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From:
Ira Zimmerman
ABC-TV's "Good Morning America" received an Emmy for its story on the SpeechEasy Device. What is the role of devices like the SpeechEasy Device in the treatment of stuttering? Are there any peer reviewed studies on the long term effectivity of the SpeechEasy device? If not, why hasn't the speech language pathology community held a press conference cautioning the public about this kind of device?
From:
Howie Schwartz
Hi Ira,
I think there has been a lot of concern expressed at professional meetings and on internet list servs regarding the use of any device that makes grand claims for fluency success. In addition, speech pathologists can provide their opinion regarding the speech easy device when asked by their clients or people within the community. I don't know that we have to enter a public forum to provide an opinion when results are still in question.
Interestingly, despite recommending against the purchase of the device, my client (now former client) purchased one anyway.
Until we have one or more systematic investigations of the long term effects of this device and or any other fluency enhancing devices, the slp community will probably not enter in a public forum to condemn or support their use.
Are you or members of the NSA planning a press conference to discuss the use of these fluency enhancing devices and the results?
From:
Ira Zimmerman
I sent ABC News an email about doing a more balanced report on the SpeechEasy device. I got no response from them. And the Academy of Television Arts and Sciences gave them an Emmy for the report. Goes to show how little the Academy knows about chronic stuttering. TV has been broadcasting stories about instant cures for stuttering for as long as I can remember. Yet stutterers still exist. We must all be pretty lazy or just don't have the money for all these quick cures for our stuttering.
From:
Steve Hood
Hello, Ira-- I suspect that there may be a lot of interest in Speech Easy as a result of the marketing that has taken place, and the publicity in People Magazine, and on television. Seeing Opra shed tears of the "miracle cure" was certainly an attention getter, was it not? So, for those interested, here is a really good source of objective information:
https://web.mnsu.edu/comdis/kuster/TherapyWWW/dafjanus.html
Unfortunately, the marketing that has been done has been designed to sell the product, and difficulties experienced by people have not been widely circulated: e.g., difficulties in noisy background environments, the fact that persons with primarily silent blocks have difficulties, that some people do not want to wear a conspicuous prosthesis, and as happened with a person I spoke with over the summer -- you cannot wear it when you go swimming at the beach.
Independent long term research is needed for publication in peer-reviewed journals. I suspect that until more information is available, press conferences will not take place.
Let me also say that I found it interesting that the Janus Corporation was highly conspicuous at the 2002 convention of the American Speech-Language-Hearing Association in Atlanta. The Speech Easy folks were conspicuously absent from the recent convention of the National Stuttering Association in Nashville. There were certainly a lot of persons who stutter in Nashville, and this would have been quite an arena for marketing and sales people.
Those reading this reply should also visit the ISAD paper by Dr. Richard Merson.
Steve Hood
From:
peter ramig
I, too, have a problem with the way the speechEasy device was portrayed via television exposure; however, as a clinician who has fit many, I want to state what I feel are the facts based on my experience thus far. 1) It does not cure stuttering; 2)It helps some people VERY significantly; 3) It helps some others FAIRLY significantly; 4) It helps some others VERY LITTLE or not all all; 5) There have been a substantial number of stutterers who have been helped more than many years of traditional speech therapy. To best determine if the device might be helpful, the client should first go through a fitting session with a certified provider that will last about three hours. The cost for this ranges from $200-$400. Then and only then should a determination be made to purchase it. If it is purchased, there is a 30-day period in which the device can be returned for a 90% refund of the purchase price of the unit (does not include the professional fitting fee) if they are not satisfied. Over the six months my private practice has been fitting and selling SpeechEasy, we have had no returns. I think that says something as to its usefulness to people we have fit. Keep in mind, however, there have been a small number of clients we have discouraged from purchasing the device as a result of little success during the fitting session. The reason I continue to view the SpeechEasy as viable for some, is the fact it has helped some achieve more fluency than , in several cases, years of stuttering treatment. Although this is the case with some, I continue to support traditional stuttering treatment if administered by a clincian who understands fluency shaping , modification of stuttering, and the devastating impact of the resulting embarrassment, frustration and shame on the continuation/exacerbation of stuttering.
From:
Gert Reunes
I have made a study with the University of Ghent (Prof. Van Borsel). It was a 3 month follow up research and what we have seen is that the device DAF works the whole time!!!
From:
Rick Carney
I would like to know how many of you think stuttering may be caused by a chemical imbalance affecting neurotransmitters i.e.. Dopamine. In my own research the common thread of high levels Dopamine was present. With the help of propranolol and other medication, my stuttering has totally disappeared. I never would have found the proper medication had I not made the link with Dopamine. I am not sure if this is a rare situation or if in fact research is being done to further explore the Dopamine connection. Thank you for your reply. PS. I am by no means a scholar on the subject but just a lucky soul who found my own cure after searching for 20 years.
From:
Ken St. Louis
Hi Rick,
It's fantastic that you found a "cure" for your stuttering. I have reached the point where I never dismiss any real experience that someone has and believe that we need to incorporate those experiences into the every growing knowledge base for stuttering.
I am not an expert on drug treatments of stuttering but know that there is yet to occur a series of clinical trials that show that stuttering can be essentially eliminated by any particular drug. Instead, it seems that most of the drugs that have been tried have variable effects, that is, they work well on some stutterers but not so well--or not at all--on others. Other drugs seem to make speech therapy a bit easier for the majority of subjects studied.
I would presume that it is premature to know exactly what has happened in your case. Dopamine levels can be modified in lots of ways. But your experience is clearly significant. You mention your "own research." Do you have stuttering frequency counts or severity ratings as a function of propranolol levels? Were these objectively obtained and checked for reliability? If so, you might have the raw material for a useful case study (of yourself) for and ASHA Convention or even a publication.
Thanks for the interesting post.
Ken
From:
Ed Feuer
Self-medicating is very dangerous. The NIH has been doing the proper clinical trials of various drugs and looking at proper dosages and safety issues. As I understand it, the results so far have not been promising. Unfortunately, there are desperate people out there looking for the shortcut, the pink pill. People spend thousands of dollars for distractor devices. While certain powerful drugs may be useful for conditions far worse than stuttering, their use for our problem should not be based on anecdotal accounts.
From:
John Tetnowski
I actually just made a post to a different question on a similar topic, but there is some research with L-Dopa and stuttering. Refer to Goberman and Blomgren (2003) in the Journal of Fluency Disorders.
From:
Holger Stenzel
I do since nine months a treatment of the stuttering with Olanzapine. With a good result. Olanzapine is an antagonist of serotonin and dopamine. The dopamine hypothesis of stuttering under consideration states that adults who stutter, as a group, have excessive dopamine in the striatal regions of the brain. The National Institute on Deafness and Other Communication Disorders instructed a study for the Pre- and Post-Synaptic Dopamine Function in Developmental Stuttering: "Assessment of Pre- and Post-Synaptic Dopamine Function in Developmental Stuttering Using 11C-Raclopride and Positron Emission Tomography". They know already results of this research? There will be a FDA - permission in next time? The best greetings from Germany! Holger Stenzel
From:
John Paskievich
Rick Carney; The complete elimination of stuttering using drug therapy is certainly unusual. What combination of drugs are you taking and in what doses? You say that you came upon your formula by doing independent research. Are you a doctor or pharmacist? Please tell us more.
