self-administered questionnaire which asks for ratings from 1 to 9. The last two items on the questionnaire, which I called the "Inventory of Life Perspectives and Stuttering" (ILP-S) were: "Overall, how satisfied with your life are you at this time?" and "Overall, how much did stuttering affect your answer on the previous question...?" We tested the ILP-S on 120 adults who stutter who ranged in age from 18-79 years.
The information on the last question addresses your question. On the 1 to 9 scale with 1 being "no effect," 5 being "moderate effect," and 9 being "completely determined," the percentages of the 120 adults were as follows:
It looks like slightly more than 1/4 of the stutterers thought that stuttering had at least a moderate effect on their life satisfaction, with a few reporting almost complete determination of that overall rating.
From:
John Tetnowski
Chris,
In addition to what Ken said in his response, I kind of like the Wright and Ayre Stuttering Self-Rating Profile. It can serve as a helpful guide in assessing self-attitude.
From:
Gunars
Ken & John,
Has there been any study or an instrument which has tried to parse out the following three elements on the life satisfaction scale?
I myself have seen no instrument that tries to distinguish between these three types of causes for low satisfaction of life. The feelings of shame, guilt, and worthlessness can and SHOULD be addressed by a good psychologist. There is nothing intrinsically bad about us because we stutter. The whole rating game is a sham that has been hoisted by an uncaring culture upon us. Unfortunately, it is we, who stutter, who have to realize that as Pogo said, we have met the enemy and it is US. We need to screw our heads on right by doing some heavy thinking or getting help from good professionals: either stuttering therapists who are also VERY GOOD counselors or good psychologists such as Rational Emotive Behavior Therapists or other Cognitive Behavior Therapists.
From:
Ken St. Louis
Gunars,
I don't know of any well-known instrument that deals directly with *verified* handicap, discrimination, and personal feeling issues with stuttering. Scott Yaruss and Bob Quesal's forthcoming OASES (Overall Assessment of the Speaker's Experience of Stuttering) questionnaire does get close to all the issue you raised. They are in the final stages of development of this instrument.
The Inventory of Life Perspectives and Stuttering, a short questionnaire I developed last year deals with overall perceived suffering and handicap and the perceived extent that stuttering has affected life satisfaction.
You bring up a very good point that could be leveled as criticism to any questionnaire data wherein respondents report what they *would* do/think/feel in various situations. Would they, in fact, do that? I am reminded of a little study I read many years ago in Psychology Today. People were stopped on the street and asked by one interviewer if the way people dress would affect them. Almost all of them answered "no." Right around the corner was a person (another interviewer in the study) looking for change to put into a parking meter who asked the unsuspecting respondent for a dime or quarter to put into the meter. One third of the time, the person was dressed very informally and appeared rather unkempt. One third of the time, the same person was dressed in a suit and tie. And one third of the time, he was dressed in a security guard uniform. You can guess what happened. The "guard" received the most dimes or quarters, followed second by the "businessman," followed last by the casual dresser. It goes to show that what people say or think they might or will do is not always what they actually do. The only way to know for sure is to follow people over time, as you suggest in two of your examples. The stories that people tell on STUTT-L provide meaningful glimpses into the numerous possible explanations.
Yet, lots of people, including me, are involved in trying to get a better handle on such things as handicap, stigma, and discrimination. We use questionnaires to hopefully identify and quantify attitudes, thoughts, and (reported) behaviors. But you are right; we must not make the mistake of assuming that self-reports are completely valid.
From:
John Paskievich
I have been reading about the Lidcombe Method, a therapy for pre-school children that is popular in Australia. Therapists in North America however, seem wary of the Lidcombe Method. For 10 marks, please explain why.
From:
Bob Quesal
One of the reasons is that folks in North America are less familiar with Lidcombe than folks in Australia. I - and a lot of my colleagues - are eager to attend a Lidcombe training program to ensure that we understand the treatment. The online information is helpful, but doesn't substitute for learning from someone who can answer questions.
I think those of us who have been around for a while have seen "the cure" in various forms. It is perhaps better to wait for evidence to come in - from multiple places - before embracing a new treatment. And even the Lidcombe folks admit that they are not sure exactly why the treatment works.
This answer probably isn't worth ten marks - how 'bout seven? ;-)>
From:
Judy Kuster
Bob is right about that there are many here in the US who are interested in more training in the Lidcombe program, and interested in the outcomes of the research being conducted on the program in Australia. One person I know in the US who has had some training in the program is Barry Guitar. He has co-authored a paper for this conference on his experience with a modified Lidcombe approach. You may find
his paper of interest.
From:
Caroline Bowen
Bob,
As a speech-language pathologist I have used the Lidcombe Program, and ("impure") variations of it, throughout its development here in Sydney, Australia.
Mostly, I have used it with children 3-5 years, who stutter AND who have phonological impairments and / or SLI as well as fluency issues.
Although the diagnosis and treatment of stuttering in pre-school aged children is within my clinical orbit, I must admit I am not very well acquainted with the current INTERNATIONAL research in the area (of fluency generally).
With the growing necessity for clinicians to adhere to, and demonstrate, the principles of evidence based practice, and the emphasis worldwide on outcome measures, practioners are increasingly interested in demonstrating that their therapies WORK.
It was in this connection that your words, "And even the Lidcombe folks admit that they are not sure exactly why the treatment works." captured my interest.
With regard to "therapy that WORKS": there are many approaches, procedures and techniques in speech pathology intervention ("speech therapy") for a range of delays and disorders that clinicians believe in because they "work", and their faith in these things is supported by experimental evidence.
But as every schoolboy knows, knowing that a therapy works (or is efficient and effective) is a different thing from knowing WHY it works.
In the area of stuttering treatment for young children (the population the Lidcombe Program was designed for) are there "successful" therapies that have been evaluated, where the evaluators have been able to determine WHAT was doing the trick?
This is SUCH an excellent conference!
From:
Bob Quesal
Hi Caroline:
You raise important points (and also show why my trying to respond to these complex topics with a "Reader's Digest" response is not always a good idea).
As someone who believes that there is a lot more to the disorder of stuttering than the surface behaviors, I find the arguments about "evidence-based practice" to be a bit circular. Most of the "evidence" we have for "effective" treatments show changes in surface behavior. Most of us have worked with clients who have not been helped - LONG TERM - by such treatments. When we work on less observable aspects of the disorder, like attitudes and beliefs, we are told either that 1) they are not important, or 2) the effectiveness of the treatments that address these aspects has not been empirically demonstrated, so they are not valid.
So, my comment about WHY Lidcombe works, addressed (in part) the notion that it is POSSIBLE that the children undergoing this treatment are simply learning to hide their stuttering. Not likely, I admit, but possible. Further, it is also POSSIBLE the the kids you are seeing, who have concomitant problems (SLI and phonology) may be evidencing a different type of disfluency (perhaps language-based) which is being remediated as language and phono skills improve. Is that definitely the case? Of course not. Is it possible? I'd say it is.
There is no doubt that Lidcombe appears to be a valuable treatment for certain kids who stutter. That's why I am eager to learn more about it, so that I can do it RIGHT. Because the other argument I hear about why these "evidence-based" treatments fail is that they are not applied properly. So it seems to be blame the clinician or blame the client, but never blame the treatment. After all, there is evidence to support the efficacy of the treatments.
Of course, the Diagnosogenic theory was also based on published research. ;-)>
I hope this clarifies things, although I fear I may be digging myself I deeper and deeper.
;-)>
From:
Dick Mallard
Caroline, I would like to comment on your statement "...practitioners are increasingly interested in demonstrating that their therapies WORK." In 35 years of clinical practice, I have yet to find a therapy for stuttering that WORKS. Individuals who claim that their therapy "works" are implying that the therapy process does something to the client that causes the client to change. That is simply not the case (yet) in speech-language pathology. The success rate (however this is defined) of practitioners simply means that X% of clients were able to use what was taught according to some criteria. This is quite different that implying that some program produced a certain success independent of the client effecting what was taught.
Before a client agrees to participate in a therapy program, the following questions should be asked by the client to the individual who is to conduct the therapy. If suitable answers cannot be provided, then perhaps continuing the search for the most appropriate program for the client should be undertaken.
Perhaps there are other questions that my colleagues think should be added to this list. These are issues that I address with each client that I see prior to beginning a program so proper expectations can be developed. The last thing that I want is for a person to see me for therapy and think that my program will "work" when in fact it is the client that must work.
From:
Steve Hood
Hi, John.. For starters, I agree with what Bob and Judy have thus far said. I hope Barry Guitar will reply to your question. As for me, I want to learn more about the program. I am especially interested in knowing the "speech characteristics" of the youngsters involved in the program, because from what I have been able to read (and read between the lines) I am not sure if they are actually 'normally nonfluent' or 'borderline'/just beginning to stutter, or actually stuttering 'mildly.' (I know this in and of itself is controversial, but I feel I need to mention it.) Are these kids showing enough frequency of disfluency, associated beginning of effort, units of (re-)iteration with repetition, and "stutter-like disfluencies" and "short-element repetitions" of sounds and syllables, sound prolongations, tense pauses/hard contacts. and possible also the repetition of single-syllable whole words) to be concerned with. I think that the "conditions at onset" issue is a particularly important one. And even when we read about this on the printed page, it is not the same as actually being there, in person, to watch and listen to what is going on. You have introduced an important issue, and I am sorry that I have not really done much to answer it. I need to learn more. Indeed, I think we all do.
From:
Larry Molt
Echoing the comments from Bob, Judy, and Steve, my impression is that there is a great deal of interest in the Lidcombe Program in North America. I've attended several presentations by Mark Onslow and Ann Packman at ASHA conventions over the last few years, and there is usually a full-house. There are workshops appearing, and they've been well-attended. From the feedback I've gotten at the ASHA Special Interest Division 4 (Fluency and Fluency Disorders)Leadership Conferences, Lidcombe is definitely a hot topic and I'm seeing it discussed in the curriculums in the stuttering courses at the universities. It's a program, however, that appears to be best learned through direct training, rather than reading the manual, so the implementation is lagging behind - and , as Bob said, there is still concern over exactly what is happening, and why - and as more and more research comes in, more clinicians will be making decisions about program implementation.
From:
Linda Marquis
I am interested in learning more about the Lidcombe Program. Where is the US can I find information pertaining to locations and dates for upcoming training sessions ?
From:
Ardell Fitzgerald
Linda, You asked about training programs for Lidcombe. I am attending a two day training in Albuquerque, New Mexico on November 15 and 16th with Mark Onslow. I'm sure others can tell you of seminars in other places.
From:
Rosalee Shenker
We have been giving a four day clinician's training workshop for the past three years in conjunction with the Australian Stuttering Research Centre. Workshops will take place in Ottawa from Nov 1-3, 2002 and the schedule for 2003 includes Vancouver, British Columbia and Edmonton, Alberta in March 2003. You can contact me for details.
From:
Jonathan Bashor
Is there any evidence to suggest that children who later become stutterers acquire language differently than children who do not become stutterers ?
I'm not referring to baby talk. I mean the real beginning of self-expression: word selection and syntactical formulation.
From:
Nan Ratner
I actually do a lot of work in this area, so I will chime in here. There seems to be a trend in studies we and others have conducted, for children who stutter to have slightly lower lexical and syntactic skills than comparison children who don't stutter. A lot of this stuff is in print, including one additional one in press that I will be posting to my web site, and you can read the original articles there. Additionally, we find that children at the onset of stuttering are more likely to stutter on sentences that are more difficult to formulate, as measured by complexity estimates and their own formulation errors. Finally, recovery from stuttering MAY be linked to a guided or self-discovered reduction in children's spontaneous language attempts. We did some work with the Lidcombe people (see above thread)(this article is under Bonelli et al. on my web site) that showed that children who became more fluent during this program used simpler language than they had previously, perhaps as a result of their parents' reinforcement of fluent utterances, which are usually shorter and simpler than those that are stuttered in a child's speech.