From:
DOlivastro
I've stuttered all my life, but it was mostly under control and I had several days of complete fluency. In my early 40s, I was placed on several medications for blood pressure, cholesterol, and blood sugar. Now my stuttering is much, much worse, and I have no fluent days. Also, I seem to run out of breath after only 3-4 words.
Is there a connection between stuttering and any of these drugs?
From:
Gert Reunes
Are you aware that Parkinson patients have also stuttering problems. Is there a link between Parkinson disease and stuttering? Dopamine?
From:
Judy Kuster
Nancy Pearl Solomon has written about this relationship. You might be interested in reading some of what she has said on http://www.mankato.msus.edu/dept/comdis/kuster/related/parkinson.html
Judy
From:
John Tetnowski
There is a paper in the Journal of Fluency Disorders in 2003 by Goberman and Blomgren that is directly related to Parkinson's and stuttering.
From:
Marie-Claude Monfrais-Pfauwadel
In my answer to Judith Kuster (self referral and neurological findings), I mentioned I have worked with PD patients for a long time- as well as mith stutterers. Beside what I just wrote about palilias (which cannot be mistaken for typical stuttering dysfluencies as they keep some rhythm and they do not show any hypertonicity....just the contrary), one must keep in mind that PD patients suffer of dysautonomia and that their larynx lacks sensitivity. The swallowing reflex is impaired, and if you make a fiberoptic examination of the larynx, the epiglottis lacks of sensitivity. Inhalation and subsequent pulmonary infections are the first cause of death for those patients.
From:
Maggie Mitchell
This summer I interned at a Rehabilitation Center and had a patient with Parkinson's on my caseload. He too suffered from stuttering behaviors whenever his medication was wearing off or when he was tired. If he had just taken his medication then he was completely fluent, though quiet. And then they switched medications on him, making it impossible for him to speak at all for the first few hours after taking the new meds. When he would regain the ability to phonate, the stuttering was immediately there, consisting mostly of blocks and initial syllable or sound prolongations. We worked on teaching him techniques to use when his meds were wearing off or changed, or when he was tired. It was truly amazing to hear him be completely fluent at breakfast but struggling to speak at lunch or vice versa.
As far as a connection, I am not too sure. As a graduate student I am learning more and more, but as I understand it, Parkinson's is more a motor problem and the stuttering results from poor motor control (increased or decreased depending on meds and other factors). Maybe stuttering has more of a neurological basis than some people think...
From:
Brent Raymond
When I have done acting I tend to be very fluent; even though I am in front of up to 100 people. Do you have any knowledge of research/papers regarding this topic? Thank you for you time.
From:
Ken St. Louis
Hi Brent,
You describe a fairly common phenomenon: being more fluent in front of an audience while acting than while "being yourself" with friends and family.
I worked with one college student who stuttered--who also was a theatre major--with the same story as you. His *easiest* situation, stuttering-wise, was when he was on stage. Therapy obviously dealt with helping him control his stuttering in one-on-one situations.
I don't know of any research studies on this, although there may well be a few. My guess is that the majority of people who stutter would be less fluent while acting in front of a large group of people, but there would be a substantial minority who are more fluent. A few important confounding variable would no doubt come into play in this situation that would make research rather messy. The researcher would need to control such things as: number of people in the audience, likelihood of audience members responding or "talking back," degree of rehearsal of the lines, degree to which the actor "felt" the part, changes in fluency during the rehearsal/production process, changes in usual accent/voice quality/loudness/etc. during on-stage vs. normal conversation.
Thanks for the interesting question.
Ken
From:
Lynne Shields
Brent,
I, too, am not aware of any research on performance and stuttering. I can report anecdotal information from several of my clients who experience a lack of or minimal amount of stuttering when they are 'performing', albeit not on stage. I saw a man a few years ago who was studying to be a minister. He reported that he was almost totally fluent when giving a sermon. He brought a videotape of one of his sermons, and, indeed, he was quite fluent. He attributed his ability to be fluent in this situation to the amount of rehearsal he did prior to a sermon. He reported that he was generally fairly disfluent when leading a study group or participating in a men's breakfast at his church, examples of job-related tasks where he did not rehearse ahead of time. Another client reported that she is quite fluent when making presentations at work. She also indicated that she rehearsed for these events.
It is an interesting phenomenon, which might shed some light on the nature of stuttering if it could be examined. I'm not sure how much clinical application could be gleaned from such a study, though, as many professions don't lend themselves to rehearsed presentations, role-changes, and so forth.
From:
John Howley
Stuttering seems to affect the whole spectrum of personalities from intro- to extrovert. Some people can slip into an 'act' without problem, some cannot. I personally would hesitate to make a general classification of PWS vis a vis being extrovert/ActorStuff or not.
From:
Walt Manning
Not everyone can do that...become fluent when acting or something similar. I have known several PWS who can. As much as anything, it has to do with our self constructs or role. It likely relates to long term success following treatment and we have some indications of that with some of our research. Marty Jezer mentions this in his book "A life bound up in words". Here are 3 quotes: (1) Like actors who are able to move outside their stuttering selves and envision themselves as a fluent character, stutterers learning a second language can sometimes throw themselves whole into a new language and see themselves as, for example, a fluent Frenchman rather a stuttering English speaker. (p. 105) (2) Being a flirt was the only role I could adopt in which I didn't feel as if I were being dragged down by my stuttering. To flirt was to reinvent myself and to become someone I ordinarily wasn't . In the first draft of this book I wrote. "Of course, in assuming this flirtatious role, I was being a total phony." Upon reflection, I'm not so sure about that. Who's to say that this identify or that identity is not as real as the identify we usually inhabit. What's phony about getting out of yourself and playing the Lothario,(p. 119) The last quote indicates how (and why) this may be difficult to do(3) Just as I'm uncomfortable in changing the style of my clothes, I'm unable to get out of my skin and imagine myself as a different personality. Except when I'm flirting, I cannot play-act or assume a new identify. I believe that this has something to do with my stutter. I interpret any effort to get out of myself, even if only to be playful, as a rejection not only of what I am but of my stutter. Tempted to be smooth and stylish, I hear an inner voice (it must be my own voice, for I can't identify it as belonging to either of my parents) making a sardonic comment. "Watasmatter, you're not satisfied with who you are" To which I instantaneously and defensively respond, "I am satisfied! I am satisfied! I don't want to be anyone but me!" (p. 120)
From:
Peter Ramig
Experiencing less or no stuttering when acting is a common phenomenon associated with stuttering. A number of us published articles on ameliorative effects that occur in several fluency enhancing conditions such as singing, talking to very young children, choral effects, etc. What we learned from these studies tells us fluency is often generated when we change the way we typically speak. In all of the fluency enhancing conditions that I am aware, speech is produced differently to create the perception of the condition, such as in singing, changing pitch significantly, speaking in a monotone, etc. In the case of acting, I suspect the difference in the voice that is created by projecting, speaking louder, imitating an accent, etc, may be at least part of the reason fluency is created, as we suspect in the other fluency enhancing conditions mentioned above. So, speculatively at least, whatever causes stuttering in our normal speech, appears to be lessened or eliminated when we substantially change the way speech is produced as we do when we sing, speak in a monotone, high or low pitch, to young children, to a metronome, etc. etc.. Perhaps neural pathways are also modified or perhaps distraction plays a role (although this later is less likely in my view).
From:
Dale Williams
Just a quick addition to Dr. Ramig's fine post. In situations where the person is speaking before a group, like acting (or the aforementioned delivering a sermon, probably a better example), there is often less communicative pressure (in an interpersonal sense). No one else is talking. Hence, no one else can dictate the rate of speech, or interrupt, or finish the speaker's sentences. I have often thought that speaking to my classes was easier (and involved fewer breakdowns) than talking to someone one-on-one.
From:
Brent Raymond
First, thank you to all who responded. Secondly, I agree with a little from each response. From environment of the speaking situation to the roles of participants (speaker & listener) and the way speech is delivered (projection, rate, etc.) I have also found speaking in front of a class I am presenting a lesson to as a more fluent time.
From:
Ed Feuer
Question for Doug Cross: Regarding your computer generated animation programs, human athletics have been animated for training purposes. If you could create slowed-down animation of the movements of the idiosyncratic blocks of individual stutterers, that would be instructive for all concerned. It would show stuttering clients what they were doing in a highly graphic and less emotionally charged medium than video. And such animating of stuttering would be useful as a desensitization tool before moving to video. Is this technologically possible, given the quick movements of the block? Do you do this now or is a goal?
From:
Doug Cross
Ed, Thank you for your interest in my animation work. My primary focus is to identify methods for helping clients both understand and shape principle features of fluid speech. Examples include pace, rhythm, transitions, and abruptness. Clients have responded very favorably to nonspeech based visualizations of movement fluidity.
I believe your idea of creating visual representations of similar, albeit disrupted, movement/speech patterns is very worthwhile - as long as the emphasis is on shaping natural, fluid speech. I have been working on developing animations that depict recovery from disrupted "stutter-like" movements, which seems to be along the lines you are suggesting. The technology is available, but the learning curve is steep. I began working with Macromedia Director, but am not focusing on Macromedia Flash. Director is a more powerful animation tool while Flash allows for greater creative flexibility and accessibility.
From:
Ed Feuer
Doug,
I'm not sure if we're talking about the same thing here. I was referring to use of 3-D computer animation of each client's blocks for two purposes: 1) To allow the client to see what he or she is doing in order to be able to break up these highly conditioned patterns. 2) To serve as a desensitization tool.
From:
Ellen-Marie Silverman
Ed,
Would people who stutter not learn even more if technology was available to animate their fluent utterances? I think it is important to strengthen fluent behavior than to try to stop stuttering!
Ellen-Marie Silverman
From:
Ed Feuer
The failing in what passes for stuttering therapy today is the lack of genuine and thorough desensitization. We who stutter do violate speech mechanics; we have to know what we are doing incorrectly under communicative stress and develop coping mechanisms (PFSP's failure is that it simply ignores the stutters' blocks); we have to, as Van Riper said, learn to touch the untouchable.
Simply trying to strengthen fluency while ignoring intensely conditioned and idiosyncratic blocks doesn't work when things go haywire as they invariably do. It's like trying to paper over a volcano. That doesn't work very well.
I do believe that technology can be used in the needed desensitization, healing and strengthening.
I believe that a coordinated multidisciplinary team approach is needed, given the nature of stuttering. For details, check out my brief futuristic essay In The Year 2025, on the
Stuttering Home Page at: http://www.mankato.msus.edu/dept/comdis/kuster/TherapyWWW/In2025.html
From:
Ellen-Marie
Ed,
I think we both are interested in the same outcome, that people who stutter learn to speak in such a way as to feel free to concentrate more on what they want to share rather than on whether or not their speech mechanism will allow them to do that. Concentrating on speaking fluently more (I wish I could underline the word "more") than being vigilant for signs of stuttering when engaged in speaking helps in that regard. This is not (I wish I could underline "not") to say that in a program of change analyzing the act of stuttering is unhelpful. It is inded and should, as Van Riper insisted, be an integral part. But "part" is the key here, Ed. It is part of the program. I believe studying and strengthening fluent speech is, too, and, maybe, a bit more important because it strengthens the ability to do what one wishes to do. A, perhaps, not so complete analogy of the relationship of the two is when, in football, a wide receiver studies a game film in preparation for playing in the game to follow. He may realize he had been running too far from the sideline to allow the quarterback to safely get the ball to him. He corrects that tendency and makes more complete catches the following week because, having eliminated the tendency to interfere with his pass reception responsibility and noting all else was right with his game, he, with confidence, strengthened what he had been doing, i.e., route running, etc. to go about doing a good job on the field.
Analyzing stuttering is necessary and helpful as it allows freedom from the grip of fear and anxiety stuttering can have when it is an unknown. Studying the actual stuttering "brings the monster out of the closet" into daylight where it is no longer so fearsome or even fearsome at all and can then be tamed. Knowledge one has the ability to do this, of course, will reduce one's general level of speech anxiety. So, it is in the study of both fluent speech and stuttering that ultimately proves maximally helpful.
I'm sure I've said nothing new to you, Ed. I just wanted to be clearer about what I believe.
From:
Bernie Weiner
There was recently a post on Stutt-L about an SLP who has just now begun to get over his "fear" of treating people who stutter. What is it that scares some SLPs away from working with a person who stutters. While passing out literature at the Michigan Speech and Hearing Association Conference this year, I overheard one SLP say that she "just can't handle people who stutter." Anybody care to comment on what people who stutter can do to help SLPs get over that "fear." I know that I have probably driven a few Speech Pathologists over the edge. :-)
From:
Katie Daueer
Bernie,
I really think the fear comes from not understanding the disorder, not having much experience with it, and also not having much success treating the disorder. I know that I used to be fearful of treatment, but it was because I didn't want to feel like a failure. The more knowledgeable I become about it, the more I enjoy working with PWS. I also think that much of my knowledge comes from the clients themselves.
Katie
From:
Bernie Weiner
Thanks for the reply Katie. I am the cochairman of a very large NSA stuttering support group in Royal Oak, Michigan. Our SLP sponsor, Dr. Richard Merson, has told us that he learns something from us at every meeting. And we learn a great deal from him.
It's too bad that not more time is spent on fluency disorders at the college level. But, naturally, I am biased. :-)
Bernie
From:
Ken St. Louis
Dear Bernie,
You bring up a topic that has occupied a good bit of my attention over the years. Actually, Wingate wrote an article in 1971 entitled "The Fear of Stuttering" that dealt with clinicians' fear of working with people who stutter. I have written a fair amount about the issue, most notably an article in Asha 10 years ago. Here is the reference:
St. Louis, K. O., & Durrenberger, C. H. (1993). What communication disorders do experienced clinicians prefer to manage? Asha, 12/35, 23-31, 35.
I also did a follow-up study of that which I presume most of my colleagues have not seen. It was published in 1997 in the Bulgarian Journal of Special Education (in Bulgarian). Since that is unavailable, let me quote extensively from the discussion section of that article (in English of course).
"This survey of [86] practitioners confirmed earlier results that the majority of clinicians definitely prefer not to manage fluency disorders. There was no ambiguity in this finding. The St. Louis and Durrenberger (1993) study asked respondents to select their three favorite and least favorite disorders after rating 30 different disorders on a 1-9 scale. In that study, stuttering emerged as one of the least favorite but its selection may have been influenced by the categories provided. The questionnaire used in this study began directly with the open-ended questions, "What are your favorite and least favorite disorders to manage clinically?" Stuttering (as least favorite) was the most frequently identified disorder for either question (49%).