From:
[no name]
Mark Onslow has asked that I clarify my discussion of the language impacts of the Lidcombe program. The article I refer to does this more fully, but I will reassure readers that the children observed in that study were still using age appropriate language after Lidcombe treatment. They had started with an unusually high profile of language production (using relatively longer utterances than would be expected for their ages) and were more age-appropriate at the close of therapy.
From:
Jonathan Bashor
Thanks for the info !
In addition to attempting overly complex formulations, I wonder if children who begin to stutter are over-planning their speech, i.e planning it out too far. I've read Willem Levelt's "Speaking" and kinda like his speech production theory. Using his idea, the Formulator and the Articulator get out of sync.
From:
Mark Onslow
Nan, I'd like to clarify further what we reported in our study (Bonelli et al., 2000). I think it is important to point out that there was no evidence that the children in this study changed their language production in any systematic way as a result of the Lidcombe Program. This lead us to conclude that "it is clear that this treatment is not associated with clinically significant curtailment of language functioning in children" (p. 443).
From:
Evodia Nyingsha - Cameroon
I am a nurse by profession and a member of SCAC. It is my first time of taking part in your conference. Joe our Coordinator gave me some papers from the conference that I have read and have gathered much from there. My question concerns my first daughter who is a stutterer now.
I came to Douala from Buea in the English speaking part of Cameroon with my daughter when she was 4 years old and by then not stuttering. When she started mixing with her mates and learning French and the Bassa dialect that are spoken here she developed stuttering. Now she stutters and much in French and the Bassa dialect. When she speaks in my mother tongue or in English she is a bit fluent. Can I say that the change in the environment is the cause of her stuttering? Nobody stutters in my family. I am afraid as my second child will be 1 year soon and will copy her example.
From:
Peter Ramig
Most specialists of stuttering do not believe parents cause stuttering; however, the parent's home environment, once the stuttering is evident, may very well contribute to the maintenance or even worsening of stuttering. More specifically, a home (or school) environment that is fast paced, punitive toward the child's stuttering, or a home that has been changed due to a move or family upheaval, may influence stuttering in a more negative way.
Regarding another question of yours, the vast majority of experts do not believe you need to be concerned about your youngest child developing stuttering as a result of her copying the stuttering of your older daughter.
Finally, your daughter's stuttering could be negatively influenced by the fact she is learning additional languages. A commonly accepted theory pertains to stuttering occuring as a result of too many demands on the child's speech and thinking systems. It is thought that is the reason why there is a slightly higher percentage of stuttering in children who are learning more than one language. The fact your daughter is more fluent in her first language (English) as compared to her second languages, French and the Bassa dialect, may add support to this theory.
Finally, the fact your daughter is female who stutters is positive because more girls than boys recover completely from stuttering
From:
Murray Braha
I'm back for another question. As I stated in my previous posting I'm a 45 yr. old male who's been stuttering since early childhood. I also have an older sister who stutters as well as 2 first cousins who stutter. I guess we're a great example of the "stuttering gene" theory. I'd like some feedback.
From:
Dale Williams
Murray,
As you noted, stuttering does tend to run in families, and does so in ways that suggest genetic transmission. However, environmental factors clearly play a role also. It's just hard to nail down what these factors are and to separate their influence from the genetic factors.
Just as with most questions about stuttering, the issue is complicated & the answer isn't straightforward.
From:
Elizabeth from Cameroon
I have read many books on stammering and I always see these words: Speech therapist, speech and language therapist, speech pathologist, certified fluency disorder specialist, speech clinicians etc. Do they have the same meaning?
What does it require of one who wants to be a speech therapist? I am holder of the General Certificate of Education advanced level in the following science subjects, Maths, and Biology. Can I aspire to study in this field of speech therapy?
From:
Ken St. Louis
Hi Elizabeth,
Thanks for your question about terminology and training. I can clarify a few things from the USA perspective, but I will have to leave it to others to talk knowledgably about training in Cameroon or Europe.
In the USA, our official name for ourselves is "speech-language pathologist" or "SLP" for short. That term has been around for about 30 years, since the term, "language" was added to our professional association, i.e., the American Speech-Language-Hearing Association. Even so, we still refer to it as "ASHA," which were the initials of the earlier Amercan Speech and Hearing Association.
Before the 1970s, we called ourselves "speech therapists" or "speech clinicians." Sometimes we still use one of those terms, even though that is not our official title. Nevertheless, this was not true in Great Britain. I may not be entirely correct, but I believe that "speech therapist" was the preferred term for a long time in the UK, but has recently been replaced with "speech-language therapist."
Various states in the USA may use different terms for their professionals in the schools who treat individuals with speech and language disorders. Different states also have varying standards for certification. However, we have a national certification from ASHA known as the "Certificate of Clinical Competence in Speech-Language Pathology" (CCC/SLP). This is earned after a person earns a master's degree in the field, which has very specific coursework, clinical practicum, and other requirements (e.g., a national examination). Most individual states also have licenses that people who work outside the schools, such as private practice or in hospitals, must obtain. Most of these states require the ASHA CCC standards for their minimum licensure requirements.
We also have a brand new "Board Recognized Specialist in Fluency Disorders" (BRSFD) credential. The Board is affiliated with ASHA but is not governed by it. We have approximately 300 specialists now in the inaugural cadre of specialists (mostly from the USA and a few from Canada and other countries). To become a specialist requires finding a recognized mentor (another credential), and with that person, arranging a post-master's course of study and practice specifically in fluency disorders. This will involve instruction, preparing a portfolio, getting experience in a number of clinical settings, becoming involved in continuing education, and finally taking another examination. It may seem daunting, but it really is quite possible for those really interested in specializing in stuttering. In the years to come, I believe the BRSFDs will greatly improve the treatment of stuttering in our country. They will do this, not only by their own work, but by helping train/consult with/encourage their SLP colleagues who also will work with the vast majority of people who stutter, clutter, or have other fluency disorders.
I know this is complicated, but there you have it. ;-)
I wish you the very best in your future and hope you can arrange the training you wish for. Cameroon, and most countries, can use all the SLPs and specialists in fluency disorders they can get.
From:
Lynne Shields
Elizabeth,
Your first question points out a fact that has always rather amused me about our profession--we purport to be about the business of helping people communicate better, yet have had an historically difficult time deciding what to call ourselves. Hence, we end up confusing the public that we hope to serve. The terms you mentioned, speech therapist, speech clinician, speech pathologist, speech-language therapist, along with a few other variations I can think of, are all essentially equivalent terms in the United States, referring to someone who has been trained to provide assessment and treatment services for people having speech and/or language disorders. In this country, this typically involves obtaining a master's level degree and meeting the requirements for the certificate of clinical competence as established by the American Speech-Language-Hearing Association (ASHA). The other term that you mentioned, certified fluency disorder specialist, indicates that a certified speech pathologist has obtained a higher level of preparation/training in the area of fluency disorders, and has worked with a significant number of individuals who have fluency disorders.
I encourage you to make contacts within your own country to see what training for speech pathology might be available there or in a nearby country. Perhaps someone else on this panel may know. I think it would be helpful for you to be in touch with Joseph Lukong, who has an article at this conference entitled, "Out of Africa: Emerging Self-Help". He is involved with a stuttering support group in Cameroon called Speak Clear Association of Cameroon.
I am pleased to hear that you are interested in studying this field. I suspect that there is a need for trained speech-language pathologists in Cameroon. Best wishes to you.
From:
Elisabeth L. Bongkem
I am a member of SCAC and Joe our Coordinator has been helping us with some advices and books. Without talking for Joe, I have to say that there are as of now no institutions here that offer speech therapy courses as well as specialists in that field. Proof is that when one scientist who wanted a speech diagnostic evaluation of some SCAC members and asked Joe to look for one specialist here to help in doing that, Joe contacted the national order of medical practitioners here and there wasn't any specializing in speech therapy. Same the Faculties of medicine in the University of Yaounde and Buea were contacted and there was no one offering a course in speech therapy there.
After learning of the BRSD and CCC/SLP in the US, I would be grateful if you or any other person there can link me up to any institution there where I can undergo a speech therapy course by correspondence. The knowledge acquired will help many people here.
From:
Dorvan Breitenfeldt Professor Emeritus Eastern Washington University Co-author SSMP
Tom Gurrister Director, SSMP Workshop Univ. of Utah Salt Lake City Utah
Dear Professors,
By now all of you have likely heard of the stutterers in Cameroon, Africa including the Lukong family with an unusual high incidence of stuttering. An Article appeared in the recent newsletter of the Stuttering Foundation concerning Dr. Drayna's genetic research. We have had considerable contact with Joseph Lukong and the Speak Clear Organization of Cameroon (SCAC). They would like to send two of their members to the USA to be studied by Dr. Drayna and attend the Successful Stuttering Management Program (SSMP) at the University of Utah summer 2003. These two stutterers would then function as liaison people and assist in setting up a continuing SSMP Workshop at one of their Universities. Dr. Drayna of the NIH and a member of the stuttering community willl finance the travel expenses for Joseph Lukong. Some scholarship funds will likely pay much of his therapy and room and board expenses. Our goal is to obtain funding for the second person. We feel that it is essential to have two stutterers go through and be trained on the progam if we are going to successfully establish a SSMP at one of their Universities. This, of course, also opens up a host of research opportunities as it's difficult to find so many untreated stutterers any place in the world. This all leads up to our question: What suggestions, recommendations or advice would you professors have for raising funds to bring the second person to the USA and the Workshop? We look forward to your wisdom.
From:
John Paskievich
In writing about Cameroon, you say that it is difficult "to find so may untreated stutterers any place in the world." I have read that in North America 80% of stutterers have not had therapy for their speech disorder.
From:
Walt Manning
I would guess that an estimate of 80% of untreated PWS may be a bit low. In any case, what we know about stuttering is based on those that we see in our clinics, particularly university clinics where most of the research is conducted. We know very little about the ability of others who stutter to adapt and survive. Many probably do it rather well although I've always had the feeling that, even though they may be successful by most standards, at the very least the quality of their life would be enhanced by GOOD intervention in the form of individual or group therapy or involvement with a self-help group. Our view of stuttering is probably skewed by our understanding of only those who, for one reason or another, seek and find professional help.
From:
Bernie Weiner-Co-leader of the NSA chapter of the year for 2002, and the Co-leader of the year for 2001 😄
First, thanks for taking the time to do this for all of us stuttering folks. I would like to know your thoughts about the role that support groups play in stuttering therapy. Would you like to see more emphasis on gaining fluency or more emphasis on the "feel good" aspects of therapy?
And one other question. How old is that picture of Steve Hood? That sucker looks like it was taken a looooong time ago. LOL
From:
Chris Roach
Bernie beat me to the punch on an important question -- how old IS that picture of Steve Hood? Crossed my mind, as well.
On a serious aspect of Bernie's question about support-groups, can the panel also incorporate into its response another connection to support groups. Do you believe that support groups serve more of a positive or negative influence on stutterers who find that the more they associate with other stutterers and support group, their speech digresses to a level of more disfluency than normal, thus, more frustration, self-confidence, etc.? For those same individuals who find that the less exposure they have to other stutterers enmasse (in the support environment), the better their speech remains, therefore, they question the benefit of the support environment. Bottom line: can the support environment (being around other stutterers) become a discouragement for some stutterers? Do you find that more or less common in your practices?
From:
Bernie Weiner
Chris, see, great minds think alike. :-) Seriously though, you raise some good questions and I can't wait to read the answers. Many of our support group members, myself included, have noticed that we stutter more with the group. But that would NEVER discourage me from participating.
From:
Lynne Shields
Bernie & Chris,
Thanks for your good questions. From my perspective, a support group can play a variety of roles, depending on the focus of the particular group. I see the primary role of groups such as NSA as just that, support. It is not intended to be a therapy group and, thus, I would not expect there to be an emphasis on therapy techniques. That said, I do see support groups as serving a very therapeutic function. I encourage my clients to participate in a support group, either face-to-face or through various online opportunities, such as Stutt-L. Being in the presence of others who have similar experiences, having a place where stuttering can be talked about freely, and a friendly environment in which to try out new things--you can't beat em'. I suppose that's your 'feel good' focus, Bernie, but I think it goes deeper than that. There is real power in numbers.