Training in fluency disorders continues to be a problem. St. Louis and Lass (1980) reported that 43% of master's students had never had a course devoted entirely to stuttering; 44% reported having one course. While not being entirely comparable, the results here for practicing clinicians are not quite so grim. Only 12% of the 42 clinicians identifying stuttering as their least favorite disorder to manage had not taken at least one full course in stuttering. There were none who reported no coursework at all.
In summary, experienced clinicians from West Virginia and surrounding states echo national trends indicating that stuttering and other fluency disorders are unpopular among clinicians, compared especially to language and phonological disorders. Training and experience in fluency disorders (and other disorders that clinicians prefer not to manage, such as voice disorders) is more limited than in their favorite disorders. Nevertheless, it would be hard to argue that lack of training and experience, per se, is responsible for the fact that nearly half of a sample of clinicians identified stuttering as their least favorite disorder. Other factors, many no addressed by this study, are likely important as well."
At the end of that article, I listed six hypothesized reasons why speech-language clinicians might be reluctant to treat stuttering. (These were also published in the ASHA Special Interest Division 4 (on Fluency and Fluency Disorders) Newsletter in 1997
It would be naive to assume that complete and satisfactory answers to the question "Why clinicians are reluctant to treat stutterers?" will be forthcoming due to the inherent complexities in human personalities." I don't know if this sheds any light on your question or simply buries it deeper into the inevitable complexities that science seems to uncover. There is some good work going on in this area in the UK and Ireland just now, so maybe some additional revelations of how we might combat this fear of stuttering by SLPs will be forthcoming.
From:
Bernie Weiner
Ken, Thank you so much for taking the time to post such a great reply to my question. Naturally, being a person who stutters, I am somewhat disheartend by the results of the studies. But, I also know that in recent years, treatment of stuttering has become more enlightened. By educating both the public and the future SLPs, it's getting better. I also think it's up to people who stutter to take the iniative and talk at colleges to the fluency classes and try to take away some of the "fear" of people who stutter. When I talk to a class of future SLPs at a college, I always tell them not to feel they have failed if their clients don't seem to do well in therapy. I tell them that something always "sticks" even if they don't think so. Thanks for caring so much for people who stutter.
From:
Ken St. Louis
Hi Bernie,
Thanks. I think your idea of having more people who stutter speak to students in training programs is on target. That will no doubt help. But I also believe that training programs are at fault for letting training in stuttering wain over the past couple of decades.
Students in training need more contact with people who stutter, especially those who have learned to manage it in their lives. They also need more *experience* in working with stutterers at every age level.
From:
maryann hymel
So many of us-SLPs- have been trained by professors who stutter themselves. Their views on treatments are often colored by their own experiences. This didn't work for them it's no good. This seemed to help some. This worked the best for them so it's "the answer". We all can't help thinking if "the answer" didn't work totally after so much personal and professional investment in finding a "fix" (and usually it hasn't ), how can we possibly "fix" our clients' speech. That's the essence of the "fear."
From:
Dick Mallard
Maryann, I shall never forget the first time I attended a specialty meeting in stuttering. Some presenters (the experts!) stuttered quite severely. At the closing session, I tried to count the number of specialists in the audience who had quite noticeable stuttering. There were many! I wondered at the time what prospective clients must think of going for help only to find out that the expert could not control his/her own speech. The experts who stutter and teach future clinicians about stuttering can provide valuable insights but the experts are a long way from knowing all the answers!
I suggest you not try to "fix" your client's speech. Only they can help themselves. Perhaps you can try finding out what the client's problem is and go from there. You will be surprised to learn that decreasing stuttering may not be the real problem that the person is experiencing. I improved my clinical accountability considerably by letting the client talk to me about what is important at the time rather than me assuming speech control should be the focus of treatment.
From:
John Tetnowski
Maryann,
I have certainly seen many clinicians who fear working with clients who stutter. I think the fear comes from lack of clinical training experiences in stuttering. Let's face it, fluency is a low incidence group. Most (or many) SLP's enter the work force with very little experience in many areas (fluency included). If the major professor preaches one method, that's what many students will practice. This is obviously what you are bringing up. Hopefully, those of us who teach will provide a broad knowledge base of fluency treatment methods, and not just "what worked for them". In addition, the training programs are bound to teaching the masses for the job market.
From:
Ellen-Marie Silverman
Maryann,
Thank you for voicing a concern I have heard others voice often and have felt myself for quite some time. One of my dearest professors at The University of Iowa, where I completed both my master's and doctorate degrees in speech pathology, Dr. Hugh Morris, who stuttered to a mild, sometimes moderate degree based on frequency, told me when I was his teaching assistant in the cleft palate course he taught that he chose to professionally diassociate himself from the stuttering area because he had not as yet been able to overcome his own stuttering problem. I admired his integrity. I, as he, believe an "expert" or "authority" lacks credibility attempting to teach others how to manage a problem they themselves have not overcome. I include in this group of experts on stuttering those who stutter severely both in frequency and pattern yet claim that since their stuttering doesn't keep them from saying what they want to say whenever they want to say it, they have no problem communicating. I feel this is a short-sighted view of communcating since it fails to take into account the feelings and concerns of those to whom they speak. Such individuals mistakenly think merely stating their points of view means they have no problem communicating, but such a view of communication is quite immature and problematic for an adult and tends to make a mockery of training speech therapists to work with people who stutter by suggesting that nothing can or needs to be done to modify one's stuttering.
I think that therapists exposed to these experts reasonably can be expected to question whether or not therapy can be helpful and, then, when they pursue that concern deeply realize that it most definitely can. I hope you are finding that to be so.
Ellen-Marie Silverman
From:
Walt Manning
I find myself agreeing with nearly all of the on this theme. Maybe the most amazing thing I've learned from this conference so far is that Ken St. Louis had published in the Bulgarian Journal of Special Education. I didn't even know there was one. The lack of decent training that several have pointed out continues to be indicated in the journals (for a recent example see Yaruss, J. S. & Quesal, R. W. (2002)Academic and clinical education in fluency disorders: an update. Journal of Fluency Disorders, 27, 43-63. That is not likely to change and may get worst given the new ASHA "standards". As John said, and others have suggested, now and in the future if you want to get decent training in working with PWS you have to pick your school. Clinician who stutter can have an advantage since they tend to have some wisdom about the phenomenon and some "street smarts" about the experience. It doen't make them an expert, just someone with experience on the playing field. Some people who don't stutter don't understand and are focused solely on the surface characteristics of the experience (such as %SS). Most of the people that I know who are professional clinicians (those that stutter and those that don't) understand what they are dealing with and have good ideas about how to help. Textbook information is necessary but not sufficient for being a good helper. As several have said already, listening to and understanding the client and where the person is in their process of change is basic to success. While we need to know several strategies and associated techniques I am absolutely sure that success is not associated with techniques or a particular treatment program (ANY treatment program).
From:
Ellen-Marie Silverman
Walt,
I could not agree with you more: Who we are is more important than anything else. Perhaps, you read my "Guest Editorial --- Shared Connections --Spirituality in Clinical Practice" in the last issue of The ASHA Leader? If not, I'll briefly recap: I believe, to be effective working with anyone, clinicians need to be present and to empower clients to mobilize their resources and take ownership of their life. To be present requires very careful listening to discover the concerns of the patient and his or her ability to work to meet them. It also requires an accepting and non-judgmental attitude combined with compassion. To empower, it helps to negotiate a treatment contract spelling out all the clinical and house-keeping details to circumvent "surprises" that could lead to premature termination of treatment.