Chris, your question about the experience of increased disfluency as a result of being involved in a stuttering support group leads me to ask you a question. Do you think that the increase in stuttering that you are talking about could result from people being in an environment where they can let go of controls and worries about stuttering? If this is the case, I guess I see that as a positive rather than a negative. I'm interested in what you think about this.
From:
Chris Roach
Lynne,
Thanks for a great response to a very perplexing issue. You raised a good point to me about whether or not we're perhaps more relaxed and letting our controls down when we're in the support atmosphere. Sorta like what so many PWS report when they say that their "worst" stuttering is around family members (i.e. parents, siblings) because they're relaxed and not necessarily trying to work at it or "do their best" as they would with strangers or in public.
I think that explains WHY we stutter more in support groups BUT I tend to disagree with you that it should be considered a positive, rather than a negative -- universally. But please let me qualify that further in that I'm viewing this strictly down the scope of a "covert/milder" stutterer perspective. We're on that cusp of being able to push both fluency or disfluency, almost at our whim. In the stuttering support environment, we're often viewed as "not being enough of a stutterer to understand others' struggles" because we may not stutter that much or because we have a substantial level of fluency when others don't. Thus, to gain acceptance in the stuttering environment, we "fake" stuttering more (meaning intentionally don't speak as well as we can) to find acceptance and to make others feel better (as if that would) or should I say, less offended or engaged by us. Therefore, as we stutter more, when we know we have the capability to speak rather fluently more than not, we walk away from a support meeting feeling worse about ourselves than better -- followed by a prevailing feeling that the support environment is actually discouraging our best speaking and communication capabilities rather than encouraging it.
Granted, "coverts/milds" need support like any other PWS and can find it in the support environment to find strength and mentoring to face fears and discover self-acceptance of disfluency, however, I'm afraid that the prevailing "one size fits all" message of support groups that "chasing fluency is bad; accepting overt stuttering is good" is targeted ONLY at more severe/overt stutterers without the choices of fluency improvement and capabilities that other PWS such as coverts/milds maintain.
With all other issues aside, when I walk away from a support meeting speaking less fluently than I know I can and my communication was dishonest to myself and others, I believe that experience lowered the bar for my individual capabilities and expectations. THAT's a negative influence on me. When I walk away from any other influence (professionally, socially, educationally, etc.) in which I'm speaking more fluently and up to my capability, THAT's a positive influence on me. So where do you think a similar stutterer as myself tends to migrate toward?
Bottom line, I believe, and one that I know is complicated and sensitive: to be effective for more individuals, the support environment must be tiered and segregated to accomodate different degrees of disfluency in stuttering. Severity DOES matter. PWS of opposite degrees of severity do share issues in common, however, there are many more issues that they do not. Perhaps the MIA status of the other 2.97 million domestic stutterers, statistically, from the present support environment culture encourages consideration for support services focused more toward the covert/mild consumer?
Lynne, thanks again for your feedback. Just like the darn stuttering, it's a tough and confusing subject with no easy answers!!
From:
Lynne Shields
Chris,
Thanks for clarifying your viewpoint. If your reason for letting more stuttering out is to 'fit in' as someone who really stutters, I would agree with you that this is not necessarily a positive experience. You could well walk away feeling that you have not really been acting as your true self. And, then, I'm guessing, you are not really feeling supported as a person who stutters.
For a mild stutterer to feel a need to do this suggests to me that the particular support group is, as you say, perhaps too much focused on one reality. For the group to serve the needs of all members, I would hope that this could be introduced as a topic of discussion (or reintroduced). And it should be a topic of frequent discussion if the goals of each person at the meeting are to be respected and valued. I realize that this does not always work out in the world--sometimes, there are members of a group who simply cannot see things from a quite different perspective.
You seem to be suggesting segregated support meetings--one for the more severe and one for the milder folks. That's a possible solution, particularly if this has been a long-term problem in your support community. On the other hand, where does the person who is outwardly quite fluent, but hides their stuttering through avoidance and tricks, go for support? They sound like they fit in better with the milder folks, yet they would probably benefit from being around a bunch of people who stutter openly, and might allow this person to begin to let some of the stuttering out and let go of some of the tricks. Hmmm--a dilemma, isn't it? Perhaps breakout sessions or side sessions for particular subgroups within the larger group?
There is no easy solution, but you bring up a very valid point. Support groups must work much harder, if the shoe fits, to listen to and speak to ALL constituents in the group, and to come up with ways that everyone can be heard. It is most unfortunate for any part of a group to feel like a second class citizen.
From:
Steve Hood
Woops !! Somewhere on here there might be the beginning of this post. I was well into it and we had a power surge. My computer hiccupped, and lost everything, I guess, unless the earlier message is hiding. I'm starting over.
First-- thanks for positive comments about my picture. It was taken on a colleague's boat about 4 summers ago.
Regarding support groups, I think the answer really depends upon the PWS. Some people will benefit and some will not. It may depend upon also on the underying purpose and philosophy of the support group: e.g., is it a structured group with it's own set of subgoals for members (e.g., a place to work on speech and fluency shaping targets, or stuttering modification skills?) For example, the kind of group meeting that might be conducted by an SLP to work on therapy techniques might be far different from the type of group that is set up and operated by PWS without a "therapy agenda." It might make a difference if the philosophy was **self-help** as compared and contrasted with **support group.** It might also make a difference in terms of where the individual PWS is on his road to improvement. The PWS just beginning therapy might have different wants and needs and aspirations as compared to what he might want some years later, when he is well along his road to improvement.
In our Mobile group, for example, we have a man who has been with the group since its inception back in the mid 1980's. Back then, he attended because he got a lot out of it.... And he still does. But now, he says he attends because more and more, he also wants to be able to give back to others, some of the insights he gained for himself, back in the early days.
Regarding the other part of Chris' question. I've seen it go both ways. Some people become more fluent in these settings because of the support and encouragement, etc.-- because of being with other PWS, and not feeling the inner need to be fluent, or hide and conceal and cover hp the stuttering... For others, it is just the opposite, and they become uncomfortable around their fellow brothers and sisters of the tangled tongue.
From:
mstrom
Is there a support Website for people who stutter that is written in Chinese? If so, what is the address?
From:
Judy Kuster
There is information online in Chinese. Check The Stuttering Home Page under "stuttering around the world."
The Chinese organization listed there has also translated Eelco de Geus's book Sometimes I just Stutter into Chinese. It is online in English and also available in English from the SFA. There is a medical doctor from China who has written a paper about stuttering for this online conference. You might be interested in his paper, and in contacting him.
From:
Wirbah Festus
I am Wirbah Festus, and a member of SCAC in Cameroon. I know that stammering and stuttering all have the same meaning as they all refer to the same communication disorder. What about cluttering that I have often come across. On referring from the edition of the Oxford Advanced learners Dictionary of Current English, I saw the following meaning "things lying in disoder ,especially unnecessary things,...state of disorder, or...to fill or cover something with a lot of things." Can someone explain to me carefully and clearly what cluttering is and how it is different from stuttering or stammering.
From:
Dale Williams
Wirbah,
The cluttering referred to here is a disorder of fluency characterized by poor language formulation (often, when these individuals try to tell a story, it's disorganized and hard to follow), rapid speech rate, and many other traits are are often present, but not always, including misarticulated sounds, below average reading ability, and poor handwriting, among others. Often, these individuals are not aware of how difficult they are to understand.
It's a rare disorder, probably of neurological origin and definitely different than stuttering.
From:
Liv Marit Dalen
Here in Scandinavia cluttering is called "l�psk tale", which should mean something like "bolting speech". Perhaps you will find this to be a clarifying term.
From:
Ken St. Louis
Dear Wirbah,
Good question. "Cluttering" (in English) is a rather unfortunate term. Aside from rhyming with "stuttering," it really means what the dictionary says--and that is *not* how we use it in reference to a fluency disorder.
Probably the biggest reason that cluttering is not widely recognized and accepted, even by SLPs, is that most of the authorities define it differently. Let me give you an example, Dale's excellent response starts out talking about language problems. Most clutterers do manifest language difficulties, but not all of them. That is why my work has focused on coming up the the "lowest common denominator" for cluttering. For the past 15 years I have proposed a "working definition" for cluttering as follows: a fluency disorder that is not stuttering accompanied by a rapid and/or irregular speaking rate. Recently, in an ongoing study of stuttering with colleagues (Florence Myers, Larry Raphael, and Klaas Bakker), we have modified the working definition as follows.
"Cluttering is a syndrome characterized by a speech delivery rate which is either abnormally fast, irregular, or both. In cluttered speech, the person�s speech is affected by one or more of the following: (1) failure to maintain normally expected sound, syllable, phrase and pausing patterns; (2) evidence of greater than expected levels of disfluency, the majority of which are unlike those typical of people who stutter." This definition focuses on the importance of speech rate problems and recognizes that the result of those might manifest themselves in articulatory as well as fluency dimensions.
We hope to make some inroads in generating a defensible definition that will be more widely accepted.
From:
Ren� Stes - Brecht/Antwerp - Belgium
Dear Wirbah, Dear Kenneth ...,
... an excellent and up-to-date "operational definition for cluttering" from Prof. Kenneth St. Louis (and also many thanks for his "excellent research-work" on this complex disorder!.)! (cluttering: we call it in our Dutch language "broddelen").
Cluttering is not so rare; it is a fascinating but often neglected - in my experience - "type of fluency disorder". And ... all different types of fluency disorders are very difficult to define.
The problems are ... - that there are no exclusive - single - stand-alone - signs ...(for normal fluent speech, for stuttering, cluttering, speech anxiety ... ), and ... as a consequence ... - that in many discussions,/ publications/reseach ... stuttering, cluttering and other types of fluency disorders are not differentiated and are called "stuttering" (sometines they are called "types of stuttering"), and that it is always difficult to define a behavior - speech/language - "disorder" (there is a continuity in the skills for fluency [timing, effort, forward flow ... in language/speech - articulation, voice]) and the dicions for "a behavior disoder" is always based on certain social acts, and thus ... based on social "judges").
To Prof. Kenneth St. Louis, and to our colleagues: can we - for the operational diagnosis of cluttering - further agree and define how much disrupted patterns (% ?), which one ... we need to count (as we do for the diagnosis of stuttering)? To aid in the evaluation we use at this time the Daly's Checklist for Possible Cluttering (David Daly & Michelle Burnett - Michigan, 1999) and as criterion, score > 55, but it is just a start ... based on a "checklist".
Best wishes and success of this excellent panel!
From:
Ken St. Louis
Dear Rene,
Thanks for the comment on my reply. I apologize for the delay in responding.
You point out an important problem, i.e., the lack of a standard definition for cluttering. This, of course leads to all the problems you mention about cluttering being lost in the various descriptions of stuttering.
As you know, I have worked for a long time to come up with a definition that we all might "live with" long enough to decide just what group of speech disordered individuals we are talking about here. Although we have made some progress, unfortunately, even my colleagues and I do not completely agree on what cluttering "really" is. Our working definition is about the best we can do for now.
You asked whether we can come up with specific numeric and qualitative criteria for the diagnosis. David Daly and Michele Burnett tried to do so with his Checklist for Possible Cluttering. It is certainly a start, but the most recent version does not have clear cut-off scores for cluttering, cluttering associated with stuttering, and stuttering.
Our experience suggests that there probably are subgroups of people who clutter. How is that for clearing things up? 😄 I really don't think we know enough to specify specific numbers or types of disfluencies or specific rates of speech at this time. All I can say is that the cluttering disfluencies should not sound like stuttering and the the speech rate should sound fast or jerky (irregular).
Sorry, I wish I could be more specific.
From:
Lisa Lawcock
How on earth can I help my child with his cluttering problems? He currently has an IEP, and did so well last year (2nd grade), that they thought he did not need more intervention. The school is rewriting the IEP, but I feel the staff does not understand the problems my son encounters. I contacted Dr. St. Louis last year and he did help. This year, third grade is very tough for my son.