All in all, as I said, I totally agree with you: We clinicians, above all else need to know ourselves, warts and all, and responsibly carry out the daily work required to continually open our minds and hearts, as well as to continually and systematically investigate specific clinical methods and procedures that we may be able to apply effectively.
From:
Bob Quesal
Sorry to jump into this discussion a bit late. Let me see if I understand this correctly: A person who stutters teaches a class in stuttering and brings a bias to that class (based on personal experience) and shares that bias with the class. If he (or she) has not achieved a certain degree of fluency, his (or her) credibility must be called into question. Students decide, "If my professor could not achieve fluency after investing his (or her) life in studying it and trying to understand the disorder of stuttering, it must be hopeless to try to help people who stutter." And that is why they are afraid to work with clients who stutter.
1. Message to students: ALL of your professors are biased. They all have been influenced by their personal experiences. (Attending an academic program - or two, or three - and learning about stuttering from a mentor counts as personal experience, as does knowing - or not knowing - people who stutter.) The ones who say they are not biased probably hold the biggest biases.
2. Your professor has earned a Ph.D. He (or she) teaches at a university. He (or she) probably presents at local, state, national, and (perhaps) international meetings. He (or she) has probably published a few things. He (or she) probably advises students, serves on committees, makes good coffee, etc., etc. Too bad he (or she) can't be fluent. What a failure. If you think that way, you are a fluency bigot.
Some People Just Don't Get It
3. Extending from point 2: Gee, maybe there's more to it than fluency. Maybe it'd be nice if we could define success as more than "perfect" fluency. I agree with Ellen-Marie that if someone still stutters severely and says "I'm cured" that may be a problem. But I can't understand why in these days of tolerance and diversity, it's okay to be a fluency bigot. It's a shame that more professors (both those who stutter and those who do not) can't give students the message that you can make the life of a person who stutters so much better even if you don't make them totally fluent. Unfortunately, as I understand it to say such a thing today is unethical.
4. Do all of your other clients achieve "normal" function? Do your dysphagia clients swallow "normally" again? Do your aphasics speak "normally?" How about your articulation/phonology kids? Do they have "normal" speech? Your language kids? Why is it that "do the best you can with what you've got" is acceptable for so many disorders we work with, but it doesn't apply to stuttering?
At some level, I suppose, the "fear" of working with people who stutter may have some basis. But in general, the arguments about it are essentially myths. Unfortunately, the future isn't looking all that great, either.
Check this site.
...but that's just my opinion.
Bob Quesal Angry "happy stutterer"
From:
Ed Feuer
SLPs should not be treating stuttering if they lack the competence the do so. As far as professional ethics are concerned, I don't understand how such people can keep pretending.
Furthermore I think it is high time the SLP profession reexamined the treatment of stuttering. I posted the following in an exchange with Anders Lundberg after his Significance! article. It is also relevant here. With all due respect, I suggest that to sincerely consider what I suggest SLPs would have to put the needs of the stuttering clients first in place of ego, bankrupt traditions and professional jealousies.
My view is that there are people outside speech pathology who have the tools which could be applied to the treatment of stuttering, as needed, under the coordination of an SLP whose specialty is stuttering.
For example, the great failing in stuttering therapy is the lack of genuine and thorough desensitization, touching the untouchable as Van Riper called it. Think how beneficial it would be for the client if the SLP could utilize the services of a clinical psychologist with a specialty in desensitization!
The SID-4 movement is an admission by ASHA that most people out there claiming to be able to treat stuttering lack the necessary competence.
I believe that the SID4 movement does not go far enough given the nature of stuttering. If stuttering were "solved," I would have no argument. But stuttering has not been solved. Now, a multidisciplinary team is used for the treatment of other conditions. Why not stuttering?
The treatment of epilepsy, as an example. I did a "Google" on multidisciplinary team approach and the first thing that came up was the multidisciplinary team treating epilepsy at the department of neurology at Wayne State University's Detroit Medical Centre at: http://www.med.wayne.edu/neurology/ClinicalPrograms/Epilepsy/multi.html
"The program provides comprehensive epilepsy care through the activities of a dedicated multidisciplinary team that includes four adult neurologists/epileptologists, one pediatric neurologist/epileptologist, one adult neurosurgeon, one pediatric neurosurgeon, adult and pediatric neuropsychologists, adult and pediatric epilepsy nurse coordinators, neuroradiologists, and psychiatrists. Highly trained EEG technologists, epilepsy nurses, and social workers complete the epilepsy program's team."
Last time I looked at the SID4 fluency specialty area on the ASHA site I saw under professional issues something called "multidisciplinary interaction." I would like to take that seriously and hope the SID4 people begin to pay more than lip service to this long overdue idea in the treatment of stuttering.
Consider Van Riper's credo on page 201 of The Treatment of Stuttering in his chapter headed Our Therapeutic Approach: "We feel that stuttering needs a global therapy, a total push, if it is to yield to clinical intervention and that it must be attack from every quarter with every available weapon."
From every quarter and with every available weapon. That is not happening in the status quo. It could, if progressive SLPs had the courage to reach out to those with the relevant expertise.
From:
Bob Q.
Interesting , Ed. I have no idea how they relate to what I wrote.
From:
Ed Feuer
Thanks, Bob. Let me help you with that. Here is what you wrote: "At some level, I suppose, the "fear" of working with people who stutter may have some basis. But in general, the arguments about it are essentially myths. Unfortunately, the future isn't looking all that great, either.
So I followed the link and read what you wrote. At that link, I found that, among other things, you wrote this:
"We can consider the - less desirable - possibility that ASHA in fact does not care about people who stutter. Perhaps it is time for someone else - some other profession or some "splinter group" - to act on behalf of those who stutter and to ensure that someone is qualified to work with, and help, people who stutter. How this will be accomplished, I am not sure (but I think I have an idea for next year's ISAD conference). "
That is what I am responding to. Maybe it is time for "someone else � some other profession or some splinter group" as you say. I say that someone else could be be a coordinated multidisciplinary team including people from outside disciplines as needed.
From:
Bob Q.
It still misses the point of what I was talking about.
Try this one, Ed.
From:
Bernie Weiner
Bob, thanks for jumping in here. What I find is that the new breed of SLPs that I have spoken with at things like the Michigan Speech and Hearing Association conference and at NSA conventions all have gotten away from the "perfect" fluency thing. They are the ones that are not afraid to deal with us and accept any progress we make. I always make a point to tell graduate students when I speak to them that they did not fail if their clients don't get near perfect fluency. Each client takes away something from the speech therapy experience. For the most part, I think that SLPs are willing to learn from people like me, who still stutter, but have not let it ruin our lives.
Actually, I'm kind of encouraged from what I see and hear.
From:
Walt Manning
Loved Bob Q's about fluency and people who (still) stutter conducting successful therapy. It reminds me that when I was in college I went out for the swimming team. I wasn't much of a swimmer and had absolutely NO technique. Our coach Mort couldn't swim at all. But he was a great man cared about us and knew about training. From his experience in the Marines during and following WWII, he knew about leadership and how to bring us together. He knew how to organize our workouts and modeled for us how to go far beyond what we thought we could. Our team eventualy did very well, I actually learned how to swim, broke several school and conference records and won some nice medals. And you know what, our swim coach, never did learn how to swim.
From:
Steve Hood
There are actually several sub-themes that have emerged from this issue, and I want to try to pick up on some of the ones raised by Walt, and others.
I think that SLP's who are PWS's have an initial advantage, as Walt said, because they have been on the playing field themselves. And as someone else indicated, it is important that they not let they own stuttering history bias them in their treatment of others. Having said that, let me also say that normally fluent SLP's can become highly effective clinicians.
To do this, normally fluent clinicians needs to learn to understand not just the "stutter**ing**" but also the "stutt**er." And this helps them understand not only the surface features of the behaviors, but the deep structures of the emotions: attitudes and feelings.
The normally fluent speaker is advised to do the following:
If you are not a person who stutters, you can never become a member of the stuttering culture. But, you can get involved with members of the stuttering community. You can join their community Get Involved !!!!!!!!!!
From:
Ellen-Marie Silverman
Hi, Steve,
Just wondering how you think you advice to the speech-language pathologist who does not stutter square with Walt's anecdote (above, somewhere - smile) about his very effective swimming coach who did not know how to swim but knew how to motivate and train swimmers?
From:
Steve Hood
Hello, Ellen-Marie
I appreciate your comment.
I do not think my comment is incompatible with Walt's, and I hope he will see this thread and I hope he will chime in.
Walt said that his swimming coach "was a great man (who) cared about us and knew about training. I think the sentiments expressed in my post will make the SLP care about PWS, and will help them know about training.
Walt said his coach "modeled for us...." WOW !! Yes indeed. I am convinced that clinicians need to be able to model for their clients. They can do this by modeling stuttering, and by modeling the targets and techniques of fluency shaping and stuttering modification.
I would submit that whle there may be some clinicians who can be effective, the things I tried to suggest in my post will make them even more effective.
I hope we hear not only from Walt, but from others as well. We might also hear from others who are not actually professors on this panel. I suspect that there are lots of people who hold opinions on this.
From:
Gunars Neiders, Psychology Doctorate Student
y'all,
What are the best research data bases for finding articles on research in stuttering. I have been using ERIC, Medline, and PsychInfo.
Are the databases advertised through ASHA worth the money?
Your help would be highly appreciated.
Gunars
From:
Nan Ratner
Hi Gunars, good to hear from you. If the library at your University offers EBSCO host, try that - it is a mega-vendor that offers multiple data bases for simultaneous searching. If you go to the option "select databases" it will offer you as many as 25-30, including many in psychology, medicine and the social sciences. You may get duplicates when you search, but that is better than missing something. I find that it is important to use metacharacters, such as stutter* to prevent the system from missing the difference between stutter, stutterer(s), stuttering, etc., and I also search fluency, *fluency to get related research that might not be on stuttering, but relevant. I also find that we miss much if we put "stuttering" in every search. For instance, simply searching "speech production" brings up new research and models that we might want to extend to stuttering, but haven't gotten there yet. As an example, a current doctoral student working on the genetics of stuttering and I were interested that an admittedly huge yield on the term "behavioral genetics" brought up work we think could be interesting to pursue, such as recently found markers for anxiety, fear conditioning, and novelty seeking/avoidance, which might (OK, it's a long shot maybe) be as relevant to stuttering as work done on the pedigrees of families in which stuttering seems frequent, or related work looking in the region of the new genes linked to language and articulation ability ... have fun! And let me know what you decide to do for that thesis coming up!
From:
Gunars
Dear Nan,
Thank you for your ideas. All of them are helpful. I will go to my university library(Argosy/Seattle) and University of Washington library (as an alumni) with your e-mail in hand. :-)Now I feel that the only thing that I have to add is energy, enthusiasm, and persistence. The use of * was ingenious. Also the casting of a wider net to include the "bottom feeder" :-) articles can make my search really productive.
So much to learn...when it is time to firm up my dissertation topic, another year, I will e-mail you some of my tentative thoughts on it.
From:
Gunars Neiders
y'all,
I have to analyze five articles for good research design, methodology, etc.
I hope that some of you could suggest to me some stellar research that has been done in anything that has to do with stuttering. These articles would have to use quantitative methods (Null hypothesis testing, etc.)
From:
Ken St. Louis
Hi Gunars,
If I could insert a 10-foot pole into this message, I would do so here with a note on one end stating that I still couldn't touch your question. ;-)
Seriously, in reply to this and your other post about journals, there are lots of excellent research articles in the Journal of Speech, Language, and Hearing Research, Journal of Fluency Disorders, American Journal of Speech-Language Pathology, and Language, Speech, and Hearing Services in the Schools. There are also good articles in a number of neurology and neuropsychology journals, but I don't have as good a sense of which journals I would recommend. Ultimately, research which takes seriously issues of reliability, validity, and objectivity--and reports the research in clear, concise prose--are good candidates for the kind of studies you seek.
How is that for a "10-foot pole" answer?
From:
Gunars Neiders, Psychology Doctorate Student
Ken,
Thanks. The stuttering journals exact titles will be very helpful.
Now if I could get somebody provide me with the titles of neuropsychology and neurology journals, I would be well on my way.
From:
Holger Stenzel
Hi Gunars, my favorites for the neurologic research are articles following at this time:
"A disconnection of speech-relevant brain areas in developmental stuttering" http://www.uke.uni-hamburg.de/kliniken/neurologie/pdf/buechel/stutter.pdf
"Dysfunction of the Right Frontal Operculum in Stuttering" http://www.kasseler-stottertherapie.de/_documents/asha.htm
"Olanzapine in the Treatment of Adult Developmental Stuttering: A Double-blind, Placebo-controlled Trial" http://www.kasseler-stottertherapie.de/kst.asp?go=000010055
"Parkinsonian speech disfluencies: effects of l-dopa-related fluctuations" http://www.health.utah.edu/cmdis/Adobe%20Files/PD%20Final%20Article.pdf
The best greetings from germany!
From:
Gunars
Dear Holger,
Great leads! Thanks a lot. I hope that we can meet next spring when I travel to Hamburg.
From:
[no name]
My daughter, age 5.5, has been receiving therapy for awhile now. Her SLP says she thinks she has a very large vocabulary but poor motor skills and can't coordinate it all. Is this common? To me she seems to have word finding problems and is searching for the word while she does whole word repetitions and initial sound prolongations (as well as trying to talk after all the breath has been released). Can word finding problems contribute and/or initiate stuttering?
From:
Woody Starkweather
Having a large vocabulary may itself put some strain on the word-finding process. Knowing words and finding them while formulating sentences are different processes. Word-finding problems do occur in some young stutterers. I wouldn't say that the word-finding causes the stuttering, but it might place a kind of demand on the child that interferes with the task of coordinating the movements of speech. Also, word-finding takes up time and may make the child feel that she has to talk faster to "catch up." It might be helpful, as a first step, to try slowing down the rate at which you speak when talking to the child. It will give her a sense that she has more time and may combat any sense that she has to rush.
From:
Ken St. Louis
Let me second what Woody has said about the demands of using a large vocabulary. That certainly could be happening in the case of your five and half year-old daughter. If I had to judge, based on your description, I would reach the same conclusion.