From:
Ken St. Louis
Dear Lisa,
How nice of you to mention our interaction last year! I'm glad your son did better last year.
I assume the cluttering is still present and possibly getting worse in the 3rd grade. I realize that this may seem trite, but I don't know what else to suggest than to schedule an appointment with the speech-language pathologist (SLP) and share with her/him some information on the fairly widespread assumption that cluttering is not something that usually just "goes away." Your son may need some training, even if on a limited scale, for the next few years.
I don't recall what information I sent to you, but if you wish to contact me personally via email, we can determine what additional information might be helpful to share with the SLP.
From:
Fabian Lukong
I am Fabian Lukong from SCAC and I consider myself as a recovering stutterer as I have read many books collected from the SCAC library which have helped me to be my own speech therapist. What I have found useful and workable for me as a way of controlling my stutter is to talk slowly respecting pauses and also to take a deep breath when I come across a difficult speaking situation. I want some one to explain to me what connecting deep breathing has in controlling stuttering . However, when I am angry, excited or when I have taken alcohol, I find it difficult to follow these techniques. Can somebody suggest some ways to me to remedy this?
From:
Peter Ramig
Speaking more slowly with appropriate pausing can be helpful as one of several necessary tools to help lessen stuttering. Having ample breath support is imperative, and is another one of several important ingredients to speak more fluently. However, I am not sure how you are applying what you call "deep breathing." If you mean taking several full breaths when you feel you might stutter in an upcoming situation, for example, that can be helpful for some as a relaxation strategy because it can help reduce muscle tension. On the other hand, if you mean you take a deep breath immediately upon speaking, I would caution such a strategy may eventually create more stuttering IF you are tensing more to take that breath. As I said above, air is necessary to speak, but I personally prefer an easier inhalation followed by easier exhalation that allows me to stutter a little slower as I move through the word, as opposed to trying not to stutter (some of us believe trying not to stutter actually feeds stuttering). But the bottom line is this: if this technique continues to work for you, that's great!
From:
Loius Wirnkar - from Cameroon
I am Loius Wirnkar and a member of SCAC. Since November last year I have been reading a book in TA called 'T. A. TODAY A new Introduction to transactional Analysis by Ian Stewart and van Joines. Equally I have been reading a manual called CONCERNTRIC MAN. All these have helped me to control by stuttering following the racket system I always draw up. I am looking for persons who are TA students with whom we can share ideas. I do not have an email address and any message for me can be sent through Joseph Lukong our Coordinator. I hope to hear from an interested student or specialist in TA.
From:
holger-stenzel
At the University of California, Irvine was investigated in the last years the effects of Riperidone and Olanzapine onto the stuttering. Professor Glyndon Riley gave recently a review. The National Institute on Deafness and Other Communication Disorders instructed a study for the Pre- and Post-Synaptic Dopamine Function in Developmental Stuttering. Will soon a specific medicine be available against the stuttering? What can be expected? The best greetings from Germany !
From:
Judy Kuster
You might want to post this question to Nathan Lavid, a medical doctor who has an
interesting paper included in this conference. His bio includes the information that "he has been involved in a wide range of neuroscience research, including the first clinical trial of olanzapine for stuttering."
From:
Sam Carter
I've got what is maybe an unanswerable question. Stuttering seems to appear at different ages -- for some it is very early, others in middle school, still others in high school. Is this simply a matter of timing or is the time of occurrence related to the nature and severity of stuttering. What I'm wondering is whether recovery is more difficult for those who stuttered from day one -- like I did -- than those who picked it up years after speaking fluently. Or was their "fluency" just a misperception? Is stuttering the same no matter when you acquire or realize it?
From:
Ken St. Louis
Hi Sam,
Why some people start stuttering early and why some start late has always been a puzzle. Let me try to clarify a few things, although I won't able to answer the why question above, for that will require a lot more years of careful longitudinal research.
Most stuttering begins in childhood, around the ages of 3-4 years. Also, most recoveries occur in childhood. During the first year, about 30% of these preschoolers who start to stutter will recover within one year, often after only a few weeks or months of stuttering. Another 50% will recover by the time they are late adolescents or adults, most in the middle childhood years. This leaves 20% who will become chronic stutterers.
But these spontaneous recovery data do not apply as well to those who begin to stutter sometime later than preschool ("since day one" in your message). Children can begin to stutter all through the elementary school period and even through high school, although the frequency of such onsets decreases with age. There are even instances of onset all through adulthood. For example, in a book that I recently published with stories of people who stutter, one 91-year old great-grandmother began to stutter quite mysteriously!
As I mentioned, careful longitudinal research will no doubt shed light on whether or why those who begin to stutter later in life are more or less likely to persist in their stuttering. Off the cuff, however, I would say that it would have most to do with the type of stuttering symptoms and severity. In general, more severe stuttering is associated with persistent stuttering.
From:
Kevin mayzek
My son who is 3 was placed in the hospital with croup. He was given this medicine twice. Also a steroid called prednisone. The day he was being released he was stuttering a lot. I asked the doctor why? She said from the epinephrin because of the adrenalin. He still stutters. Could this be from the drug?
From:
Judy Kuster
I am not a physician so I would suggest you also consult with a medical doctor on this question, but I did find some information on drugs and stuttering.
Most of the information I found was on attempts to treat stuttering with medication. There is a long list of research studies in Oliver Bloodstein's Handbook on Stuttering (p. 464ff). There is also a list in Vogel and Carter's The Effects of Drugs on Communication Disorders p. 139ff.
I was also able to find a bit of information about drugs that MAY have a side effect of producing stuttering. A review done in 1998 of the world's medical literature and published in the Journal of Psychopharmacology found 22 cases of stuttering induced by drugs. Not all drugs that have stuttering as a potential side effect are listed here though.
In my personal searching I could find nothing about stuttering as a side effect of epinephrine. I hope someone else can respond more authoritatively to your interesting question.
From:
John Tetnowski
Gunars,
As you know, this is a loaded question, but I'll take a shot at based upon my own experiences. First of all "success" is a difficult concept because we all know that success can be measured in reduction of stuttering behaviors, elimination of the "handicapping" aspects of stuttering, reducing avoidance behaviors, improved speech naturalness, and many other ways. To use your examples, an air traffic controller would probably define success in therapy based on the observable speech characteristics, i.e., reduction of stuttering. For other vocations, success may be defined in a very different fashion, such as answering the telephone, or making your own introductions. At last year's NSA conference I was really touched by the story of Dennis Barsema (a highly successful business person). He viewed success as being able to be in the board room with investment bankers making a case for the IPO of his company. He also viewed success as having a great, supportive family (who came with him to Anaheim!!). Were those things (like being in board rooms) part of his success?......YES! Were they through a speech-language pathologist?....I don't think so (but I'm not really sure). So the question remains, did he achieve "success" even though his speech behaviors didn't necessarily change? That is a personal decision. I think he achieved success. Therefore, successful outcomes in adults is a bit of a trick question. If you refer to Bob Quesal's paper in this ISAD conference, you can see that some influential people view success in only one way. I think that we should view success in a wide variety of ways that meet the needs of the client.
Now to get to the failure part. Of course failure is also based on a person's definition about "success". Not all measures of success respond to experimental, reproduceable methodologies. This results because we still don't all agree on a definition of what stuttering is, or what are the handicapping conditions are. In Walt manning's text he refers to a quote from Bannister (1966) that states humans are "notoriously nonsensical and unfit subjects for scientific scrutiny". All humans are different, and "success" or "failure" is different for each one of us.
In my own experiences, I have referred people to the appropriate professional, and this ranges from physician, to psychologist/counselor, and even once to a person highly trained in pain management (and thus hypnosis!). Sometimes these referrals are made before therapy begins, sometimes in conjunction with active speech therapy, and sometimes after failure in speech therapy. It is obvious to me that not all people who stutter should be in speech therapy at a specific time in their life journey. Sometimes they need services outside our scope of practice. Again, it is obvious to me that we can not meet all the needs of all of clients, all the time.
OK, Final Answer. YES, I DO REFER TO OTHER PROFESSIONALS.......WHENEVER IT IS NEEDED!
Thanks (and good luck in your doctorate)!
P.S. In your studies, please also read studies in some of the other social sciences, such as sociology, anthropology, applied linguistics, etc. They sometimes look at other methodologies that can be very appropriate for understanding the human condition.
From:
Gunars
Wise men rush in where angels fear to tread. Dr. Tetrowski,
First of all I DO THANK you for tackling this issue.
It really was not meant to be a trick question. It was meant to underline OUR dedication to the most important aspect of concern to a stuttering child and his/her parents: A career choice!
At sixty-five I think I understand the difficulties and ambiguities in the endeavor of stuttering therapy. In my small way, sometimes interpreted by some SLPs as egoistically confrontational, I really do want to help other people who stutter.
In a small way you did misunderstand me. I really meant that often a person will abdicate from the "right" to be an air traffic controller, a trial lawyer, and a clinical psychologist. Let me repeat again: I have KNOWN people who would not even consider careers in this category.
The question I was asking was: can you REDUCE the severity enough for a person to PERFORM these tasks within acceptable limits of the profession.
Then if the dudes & dudettes have a psychological hang-up in pursuing their life goals maybe I or, I hope a horde of stuttering clinical psychologists, (that will follow me in that profession &mdaash; now there is a bit of egoistic ideation here :-) ) can convince them that THEIR DYSFLUENT SPEECH is not the pivotal element in performing their tasks.
Just plain ol' Gunars :-)
p.s. If I had any sense I would be lying on a sandy beach but I really think that I can help *mdash; or is it just a delusion? :-)
p.p.s. I really do hope that others will jump into these murky waters. Now that the "shark" has taken out his dentures. :-)
From:
John Tetnowski
Gunars,
I did not mean to insinuate that you were trying to "trick" us, I just meant that philosophy and theory will guide the answer to your questions (with a little clinical intuition mixed in for good measure). Personally, I like to let my "adult" clients help set their goals for therapy. If this means enough control to make a career choice, then we will indeed concentrate on that type of goal. In my experiences, I have had some clients that figured out a way to get to the job they want. A few years ago, I went through a group of files from clients that I saw through a private practice (years ago). It really did surprise me to see that the most common profession among my adult clients was SALES. I wondered why so many people who stuttered went into sales. After a few minutes I recognized that there was a logical explanation. People whose livlihood depended on higher levels of fluency sought out the services of a private speech-language pathologist. There are many people who stutter out there that did not need the levels of fluency that these select few needed. Therefore they sought out the service that they needed. People in other professions did not the same level of fluency, therefore, they sought either no treatment or a different type of treatment. Another clinical tid-bit. One of my more memorable and interesting clients was an emergency room physician. He learned a strategy that did not discount him from his chosen profession. I am sure that there are lots of other success stories like these.
Thanks for the comments, thanks for your concern and drive, and good luck with the degree (right now, lounging on the beach does sound good though!)
From:
Gunars
Sand or satisfaction. John,
My in-laws are in Hawaii. They live in Kauai, within a couple hundred yards from the beach. And here I am participating in an online conference after spending all day reading and writing papers on psychology.
And, yet, I get my satisfaction by imagining that in some way I will help people who stutter. Not to become PERFECT speakers, but to reduce their internal and external symptoms enough by collaborative, constructivist psychology so that they can be fully participating members of society. Being able to have careers of their own choosing. To empower them to advance up the chain of command as far as they want to. Do what they want to do both on the job and off the job..
As the old Calypso song says, I let "All day all night Mary Ann, sit on the beach shifting sand�"
I really think I am a determined, optimistic soul, who believes I will be able to help�
If I can achieve that, it will give me more satisfaction than a thousand days and nights on the beach.
From:
John Paskievich
If 80% of children who stutter have a spontaneous remission of symptoms what empirical proof is there that early intervention therapies work?
From:
Nan Ratner
The American Journal of Speech-Language Pathology hosted a discussion on this topic in 1997 (American Journal of Speech-Language Pathology, 6 (2). Some types of therapy, such as Lidcombe, can more easily show an effect, since the child's speech appears to change immediately upon implementation of the program. In cases where remission is more gradual, cause and effect are more difficult to link. This is a good question and researchers are working on it.