Nevertheless, I wonder if there might not be something else going on. Without further information, it would be impossible to speculate further, but..... What was it that lead the SLP to suspect motoric problems? How long has your daughter has been in therapy and for what problems? Is/were there any problems besides stuttering?
Lois Nelson, former professor of speech-language pathology at the University of Wisconsin, was convinced that there is a small group of stuttering children for which word-finding problems were important in their stuttering (or cluttering). Some of these children have coexisting problems that could involve the linguistic and motoric systems in more general ways than "pure" stuttering typically does.
From:
[no name]
She never had any other speech problems, in fact she had very precocious speech development (short sentences by 1year); however her motor development is not very good (couldn't jump until about 41/2). She has been in therapy for about 8 months.
From:
Ken St. Louis
Given this information, I think that Woody's answer is probably right on target.
I am still intrigued with the word-finding. It will be important to be sure that your daughter in fact is having difficulty finding the right word rather than finding a word that she can say more easily because of the stuttering. These would be completely different processes.
From: [no name]
Definitely agree with John Tetnowski, training programs should specialize more. In my case, I am interested in stuttering, but really don't know how to choose between the 2 grad schools in DC area. One more thing, while I am working on application, I noticed that there are few professors specialized in stuttering and I was wondering why, now I know the reason.
From:
Ken St. Louis
Dear Maryann,
Dick has given you some good ideas to think about. I agree that we don't "fix" anybody. Instead, we can serve as guides, coaches, and sensitive listeners to help people help themselves.
I, too, have observed that some stuttering clinicians/teachers tend to view the problem primarily in light of their own experiences. But I would take issue that this is the rule rather than the exception. It is those of of who have "been around the block a few times" who are most aware that simple answers are just that, simple answers." Most of the stuttering clinicians I know, including those on this panel who happen to stutter, are more open-minded about treatment than rank-and-file SLPs or even treated stutterers. In our NSA support group, I frequently serve as a mediator when someone who *believes in* a certain approach proceeds to advocate it for everyone.
The longer I'm around, the more sure I am that there is not--and probably never will be--a single explanation for stuttering or a single successful treatment. I am certain that many of my students wish I would tell them *the answer*, but I believe I would be doing them and the field a disservice to do that.
From:
sharon zabell
In regards to the panel discussion "Advertising your stutter", what do you suggest for teenagers who are dysfluent?
From:
Steve Hood
Hi, Sharon
WOW !! What a great question. Let me try to hit some highlight, and then hope that others will chime in with additional ideas and .
First, let me say that there are a couple of issues to advertising. Voluntary stuttering is certainly a verbal way to do this. Non-verbal ways to do this could include wearing a pin or button that is related to stuttering. Other methods that I know people have tried include the following: wearing a Porky Pig pin, or using a porky pig pen, wearing a t-shirt from Friends or the National Stuttering Association, etc.
I designed a t-shirt with the National Stuttering Association's logo on the front, and on the back it says: "Stuttering is OK because what I say is worth repeating.
Voluntary stuttering, or wearing pins and buttons, or other such things is a way to be up fron about stuttering. The issue, at least to me, is being open and honest about stuttering-- being willing to admit the stuttering not only to others, but also to yourself. This involves tolerating and coping with stuttering: teens certainly do not need to like stuttering, but they need to accept and cope with it while they are working to change it.
This is the opposite of trying to hide, conceal, cover up and deny the stuttering. In te long run, these attempts to deny and avoid make the problem far worse than it needs to be.
The teen years are times when kids like to run with the pack, and to fit in. Nobody like to be "different." Stuttering can set them apart, if they let it. Teens usually do not want to acknowledge negative differences of any kind, including stuttering. We need to show teens that the acknowledgement is important to long term gain. It is pretty hard to superimpose long-lasting techniques for fluency shaping and stuttering modification on top of fear, avoidance and enial. Advertising, through these and other ways, is a positive way to work on these issues.
I have offered my "stuttering is ok" t-shirt to a teen we are working with this semester. So far, he has refused to accept it. I hope that he will.
From:
Steve, Your Teenager
Steve, I always enjoy reading your comments. I must offer an alternative here, however. I agree with your teen who will not wear your t-shirt. I would not either. Personally, I have never been comfortable seeing my stuttering as something that has to be "advertised." Stuttering is a condition that needs to be faced squarely and openly. Being able to put the listener at ease by mentioning your stuttering appropriately when you begin to talk or after a bad moment is one thing. But wearing a t-shirt or button to "advertise" seems somewhat inappropriate and for sure something that teenagers will not do.
I had a client one time who suggested he make a button to wear that informs people he stutters. He asked me what I thought of that. I told him that I did not recommend it. When I asked him why he wanted a button, he stated, "So I don't have to tell people that I stutter. I don't want to talk about it." The button was an avoidance to be sure.
If I have a client who wants a t-shirt, I'll have them get in touch with you! Take care.
From:
Steve Hood
Hi, Dick
To me, the issue is largely what you said: that stuttering "needs to be faced squarely and openly." So I was thinking of the t-shirt as one way to do this that is socially acceptable. And picking up on Walt Manning theme in this ISAD conference, it can also be done in a way that can have some humor. Stuttering is not funny of course, but the person I am referring to would benefit from "lightening up" a bit-- and I was thinking of the t-shirt as one way in which he might be able to do this.
If he can verbalize acceptance in socially acceptable ways, this is also going to be a real plus for him. We have also talked about this, and I hope that this, too, might come to be.
From:
Dale Williams
To be honest, the times I have seen this work (teens advertising stuttering) have almost always been in groups — group therapy, support groups, NSA convention activities. Peter Dugan talks about getting groups of school kids to walk around and stutter openly, talk about stuttering, etc. He called it "making stuttering cool." In any case, support of peers seems to help with this, if that's possible.
From:
Sharon Zabel
Thank you for your insight regarding advertising and teens. The responses provided a range of options for young adults. Whether or not a person chooses to wear a t-shirt, I think it sent out a good message that stuttering is not a negative behavior that someone should be consumed by. The social groups are an excellent idea. Perhaps there can be a separate web site for teenagers discuss their views.
From:
Elizabeth Galletta
Do you know any references that support the suggest that some children who stutter may also exhibit some behaviors in the classroom that may look like ADD? Or any other references on ADD and fluency?
From:
John Tetnowski
Thanks for the question.
Here are two good references to begin your study.
Healey, E.C. & Reid, R. (2003). ADHD and stuttering: A tutorial. Journal of Fluency Disorders, 28, (2), 79-93.
Comings, D.E., Wu, S., Chiu, C. et al. (1996). Polygenic inheritance of Tourette syndrome, stuttering, attention deficit hyperactivity, conduct, and oppositional defiant disorder: The additive and subtractive effect of the three dopaminergic genes - DRD2, D beta H, and DAT1. American Journal of Medical Genetics, 67, (3), 264-288.
In addition, there are several other studies that show the co-morbidity between stuttering and other speech, language, and/or learning disorders. The relationship is quite high.