From:
Ardell Fitzgerald
I am an SLP working with a four-and-a-half-year-old child using the Lidcombe method, meeting with a very motivated parent once a week. I also see the child for 30 minutes by himself another day during the week. I've been using this extra session to reinforce fluency, but would like to start some therapy targeting /k/ and /g/ and consonant cluster reduction errors at some time in the future. This child has been in therapy about 3 weeks. Any opinions about the timing of adding phonology remediation?
From:
Dale Williams
Good question Ardell. Your concerns are well-founded, given the anecdotal reports of stuttering beginning and/or escalating during phonological therapy. This isn't an area of research for me, but I have a few comments based on my own hits and misses. Keep in mind that I don't know the child, so these are general thoughts. You're the expert and, as such, can apply (or not apply) them as appropriate.
If I can work on the sounds indirectly, I try this first. Yes, there is a cost (the sounds are slower to remediate), but the smooth, fluency-enhancing speech you want is more consistently reinforced. Direct practice of plosive production may include hard onsets and other techniques inconsistent with smooth speech. That sends the kid mixed messages.
Also, discuss it with the parents. Put all the cards on the table. "Here's what I want to do — here's why — here are the benefits and costs — etc." For most parents, fluency is the top priority. In this case, they will know why the misarticulated sounds are slow to resolve. If, however, the parents really want the child's intelligibility increased, they'll understand how important it is to monitor fluency, given that it might decrease once the additional therapy goals are added. They'll also understand why you'll back off these new goals if this happens.
With stuttering and additional disorders, there are no perfect solutions. Each has a potential cost. That makes these tough cases.
From:
Nan Ratner
I agree with Professor Williams' response. To really understand priorities, I would want to know how the child scores on a standardized test of articulation; not all errors would suggest the need for immediate intervention. If the child's scores are quite low, perhaps below the 20th percentile, some articulation could be done, taking care to emphasize light contacts, rather than over-articulated or strong contacts. If fluency begins to suffer, I would re-evaluate. The literature suggests that phonology-fluency trade-offs are not as frequent as language-fluency trade-offs.
From:
Gunars Neiders (a psychology doctorate student)
My reading of the stuttering literature indicates that there is a high probability that the offspring of stuttering parents stutter. Does anyone know the most accurate probability? Assuming that this is so:
1) Has anyone initiated a scientific study or case study to follow the couples and offspring from the time of conception (or when the pregnancy was confirmed) through age five of the offspring? What were the results?
2) Would it not be a good SID-4, National Institutes of Health, and National Institutes of Mental Health project which could be akin to the various long range efforts in the field of medicine such as the Framingham study or the Nurses study?
3) Is there a good chapter in a book or an article that provides guidance for the new baby's parents in how to prevent or deal with a child who is prone to stuttering?
4) Has or will SID-4 or NSA form a committee to provide such information to be included in the most popular baby care books when they come up for revision? (such authoritative books as Shelov, S. P. (editor in chief.) (1998) Caring for Your Baby and Young Child Birth to Age 5: The Complete and Authoritative Guide. Published by The American Academy of Pediatrics as Bantam Trade Paperback AND Eisenberg, Murkoff, and Hathway (1996). What to Expect The First Year & What to Expect The Toddler Years. New York: Workman Publishing DO NOT HAVE ANYTHING ON STUTTERING.)
It is more than an academic interest to me, since I am a grandfather of an eight-month old baby girl. Although my son NEVER stuttered I sure did and to some extent do. :-)
From:
Nan Ratner
Ehud Yairi has an NIH grant to do just that. Visit his website to find out more.
From:
Bob Quesal
Hi Gunars:
I can't add to Nan's reply, but as a Special Interest Division 4 Steering Committee member, find it interesting that you lump SID 4 with NIH and NIMH. Exactly how do you view the Special Interest Division 4? With about 600 members paying $25 apiece to join, we don't exactly have a big budget. So, for SID 4 to "do" things, we generally rely on the hard work of our members.
From:
Gunars Neiders
Sorry, I tried to put too many items in one question. Bob, probably my communication style has flaws. I think that SID4 is the best group to propose wording to be put into the baby care books. If you, the experts, can come up with it and do not have the energy or time to submit to the authors and publishers things that should be included maybe I can help. I do see it as a serious deficiency in these books. Cooperatively maybe we can fill the gap. Ok?
From:
Jerry Johnson
Been there. Done that, too!. Hi Gunars: have you had your meltdown yet about stuttering? As a grandparent of a three year old boy who has these associated behaviors trying to talk: stomping on foot, jumping, pounding fist, signs of avoidance, pitch rise, sometimes cannot complete sentence or word, pitch & volume rise-I have been there and done that meltdown. There is more to this story, but here are some of the suggestions I offered to these wonderful parents: back off teaching, one thought one short sentence, one thing at a time, model soft, easy speech and practice this, concrete expectations and keep choices to a minimum, interrupt associated behaviors if possible but be careful about doing this, restate his spoken statement with soft, easy speech and keep it short, pay attention when his is talking, try to ask yes/no questions when possible, so self-talk around him with soft, easy speech and short phrases, have fun with speech and even use "babble talk" about some activities, explain to his 7 year old brother what is happening if he asks and say something like "your brother is just learning how to talk like you and sometimes he gets stuck but he will get over it. Be patient and don't try to help because that is a mommy/daddy job. Continue your excellent parenting skills. You are two great parents. Be patient with yourselves too. Keep it up, be consistent and dedicated to the task at hand. It is not your fault. If we knew why kids develop these associated behaviors we would have the puzzle of childhood stuttering solved. There you are Gunars. Pick and choose. You can send to me that gold coin you are tossing around.
From:
Becky McGee
In speaking with a friend of mine who stutters, I have come to question the role of the brain in his stuttering. His stuttering is, of course, worse during times of anxiety. During times of regular conversations, his stuttering goes from barely noticeable to quite prevalent. When he is angered, the stuttering seems to disappear.
So, based on this, I wonder how if how "focused" he is on the situation affects his stuttering. He explains that he is always "thinking about a million things at once", that his mind is jumping from one topic to the other. But, when he is upset about something, that is the utmost on his mind.
I guess my question then is, what link is there between the processing of information within the brain, sending the signals to the mechanisms that control speech, and the dysfluent output? I have read about the various differences in the brain found through scans, etc., but how does the processing/focusing on information play into the situation.
From:
Walt Manning
Becky- I'll let people who know more about brain function than I respond to your third paragraph. But I want to respond to your first paragraph where you mention that your friend stutters more ("of course") during times of anxiety. Stuttering, if nothing else, is highly variable and perceived or actual anxiety and stuttering (especially the frequency of stuttering) to not correspond. It is possible for speakers who stutter to be extremely fluent under high stress and vice versa. He sounds like a regular PWS if his fluency varies from barely noticeable to prevalent. Sometimes when angered the fluency of PWS disappears and sometimes if doesn't. In your second paragraph you ask about his ability to "focus" on a topic and the apparently resulting increase in fluency. Again, this can be the the case some of the time with some people. Some speakers stutter more when they think about their speech and some less - depending on how desensitized they are about speech & stuttering and what techniques they may be using to change their fluency. So, what you're describing is typical a typical developmental PWS. If you can find someone to completely answer the question posed in your third paragraph you should receive the "Question of the Conference Award" from Judith.
From:
Gunars: A loving grandfather
Y?all,
Today I met a person, besides me, who has a child and/or grandchild who may or may not stutter. What is the best publicly available information of how to handle a child who may OR may not be a future Person Who Stutters.
Both Joe and I really want to know a source of information that is agreed on by at least some of the experts as being valid for handling these precious little persons.
In case there is not a book, a chapter in a book or a website that explains how to treat kids who may or may not stutter could one of you, at least, tell both of us what we can do or should not do to minimize the danger of defining a child into a corner where the cute little tyke is overwhelmed and defines himself as a stutterer.
My friend's three-year old son who, a) either because of his inability to decide which word to use, or b) because he wants to "choose" a word which he can say, sometimes has hesitations in his speech.
If there is a SID4 member in Everett, I would gladly pay for his evaluation.
My grand daughter as yet only squeals. Acts delightful and is the delight of my life. (While I try to have one of you, dudes and dudettes, answer my inquiry).
From:
Steve Hood
Hello, Gunars
There are a number of resources available (see below.) From these resources you can get books, pamphlets, video tapes and other documents. A great general resource is the
Stuttering Home Page, which in addition to having a lot of information, also has links to other resources.
There are sections on information for--- parents, teachers, etc.
ALSO-- go to any of the following for information, phone numbers, contact information, and e-mail addresses, etc.
From:
Gunars
Steve,
I have been there and done that.
Let me try once again with feeling: Is there one specific chapter or pamphlet that considered to be the most updated "gold" standard?
From:
Ed Feuer
Questions for Kenneth O. St. Louis: I note that one of your research interests is public attitudes toward stuttering. What methods have you employed in this research? How would you describe the current mainstream public view of stuttering? What sorts of changes over the years in public attitudes to stuttering have you discovered?
From:
Ken St. Louis
Hi Ed,
Thanks for your interest in public attitudes. Let me try to address at least two of your three questions.
What methods have I used to address public attitudes? I have been working with a wonderful group of people including Scott Yaruss, Bobbie Lubker, Glenn Tellis, Jaan Pill, and Charlie Diggs to design and field-test the first version of a survey instrument that could measure public attitudes towards stuttering. With the help of professionals from several places in the USA and from several countries around the world--along with about a dozen of my students--we have carried out pilot studies at 13 different sites in the USA, Canada, Denmark, Bulgaria, Turkey, Nicaragua, and South Africa. The questionnaire asks people to rate reactions, thoughts, and impressions to stuttering, mental illness, overweight, wheelchair use, old, left handed, good talker, multilingual, and intelligent.
What have we found? It is too soon to say too much, but in general we discovered that the general public everywhere we have sampled views stuttering almost as negatively as being mentally ill, and more negatively than being confined to a wheelchair. Surprisingly and depending on how the questions are worded, being someone who is overweight is sometimes regarded as the most negative of the nine human attributes. (I suspect this reflects a good bit of ignorance about stuttering and mental illness.)
We have not looked at attitude change over time, but that could begin to occur once we have completed the arduous process of developing the survey instrument, which we call the Public Opinion Survey of Human Attributes (POSHA).
Stay tuned for a few years....
From:
Ed Feuer
Thank your for your response. Such surveys of public attitudes are long overdue, and the results of your pilot study contains serious implications for therapy as well as human rights legislation and its enforcement.
My view is that the conversational uses of the terms stuttering and stammering — all implying shame, failure, incompetence and the like — have something to do with the results you have found. Given the huge public ignorance about real stuttering, the conversational usages, and their negative implications, are the only frame of reference most people have regarding people who stutter.
Professionals in the treatment of stuttering, unfortunately, have tended to dismiss reports of what you have found in your pilot study from people who stutter as overly subjective, as are accounts of unfair social and vocational discrimination. At the same time these professionals have not found it important to determine scientifically what public attitudes really are.
The impression is left that the reason just might be some awareness that the results would present a serious challenge to what currently passes as adequate in the treatment of stuttering.
I fail to understand why we have to wait years for development of survey instruments. Let me suggest just a few common sense questions for such a questionnaire: "Do you know anyone who stutters? — Have you ever met a person who stutters? — Would you hire a person who stutters? — Would you mind having a person who stutters as a fellow employee? — Would you be concerned if your sister wanted to marry a person who stutters?"
And why should we have to wait years? Corporations, governments and political candidates pay for professional market research to find out what their image actually is, then they decide what they want it to be, and adopt strategies to change it to the desired one.
Maybe such organizations such as the NSA and SFA might commission such a survey on how society views stuttering. The answers could certainly help in the design of better stuttering therapy programs.
From:
Ken St. Louis
Hi Ed,
An impatient man after my own heart. ;-) I, too, wonder why it takes so long to get things done.
Actually, there are lots of isolated surveys out there of the sort you suggest, and most of them show that the public (and stutterers themselves) regard stuttering in a stereotyped way. (We actually have almost all of your questions in one form or another in our pilot instrument. Do great minds think alike or what?)
The reason it takes so much time is that, to be taken seriously, a questionnaire has to undergo the standard rigorous tests of reliability and validity. For these issues, time and money are the limiting factors. Currently, I am working on an international grant, which if funded, will permit us to finish developing our questionnaire and to test it in several languages and countries around the world. Wish me luck in remaining patient while we go through that process. If we can pull it off, i.e., develop a solid instrument of the sort that the Gallup organization might create, and then measure public attitudes in carefully selected sample populations, it is not unrealistic to expect that government and non-governmental agencies will sit up and take notice of the results.
From:
J.L.
I am working with a 5-year-old little boy who was referred to our clinic for stuttering about 2 years ago. He is currently doing very very well and is about 98%-100% fluent, depending on the day. Right now the focus of our therapy sessions is articulation and fluency maintenance. A home monitoring program has also been set up. My concern is, that this little boy is very good at monitoring himself in a clinic situation and has almost become conditioned to use slow and easy speech as soon as he enters the clinic, however his parents are still seeing more disfluency than they would like at home. Is there anything I can do or suggest to help this little boy get over the final hurdle towards fluency? Or, is it more likely that the parents are expecting 100% fluency all the time and are overly sensitive to normal disfluencies in their child's speech?
From:
Steve Hood
Hello, J.L.
I assume from your description that this youngster has made progress with artic and that this is not a major issue. (If not, correct me on this.) If he has significant artic. or phonology problems, then this may be a different issue. I'll limit my comments to the stuttering.
If this child is 98-100 fluent in clinic, then this is even more fluent than would normally be expected, so frequency appears not to be an issue. But above and beyond the frequency, I would be interested in knowing the characteristics of the 2% disfluencies he does have. If they are short-element repetitions like sounds and syllables, and "stutter-like disfluencies" also including sound prolongations, or tense pause/hard contact elements, then this could possible be significant.
Would it be possible for the parents to audio or video tape the child in the home situation? I would be interested to know what he is doing in terms of frequency. But above and beyond just the frequency, I would also be very much interested in knowing the types of behaviors: repetitions of sounds, or syllables, or words (single syllable whole words, or words of more than one syllable,) or multiple words--- prolongations, tense pauses, etc. What about interjections, revisions? Do these seem to be "normal nonfluencies" or "stutter-like disfluencies" or discontinuities related to language formulation?
Are there any signs of effort/struggle? Or are disfluencies easy and effortless? Are there increases in pitch or loudness associated with disfluencies? When he repeats, are they single unit repetitions ("ca-can he do it")or multiple reiterations ("li-li-li-like this one.") Are they rhythmic or dysrhythmic?
What is going on at home when he is disfluent? Are things cool, calm and relaxed, or is there a lot of communicative stress? Is there good turn taking between the talkers, or a lot of interruption and verbal competition? Is he being bombarded with multiple questions, expected to give lots of answers? Are there lots of language demands being placed on him - e.g., are his sentences lengthy and complex?
I think it would be helpful for you to learn more about what his talking is like in the home situation.
In terms of your therapy with him, are you in a situation where family member(s) can participate in your therapy with him in the clinic? Maybe you can have activities where a parent (and sibling, if appropriate) can do activities with you and the child where you can work on pragmatic issues such as turn taking, reducing verbal competition, etc. Board games (shoots and ladders) or activities where you take turns rolling the dice, etc, can sometimes be good for this. Work to establish base rates of easy fluency (people talking slowly, with turn taking, etc.) and then slowly and gradually introduce some mild fluency disruptors (talk faster, ask questions) to help desensitize him to these types of stresses.
From:
Peter Ramig
I concur with Dr. Hood's suggestion regarding activities for carrying over newly learned targets, so I will not address treatment of the child's stuttering. Rather, I would like to make a cautionary statement about his articulation. I sometimes get nervous when clinicians focus on both articulation and stuttering. To clarify, I caution against using traditional articulation drills with a child who stutters. Drilling or working a child hard at attaining correct articulation often means the child will work hard to produce correct targets in his attempts to please the clinician. Doing so can create more tension, something a stutterer does not need, and can, in some cases, spiral the stuttering. I do not think there is any doubt that harder articular contacts created from trying to correct something that is difficult to correct (articulation), or anything that causes a child to increase muscular tension, is helpful in reducing stuttering. In contrast, vocal tension can fuel stuttering. So, I would suggest working on articulation in combination with the stuttering ONLY if it is accomplished in a more passive manner through, for example, easier contacts, modeling, etc.
From:
Viren Gandhi, Mumbai, India
Often my family Members tell me Where was your stuttering when.....
It's because I may have done something which I liked doing and avoided certain things in life. So for them question comes (rather as a insult) Where was your stuttering ....for so and so.
PWS, who are getting educated and reading Mailing Lists, ISADs, Stutteringhomepage.com, on its own get some courage and gradually try to do things which they have avoided. This change is very slow. And often hard and painful.
I would like to hear what respected SLPs would like to say to such family members. It's often insult to injury for PWS as he himself is so depressed with things he has lost in life and is trying to make up on them. Depressions are often more then encouragements in life. Rather than giving support and understanding PWS, family members dampen his efforts to improve.
From:
Walt Manning
Viren- You are doing the right thing by becoming more enlightened through contact on the internet - now if we can just get others such as family members to understand. The lack of understanding by most people ("Where was your stuttering when . . .?") is an indication that they don't realize the nature of stuttering and especially the variable nature of fluency. Bob Quesal's paper at this conference is a good place to begin so I'd suggest copying that paper for them and let them read it, and you discuss it with them. There are a number of other things written concerning the variability of stuttering that can be found during previous ISAD conferences or on the StutteringHomePage. All we can do is try to let them in on what the stuttering experience is really like. Even then, sadly, some people - even a few professionals - don't always get it.
From:
Viren Gandhi
I have tons of Materials from Stutt-L, www.stutteringhomepage.com and SFA Books. I have even discussed this topic at length on Stutt-L and Russ Hicks wrote in one of his posts that my posts also inspired him to do workshop "Reach Out and Teach others" (I hope I remember title right). I have come across some PWS from India, whose parents are well informed and understand it and at the same time many others whose family member never understand it.
For me it has become too big issue and has even forced me to seek Professional Counselling to see if I can make the situation better as it's ultimately harming me most and also to some extent, other family members.
From:
Dale Williams
Viren,
With adolescents and adults, I talk to family members about the importance of having their loved ones gradually try to do things which they have avoided, even if it means stuttering. Often the response is that, because their loved one doesn't stutter in some situations, he doesn't need to stutter at all. I then explain that fluent periods aren't necessarily good. In fact, if they're due to increased avoidance behaviors, they can be harmful in the long run. I also talk about fluency enhancing conditions — situations in which speech is easier, but also different enough that it can't be compared to speaking in difficult situations.
Remember that it is logical for family members to not only want the stuttering to stop right away, but also to view any increase in fluency as positive. Thus, even those families who understand the importance of stuttering openly, confronting fears, etc., will come to therapy sessions again and again with statements like, "He had a good week — hardly any stuttering." About gaining courage, you mentioned that this change is very slow. Quite often, the same can be said for educating family members.
From:
Lynne Shields
Viren,
Both Walt and Dale have shared good information with you. I agree that the message to keep giving your family is that stuttering is a very changeable disorder. The fact that you have been more fluent in some particular instance or set of situations has no bearing on your ability to be fluent in other situations or at other times.
It is quite apparent that you do not feel support or understanding from your family. I think you are taking a positive step in seeking counseling to gain some separation from your family on this issue. Continued efforts at educating your family may eventually pay off, but the payoff may be too far away for you at the moment. Hopefully, through counseling, you can begin to allow them to simply be who they are. Your parents are the way they are for a myriad of reasons, many of which occurred long before you came on the scene. It isn't your fault that they don't seem to understand. It's their beliefs, anxieties, and so forth, that made them who they are. I'm pleased that you are seeing someone with whom you can discuss these issues.
Continuing to gain support from others in the stuttering support community around the world is also a positive step. I hope you are giving yourself credit for going other routes to gain support and understanding for yourself and your stuttering.
Keep up the good work, Viren, and thanks for posting your question. I have enjoyed hearing from you at this conference and on Stutt-L.
From:
Kylie Johnson
I have a friend who speaks Spanish primarily, but since moving to the United States has picked up English and is very fluent. The amazing thing that I have noticed is that she stutters frequently when speaking Spanish, but I have rarely if ever heard her stutter when speaking English. Is this a common situation? What kind of research is out there about this topic and where can I find it?
From:
Lynne Shields
Kylie,
What you have noticed in your friend is similar to what I have observed in a number of clients with whom I have worked. I am seeing a woman from China at the moment, who reports that she stutters most in her home dialect, less in Mandarin and the least in English. She believes that the difference in her level of fluency for Chinese is related to the fact that her native dialect contains sounds that require harder attacks than Mandarin. As far as speaking English, she says that she has to speak slower and believes that this contributes to her increased fluency. On the other hand, she reports that some of the disfluencies she has in English are related to the fact that she cannot as easily substitute words, since her vocabulary is much smaller. So, I suspect that there are a number of factors that may contribute to differences in stuttering across languages for bilingual speakers.
While there may be factors contributing to differences in stuttering in different languages for a particular speaker, I think it is important to look carefully at each person individually. For example, a number of years ago, I worked with a teenaged boy who stuttered in each of his three languages, despite having good skills in each. His father reported that his son was much more fluent in English than in the primary native language. The boy reported that he stuttered about the same in each language. The father demonstrated by talking with his son in their native language and, as he predicted, his son was much more disfluent. However, I noted that the boy was also quite disfluent when speaking English with his father. It turned out that the primary indicator of increased disfluency was speaking with his parents, not the particular language used.
There is research related to bilingualism and stuttering. I believe that Nan Bernstein-Ratner has published in this area. Hopefully, she will comment here.
From:
John Tetnowski
Here is a citation for a recent review on this topic.
Van Borsel, J., Maes, E. and Foulon, S. (2001). Stuttering and bilingualism; A review Journal of Fluency Disorders, Volume 26, Issue 3, Autumn 2001, Pages 179-205
A very interesting topic that needs more work!
From:
Nan Ratner
The Von Borsel article that John recommends below is a great source for reading about my work and lots of other folks' work on this topic.
From:
James Au-Yeung
Ken St Louis has pointed to our IFA paper in reply to Sharon Lee-Sheridan on the same topic. I have since reanalyzed updated data from our bilingual survey and have reported the following data in June for an audience of SLPs in London:
Among bilingual people who stutter (about 200 surveyed)
27% stuttered only on their L1 69% stuttered on both L1 and L2 4% stuttered on L2
Stuttering is self-reported and caution is needed as suggested by the John Van Borsel article.
A paper on the new data set is in preparation.
From:
Sharon
Over the past few years I have had school-aged bilingual boys who stutter. Language samples were taken in their native languages as well as in English. The base rates indicated that they were generally more dysfluent in their first languages, but not significantly. In every case the bilingual parents stated that their sons were much more dysfluent in their first languages. On occasion, I brought other students who spoke their languages into therapy sessions to see if the therapy I was doing in English was impacting their first languages. My results were inconclusive. How important is it to monitor fluency in both languages?
From:
Ken St. Louis
Hi Sharon,
The issue of multilingualism and stuttering is an area that needs lots of careful study. It seems to me that a large, international study is warranted. The literature is full of case studies and surveys that show that some stutterers stutter more in the native language (your experience and that of Lynne Shields [see earlier post]), more in the second, third, .... language, or equally in all of them. Maybe it has to do with when the stuttering began, how early and completely the later language(s) were learned, aspects of the languages themselves, genetic factors, and so on. Only a large study would be able to have a chance of teasing that out. James Au-Yeung, Peter Howell, Steve Davis, Nicole Charles, and Stevie Sackin at the University College in London reported an ongoing on-line survey on this topic in 2000 at the IFA Congress in Denmark. Their preliminary findings were that there were no differences in the likelihood of stuttering in monolingual and bilingual respondents. They also found that learning the second language at around the age of 3 years was somewhat more likely to result in stuttering for girls but (inexplicably) not for boys. I do not know if they asked your question, i.e., "Is there a difference in stuttering in the various languages?" You might wish to contact them for more details and an update.
Personally, I learned Turkish after the age of 20 in the Peace Corps. This was about two years after I more or less recovered from my stuttering in English. I always stuttered a lot in Turkish for the full two years and even in the 35 years since when I try to speak it again [what I can remember, that is ;-) ], even though I have remained mostly recovered in English. Go figure....
From:
Sharon Lee-Sheridan
Thanks for your reply and references. Any thoughts on therapy being monitored in the other language(s)?
From:
Ken St. Louis
Hi Sharon,
I don't have any firm thoughts on the best way that fluency might best be monitored in other languages, but I believe it should be. Of course, you can sometimes arrange to bring another speaker of the language to therapy. If that is not practical, then you can have the person read in his/her native language and watch for stutterings. You should be able to pick them up even if you don't understand what is being said. If the client is willing to talk to you in the other language (even if you can't understand), you can do the same thing in monologue. If none of these work, you might need to resort to self reports by the client and/or reports from others in the family.
From:
Thais M. Amaro
I have a friend who was born and raised in the United States and the only language spoken at home was Spanish. He told me that he received speech therapy in middle school because he was stuttering (in English). Because he didn't want to go to the sessions at school the SLP persuaded him to provide the therapies at home. Currently, he expresses himself most of the time in English. Although he does not feel too comfortable speaking in Spanish he does use it when he is at home. I have noticed that when he speaks in English he does it very fast but with out articulation errors and not stuttering behaviors. However, when he speaks in Spanish (very rarely, he says it's too hard for him) some "core" behaviors such as prolongations and blocks are evident. If the two languages were learned basically at the same time why he is stuttering in one language and not on the other? Can the strategies that he learned to become more fluent in English be used in the other language (in this case Spanish)?
From:
Ken St. Louis
Dear Thais,
I responded to a related message posted by another person. I don't think my response to your fascinating message would be any different.
Best wishes,
Ken
From:
MLG
I am working with a first grade boy who stutters, has a phonological disorder and is ADHD. He is not taking medication to control his ADHD. I am wondering if there have been any studies on stuttering therapy with students with ADHD. He has a difficult time self-monitoring and using "slow-smooth speech" because he is on fast forward.
From:
Lynne Shields
I do not know of any articles that deal directly with fluency therapy for children with ADHD. Someone else may be able to help out here. There is an article in the April 2001 volume of Language Speech & Hearing Services in Schools by Arndt & Healy entitled "Concomitant Disorders in School-Age Children Who Stutter" which includes mention of children with ADHD.
I have worked with a child having a similar profile to the child you wrote about. Of course, each child, even with a similar set of diagnoses, will not be the same and may not respond to the same treatment methodologies. With that caveat in mind, I can share with you that the child I worked with was able to eventually master the easy talking skills we worked on, albeit over a longer time than a child with no attention issues. I used a variety of ways to help the child gain the skills, including getting comfortable and relaxed in a beanbag chair to get the idea of more relaxed talking. I also worked separately on phonological and stuttering issues, as this child had difficulty focusing on more than one skill at a time. I basically alternated work on speech sounds and on stuttering. I emphasized relaxed ways of talking in working on the phonological skills, too, but did not specifically focus on stuttering during that time.
From:
Judy Kuster
You may be interested in reading a paper from the 2000 online conference by Charlie Healey and Robert Reid entitled
"The Link Between ADHD and Stuttering: A Closer Look."
From:
Brian Passalacqua, M.D.
I wondered if any of the faculty or SLPs have had any experience with the McGuire Programme. Is it something you would reccomend for an adult or teen stutterer. What do you think of this particular model, which seems to have similarity to Alcoholics Anonymous as a vehicle for recovery. I don't know if this has been addressed in the past or not in this forum which I am excited to have just started following. Thank you for your work.
From:
Nora O'Connor
As we all know too well the second someone opens their mouth the listener is making judgments about them. People who stutter are not only dealing with their own obstacles but are forced to deal with societies value judgments.
What research has been done or is currently being conducted about communication disorders and stigma?
Also, because the affects of stigma begin in childhood and are often long lasting into adulthood ... how are professionals prepared to deal with children's feelings of social exclusion and isolation while treating the stutter?
From:
Ken St. Louis
Hi Nora,
Actually most of the published attitude studies in the literature that have shown that there is a stereotype of stutterers (people believing them to be shy, nervous, withdrawn, fearful, etc.) document stigma. This general stereotype has been replicated over and over.
Gordon Blood at Penn State presented a wonderful paper at the ASHA convention two years ago on stigma. I suggest you write to him for additional information.
I have been working with a number of others both in the US and in other countries to look at public attitudes toward stuttering internationally. We have found some fascinating (and some disturbing) things in our initial pilot studies. For example, whereas the public generally believes that stutterers can live a normal life, they are doubtful about their abilities to do such things as raise a family, get a job, make friends, and do well in school. I am working on expanding this study and hopefully will have a lot more to say about the subject of stuttering and stigma in the next few years.
From:
Joey Valenti, Age 11
When did you start to stutter? When did you notice you had a stuttering problem?
From:
Dale Williams
Hi Joey. Thanks for the questions. My story is a typical one, straight out of the stuttering textbooks. I started around age 4. My parents brought me to the pediatrician, who told them not to worry, it would go away on its own.
Well, it's nearly 40 years later and I'm still waiting.
I don't really know when I first noticed it. But I do remember that in junior high (about your age), I began to worry about it more. I wish I'd had self-help organizations and present-day internet resources back then. I pretended it didn't bother me and tried to deal with it alone, both mistakes.
If this is a problem for you or any of your friends, one piece of advice I could offer is to put together some sort of support system to make life easier.
From:
Bob Quesal
Hi Joey:
My story is similar to Dale Williams's (but goes back farther). ;-)>
I started stuttering around the age of four or so, following a fairly severe case of rheumatic fever that put me in the hospital for (I think) about three weeks. According to my parents, I didn't speak for a while after returning home from the hospital, and after I began to talk again I spoke very rapidly and was disfluent. They advised me to "slow down" and other things like that. The doctor told them to leave it alone and it would get better.
My first recollections of my stuttering were when I had to go to speech therapy in first or second grade. It really didn't become a "problem" until I got older - around junior high or high school - when I began to try to "cope" with my stuttering because I started to suffer some social penalty because of it.
The more I tried to control my stuttering the worse it became. It wasn't until I got into speech therapy in college that I was really able to understand my stuttering, my speech, and myself. I wish groups like the National Stuttering Association and resources like the Stuttering Home Page had been around when I was your age.
From:
Jerry Johnson
Hi Joey: Why do you ask this question? Most of us hard-core stutterers started early in childhood for reasons yet to be determined. If we knew the answer to WHY we would have the answer to why we stutter. But the real question is "what to do about it now that you got it?" In short, don't give in to the Stuttering Beast! If we do then we give up our personal right to be ourselves and to keep on truckin' through life. But this is what all people have to do whether they stutter or not. Don't be afraid, don't give in or give up, don't avoid talking, stand tall and proud, attack stuttering head on and do something about those moments of pre, during, and post stuttering moments, and have a sense of humour. Stand your ground and demand your talking time and space to figure out what is going on in life. Don't do stupid things to try to make stuttering more tolerable. Focus upon the positive and eliminate the negative (a Johnny Mercer tune). Talk to people who you have confidence in and share your feelings with them. Remember your parents too! They love and care for you more than anyone else in the world. Don't try to go it alone. Keep the faith.
From:
Barry Guitar
Hi Joey, I think I started stuttering when I was 3, because I remember getting quite stuck when talking to my grandfather at about that age and I also found a picture that was dated 1945, the year I was 3, showing me at the Thanksgiving table with a lot of serious and concerned looking adults in suits and me with my face screwed up trying to talk. I noticed only intermittently at first, but soon, by age 4 or 5, remember worrying about it. How about you?
From:
Viren Gandhi, Mumbai, India
Do SLPs nowadays recommend to use Voice chatting either one to one or in Public rooms for PWS. Can Internet Technology be put to better use for PWS in this way?
What would SLPs advice to Family of PWS, who may feel it's waste of time.......
Personally I till date have never done voice chatting and still have some fears doing it. But with PWS I think I would not hesitate.
From:
Viren Gandhi, Mumbai, India
Does PWS, who have little or few social contacts and exposures tend to be emotionally Deprived? Do they need emotional support more ? Do they become Vulnerable?
I had read about a Study in Letting Go Archives that PWS tend to be more sensitive. (Sensitivity and Vulnerability: Are They A Blessing? by Mary Elizabeth 'Libby' Oyler, Ph.D.)
In my examples I feel like when watching Emotional Soap Operas, I get emotional. I am thinking on this and trying to find reasons. Sometime I now avoid watching such scenes now. Or I avoid watching Disaster scenes shown in news.
Should PWS work towards being emotionally more strong? If so, How?
From:
Judy Kuster
Viren,
Your basic question here is
"Should PWS work towards being emotionally more strong? If so, How?"
I think since you ask that question, perhaps you are feeling that you would like to feel "stronger" inside. Some friends and family members are very good at helping people do that. Some speech therapists are also good at helping their clients do that. But if friends, family, and my professional community are not able to help in that area, in my country I would suggest that there are professional counselors who are trained to help people look at those questions. I am not sure about those kinds of services in India, and I am also not very familiar with the cultural biases about types of counseling services there are available to you.. But I do know that there are counseling services available in Mumbai, India (I found several listed doing an search of "Mumbai, India" +counseling on google.com). If you are feeling that you would like some direction in helping you become more "emotionally strong," you might look into what counseling services are available in Mumbai.
From:
Abu Naser jaman
Stuttering is an enormously embarrassing and frustrating problem that can affect our job performance, income level, social life, self-esteem, and emotional well being. new device, known as the Fluency Master, may help us stop stuttering now, But i just wanna know is there any new advanced device that can reduce stuttering?
From:
Ken St. Louis
Dear Mr. Abu Naser,
There is a lot of interest, as there has been for hundreds of years, in devices that might cure one's stuttering. May I suggest you read the posts and responses at the beginning of this section on both the Fluency Master and a newer SpeechEasy device. Apparently, these and other devices (such as the Edinburgh Masker) can be helpful for some people, but not by any means for all of them. Many stutterers who find them useful combine their use with speech therapy or self help group support. That puts people like you in a difficult situation because speech therapy or self help groups might not even be available where you live. In addition, the devices can be very expensive.
My advice would be to join the STUTT-L ListServe and follow the discussions there. There has been a great deal of discussion recently about these stutter-reducing devices. Also, you might consider starting a self-help group in your area.
From:
Jeff Shames
I have known many of the panelists from stuttering conventions. This kind of open discussion is an online way to replicate the give and take that takes place when pws gather. Reading this threaded discussion has been helpful and informative.
Re the issue of self acceptance: my being a part of the self-help/mutual aid stuttering world, and producing the film "Stutter Step", have helped increase my feelings of self-acceptance as a stutterer dramatically. It is easier for me when I do not stutter while speaking. But I now know that I am able to communicate effectively whatever my degree of "fluency".
For many people, both pws and the general public, however, it still comes down to the old "fluent speech is good; stuttered speech is bad" model.
I tell people that gaining a degree of self-acceptance helps deal with one's stutter. But it remains a paradox that one is striving to become more self accepting about stuttering while doing what one can to "stop" stuttering. Or get "cured".
From:
Ken St. Louis
Dear Jeff,
Good question. I don't have the answer! A few in our NSA self-help group thought that accepting one's stuttering was maybe the best any given stutterer might be capable of. But one rather forthright member stated that to assume that all stutterers must give up fluency as a goal is a "cop out." Again, I don't know, but here is my take on your question.
Stuttering is a bit like being seriously overweight. (Let's assume for the moment that one's physical health is not the issue--although more and more evidence suggests that it probably should be.) Most people do not want to be overweight because of the inconvenience and stigma it causes. Even so, there are a few who really don't care. Many overweight people have gone on strict diets (some, dozens of diets) and lost weight, but most have gained the weight back sooner or later. A rare few just lost the weight without doing anything in particular. A few have been successful with the first or second diet they tried and kept the weight off rather easily. Many have been intermittently successful, keeping the weight off most of the time but gaining too much during stressful times or during holidays. A few were pretty much unable to lose the weight at all unless they resorted to various drugs or surgeries (sometimes no doubt due to their atypical metabolic characteristics). A few have had such difficulties that they have made peace with their weight and learned to accept and celebrate it.
I really don't think there is one answer that fits every stutterer or overweight person. For my stuttering clients who are old enough, intelligent enough, or mature enough to make choices, I then lay out their choices and give my best guess of their likelihood of success with each. I believe they can expect that of me as a so-called specialist in this area. But I never assume that I am 100% correct and would never stand in the way of someone attempting to reach a level of fluency that I have doubts about. (David Daly has debated eloquently on this topic.) As clinicians or clients, we really never know the limits of human potential even though we can and must consider probabilities. On the other hand, I will take off my hat to someone whom I believe has the capability to be more fluent but chooses not to.
From:
Steve Hood
Hello, Jeff.
You asked a great question, I do not have an answer to it. I would, however, like to make some comments.
Regarding what you way in the second paragraph, on the one hand you indicate that it is easier for you when you "do not stutter while speaking" and then you also say that you can "communicate effectively whatever (your) degree of fluency." I believe one of the major issues here is not the stuttering per se, but the severity of the stuttering. There are always a few listeners who are idiots (Bob Quesal might say people "who don't get it.") These are the exceptions. I think it is fair to say that the vast majority of listeners do not react negatively to stuttering-- what they react negatively to is the severity of the stuttering. People who stutter mildly (and I mean because their stuttering is **mild,** and not covert/hidden/interiorized) do not get much in the way of adverse listener reactions, and for these people stuttering need not be "disability" or a "handicap." As Walt Manning has said, these people can make decisions independently from the possibility of stuttering, so the factor of stuttering doesn't enter into the decision making process. People for whom stuttering is still an issue make decisions based on the possibility of stuttering, and let stuttering become more disabling and handicapping that it needs to be....
For this second group, I believe a major reason is that they do not have the degree of self acceptance that is needed. This is where being open, honest, and tolerant become important.
I think Ken St.Louis made a good point when he talked about explaining the various outcome-options that might be available; e.g., fluency shaping -vs- stuttering modification.
But in either case, **fluency is more than the absence of stuttering.** Just because you "stop stuttering" doesn't necessarily mean that you are "cured"-- especially if the reason you stopped stuttering involves things to postpone and avoid stuttering through tricks and crutches that are only temporary.
Finally, I would suggest that while self-acceptance alone may not solve the problem, self-acceptance will go a long way toward reducing the shame, guilt and denial that help serve to perpetuate the problem.
Well, Jeff... You invited the panelists to pick up on this issue. In the 36 hours remaining, I hope others will join in and comment further.
From:
John Tetnowski
I really agree with Ken's comments. I like the parallel that he uses with weight loss. Many of us would like to lose 15 or 20 pounds (myself included). I know how to do it, but I am willing to accept myself at this state because it is either too hard to give up my favorite foods, or more likely it just isn't that important to me. If it was important enough to me, I would lose the weight. Nonetheless, I am happy with the way I am now. I think this is like stuttering for some individuals. If the stuttering is something that you can live with........fine. But for those who choose not to, help is out there.
From:
Jaime Leschke
I am a speech-language specialist working in the school setting. A first grade student was recently referred to me by her classroom teacher for stuttering (she will be my very first stutterer). I was discussing this student with her teacher and I was shocked at her perception of stuttering and her attitude towards this student who stutters. She truly believed that this child's stuttering behavior was a factor of unintelligence, and she reported that she never calls on this child to answer questions because it is frustrating for her to listen to the child stammer. My question for you is how do I go about educating this teacher to have a more understanding and accepting attitude towards her extremely bright student who stutters??
From:
Ken St. Louis
Dear Jaime,
Are you sure that the teacher is not a latent ("closet") stutterer herself or does not come from a family where stuttering is considered a shameful thing? Talking about various family attitudes toward stuttering, neutral or negative, might be a good way to start the conversation with her.
You might have to do a little "covert" desensitization with her, maybe by stuttering a little yourself.
I would suggest getting some the wonderful materials that are available for free or nearly free from the National Stuttering Association and Stuttering Foundation of America to leave with the teacher. Remind her that people like Winston Churchill and Charles Darwin stuttered. If that does not work, look up my name on the West Virginia University website and ask her to give me call. I'll be happy to share with her *lots* of reasons why she might want to reconsider her position for the sake of the child.
From:
Abu naser jaman
I think teachers' attitudes toward the student who stutters should not be discriminated againsst and the teachers can help the student to overcome stuttering.
From:
Lynne Shields
I recently previewed the videotape, "Stuttering: Straight talk for teachers", published by the Stuttering Foundation of America. It is a wonderful videotape that also comes with a booklet which you may find helpful. The videotape provides wonderful information for teachers--you may want to use it as a part of a teacher-Inservice on stuttering at your school.
Ken and Judy mentioned other ways to obtain good resources. And, I agree with Ken that this teacher needs some concrete reasons as to why she might want to reconsider the way she is interacting with this child in her classroom.
Best wishes to you. I'm delighted that you are using this conference as a source of information.
From:
Linda - a mom
My son is 23 years old, a recent college graduate with a finance degree and is still looking for his first "real" job--he has since graduation done his "summer job" and is currently helping us with the harvest.
He has had a challenge with stuttering since he was four years old and was in and out of speech therapy during his time in school. After middle school, however, he had very little therapy and did a good job of "hiding" the problem in the classroom.
He has let me know that his speech is much worse recently--no doubt apprehensive about the interview and the new job situation where "someone new" will find out.
He has done some research on the internet. Can you tell me any response that you have heard about the Precision Fluency Program? Or are there any other intensive programs that you would suggest?
From:
Dick Mallard
Linda, I can give you some perspective on the Precision Fluency Shaping Program. Look forward to hearing from you and your son.
From:
Walt Manning
Intensive programs require commitment on many levels (effort, time, money)and by their very nature require more commitment and focus on the part of the participant. That is what I wanted to do - jump in all the way - since I was tired of living live as I had to that point and ready for change. That often happens, by the way, at about your son's age. Up to that point in life we often hope the problem will somehow go away but often during the early to mid 20s we realize that we must go to work and make changes. So I think that most of the intensive programs provide that opportunity for making that choice. People that are ready to take the time and money and make the required effort are more likely to make meaningful change than those that are not.
Regarding specific intensive programs I've met and worked with people who have had success in many of the programs and also many that have not experienced long-term success. Of course it depends on how much the speaker can assume the role of monitoring and modifying their own speech in an ever-expanding world of speaking situations. The programs I'm most familiar with are the Precision Fluency Shaping program has many success and the Successful Stuttering Management Program (SSMP). They aren't going to be the "ANSWER" for everyone depending on their motivation, history of stuttering, talents, etc. but they do provide well thought-out and useful experiences for people who are ready to work hard for change.
From:
Gunars
y'all,
In psychology in Washington State we have to come up with a written plan of therapy before we start to treat a client. This includes informed consent.
Do you think it would be a good idea have this be extended to stuttering therapy?
For example the plan could include the following topics:
1. The goal of the therapy is to minimize the client's stuttering interfering with his or her occupational and avocational goals.
2. The therapy will be a cooperative process between the client and the therapist.
3. The therapy is aimed at achieving unconditional self accepatance (positive self-regard) whether the client manages to achieve his or her fluency goals. Self-esteem is a slippery term. Sometimes, it is used to denote conditional self-acceptance. For example, I can accept myself if my therapist accepts me or I can accept myself if I perform well in some area. Thus, it is better to just work on unconditional self-acceptance, whether the client stutters of not.
4. Perfect long term fluency may not be possible, because NOBODY is perfectly fluent. However, all clients, to the best of my knowledge, can improve the naturalness of their speech, ability to communicate, and minimize their shame and anxiety about speaking situation.
5. Practice usually makes ones speech more flowing. But in the therapy we will investigate what type of practice is a) palatable to you as the client and b) what type yields more bang for unit of effort.
6. I also think that a statment of self-disclosure such as mine: I, Gunars Neiders, as the therapist do not expect to be perfectly fluent. I also expect to work on my fluency as long as I live. My work involves informing everyone that I stutter time to time. (I think la belling myself as a "stutterer" or "Person Who Stutters" (just another label) is counterproductive - I do many, many other things than just stuttering and I am not defined by it.)
7. I intend to re-repeat one syllable in every conversation. Even when I am talking to myself. This, for me, has proven to be helpful. This prevents big swings in my fluency. However, I do not say that this is an answer for everybody.
8. The final statement of the informed consent form should be the success rate with the type of clients that either I as a therapist have had. Or the success rate that my mentor or the method of stuttering therapy has had. This should also include what is meant by "success".
Do you think that this type of informed consent/treatment plan, fleshed out with details of the techniques used would hinder or encourage the SLPs to be more open and, as a result, more effective?
From:
Nora O'Connor
I know this is the last day of the conference so I don't expect an overwhelming response to the question I have ...
In my self-image paper for Woman and Stuttering I listed a few questions "for the professional". I was hoping these questions would be picked up and discussed by grad students and SLPs during the threaded discussion.
One of the questions of mine I was most interested in is the following:
We know generally that boys are called on and participate more in classroom discussion than girls in elementary and middle school. What measures are being taken by speech language pathologists and teachers to not only include female stutterers in classroom discussions, but also to identify possible academic weaknesses in the less verbal female?
From:
Lynne Shields
Nora,
Thanks for your question. I wish I had a good answer for you. I know of no research related to verbal expectations for girls who stutter. I can only speak for myself and say that I always encourage teachers to check with any students who stutter to see how they would like to handle speaking in class. My goal is that a child who stutters, either a boy or girl, would eventually be willing to speak in the same situations and under the same conditions as non-stuttering children. However, I think it is important to allow a child to work out ways that are comfortable for them to participate verbally in class, and gradually modify those as they become more confident. In terms of the last part of your question, it is important that any child who stutters be evaluated for co-existing problems, be they speech and language or educational in nature. This is important since children who stutter show other problems at a higher rate than is found in the general population. Again, this should be applied equally to boys and girls.
Whenever I give a workshop to school-base clinicians, I try to make these points clear. That's my personal attempt to try to encourage teachers to include children who stutter as participating members of their classroom. After reading your paper (sorry that I didn't get around to commenting or tackling your good questions!), I am motivated to be sure to make the point even more clearly that it isn't O.K. for the girls to be quiet, either just because they are girls or because they stutter.
From:
Michelle
I was interested in possible suggestions in planning fluency treatment when you have only one child who stutters in the group and the rest of the group consists of articulation students. How can you effectively and creatively incorporate the two (fluency and articulation therapy) together?
From:
Lynne Shields
Michelle,
I have to say that I do not think it is possible to do effective fluency therapy with a child who is in a group comprised of children having articulation problems. This type of grouping is typically the result of caseloads for school clinicians that are much too high. I understand the frustration of trying to schedule children for treatment, but I do believe that it is imperative that this child have individual sessions if there is not an appropriate group for him/her. In my book, two 10-15 minute sessions alone, focusing on fluency strategies, teasing, talking in class, or whatever the issues, are far better uses of time and are likely to be far more effective than even two hours of group therapy where all of the other children are working on different issues. The longer group sessions are most likely a waste of this child's time and a disservice to him or her.
I'm sorry that I can't help you with solutions within the group setting you describe, Michelle, but I simply don't think that this is workable. Best wishes to you in trying to provide services for this child.
From: Judy Kuster
The live, threaded discussion part of the 2003 ISAD online conference is now closed. The answers given here during the conference will remain online. Thank you for stopping by.
Judy Kuster