From:
John Kagie
Dear panel,
What would you consider the most important new insights into the cause of stuttering from lets say the last five years. I know, I know, one fool can ask more than ten wise men can answer. :)
From:
Nan Ratner
My own personal favorite is the finding of Anne Smith and colleagues (e.g. Maner, Weber-Fox) that the demands of formulating more sophisticated language can uniquely destabilize the speech motor systems in people who stutter, the first empirically documented example of a multi-factorial interaction among speech-language abilities that could produce stuttering symptoms. I personally like this because of my own work that shows the significant effect of language demand on stuttering in young children close to stuttering onset (they stutter more on longer, harder, utterances for which their grammar is not as robust). To this, I would add the two recent new studies on brain morphology in people who stutter (Foundas, Sommer et al.) which somewhat helps to interpret the fMRI studies showing atypical cortical organization for language and speech in people who stutter. We keep asking ourselves whether the functional imaging findings reflect the CAUSE of stuttering or merely how people learn to live with stuttering; structural differences make it more likely that SOME of the functional differences contribute to cause, rather than reflect the outcome of living with stuttering. But these are just my personal choices....
From:
Adele LaSalvia
What do you feel is the most difficult aspect of stuttering that a client must overcome?
From:
Dale Williams
Good question Adele. The first thing that popped into my head when I read it was that once the client decides it's OK to stutter, everything becomes easier.
From:
Ken St. Louis
Dear Adele,
I'll be a bit sarcastic here. [I'm sorry, I can't help myself sometimes. 😄 ] The most difficult aspect of stuttering that a client must overcome is dealing with the difficulty of getting the #$%& words out.
End of sarcasm. That being said, there are mine fields hiding in this simple, straightforward statement. The first evidence of the validity of my statement is that stuttering is almost never something that is desirable. Most stutterers do not like stuttering and do a whole host of things to hide it, minimize it, or seek help for it. (I have only met one adult stutterer in my life who reported that he always rather enjoyed his stuttering.)
*Not stuttering* is the goal of most of the clients who first come to see us. And why not? They can't get their words out consistently and easily. From most of recorded history, there are accounts of therapies, devices, and concoctions that were purported to eliminate the occurrence of stuttering. And 2003 is no exception. There is no lack of new and old devices and therapies being advertised that will greatly reduce or eliminate stuttering. This is exactly what most clients are hoping to find. For those lucky individuals who are successful in eliminating, minimizing, or otherwise successfully treating their stuttering, this is a clear win-win situation.
Unfortunately, there are many stutterers who find that the stutter-removing devices or therapies don't work for them, work only temporarily, require too much effort, produce undesirable side effects or life circumstances, or otherwise are unsatisfactory. What are these people to do? Some give up; some decide to live with the stuttering more successfully (e.g., by confronting it and stopping all avoidance); some keep seeking the elusive "cure"; some are confused.
So when you ask what is the most difficult aspect of stuttering that a client must overcome, you must first find out if this person could be successful in doing what he or she most probably initially wanted: getting rid of the problem entirely. If so, then the answer was finding that "cure." If that did not work, and if often does not, then the answer is entirely different. It depends on what the person decides — with or without the advice of others — to do next. If it is to learn to live well in spite of stuttering, then perhaps the most difficult thing the person has to do is what Dale mentioned: decide it is OK to stutter. And then take the difficult steps in risk and self-disclosure to make that happen.
There are lots of other answers. People are different. Different people seek and need different solutions. Each solution presents its own unique set of problems. My advice is to get to know your client. Listen to his or her story (or the parents' stories) and then sit down and try to work out a plan that meets that person's needs. You will find what is most difficult and hopefully some ways to help the person overcome the challenges inherent in the course of action you jointly planned.
From:
Brenda Fisher
What is the most effective way to prevent an initial secondary behavior from reappearing as another secondary behavior?
For example, a client comes to you with a secondary behavior of making a fist while he is experiencing a block. During therapy, the client stops making a fist with each block. Weeks later, you notice he is tapping his leg instead.
How do you ensure that the secondary behavior will not emerge in another form later?
From:
Gert Reunes Belgium
What do you think of a cooperation between SLP's and self-help groups. Is this a good thing to do or not.
From:
Walt Manning
Professional help and self-help groups (good ones) are one and the same. The first NSA (then NSP) meeting I attended in 1989 was not quite like that. I was an outsider - as a generally fluent speaker even though I am a PWS and especially as an SLP. I know other PWS who, now being fluent, have experienced some of the same feelings. People at self-help meeting are there to help and if you don't appear to have the problem it's not so easy to help. That has changed and there are a lot of SLPs who attend groups like the NSA. I tell my students and those attending workshops that if you really want to understand the stuttering experience attend at least one of the national meetings of the NSA (or similar groups). If you've even been involved in a self help group you will eventually (after a few meetings) see the positive and often essential help they can provide. Like selecting clinicians, it helps to choose (the group) wisely. I think formal treatment and self-help attendance can go hand0in-hand. It is also very helpful to attend a self-help group following formal treatment to keep the stuttering from getting hot and to provide help to others.
From:
Steve Hood
Hello Gert--
You asked a good question and Walt Manning has provided a terrific reply. I would like to agree with Walt and take things a step further. (I do not know enough about what is happening internationally to be inclusive, so my will need to be related to things closer to home here in the USA.)
Yes !!! In the early days there were some "us-against-them" attitudes. This was between the SLP's and the self-help groups, as well as mild and general fluent PWS not being accepted by those whose stuttering remained severe.
At the last three NSA Conventions, there have been workshops devoted to "covert stuttering:" e.g., those who have interiorized their stuttering through avoidance. Many coverts do not feel accepted or understood by overts.
About 20 years ago, the Vice President of ASHA for Clinical Affairs was Hugh Morris. Hugh was both an SLP and a PWS. He asked me to work up a task force to explore ways to do more to unify the SLP and PWS communities. I was distressed by how much distrust and dislike was held by PWS against the SLP community.
Gradually over the years, much improvement has occurred, and as Walt wrote, many more SLP's not attend meetings of groups like NSA (and Friends) than in the past. There were a number of international PWS at the Anaheim convention in 2002, they from what they reported, this is also true with BSA, CAPS, and support groups on the European continent.
Although I am distressed that the American Speech-Language-Hearing Association has not taken a more proactive stance in terms of supporting stronger educational and clinical requirements for persons who want to work with PWS, at least we now have the Specialty Interest Division, and we are increasing the number of Board Recognized Fluency Specialists. This is a step in the right direction. Last year, the ASHA Distinguished Service Award recognized the contributions of the National Stuttering Association.
I would like to see the day when unified efforts are made collectively, rather than individually, between ASHA, The National Stuttering Association and the Stuttering Foundation of America in this country, and possibly with overlap including the International Stuttering Association as well.
From:
Bernie Weiner
Steve, you are one of the SLPs that really "gets it." And there are a host of others that come to NSA conventions and assist people who stutter, like me, at support group meetings. Self help and professional help go hand and hand. You guys give us the "tools" to work with and it's up to us to follow through.
From:
Ed Feuer
There are problems. The best type of stuttering self-help group is one whose members have experienced the same kind of therapy, where people are reading off the same page so to speak.
When this is not the case, these groups are more prone to churning. By churning I refer to a situation where people who've never had therapy come out for a look-see. Expecting stuttering therapy and not finding it, they never return. That's why such groups often never get bigger than a core membership.
As for the professionals, the saddest situation occurs when people in private practice come around trolling for customers rather than offering constructive ways to help the group.
From:
Raf.
Buon giorno signori. Voi professori lavorate per aiutare i balbuzienti. Se una persona viene a casa vostra, vi dice che conosce l'origine, i meccanismi, ecc. della balbuzie, voi cosa fate ? Finora l'unica risposta che ho avuto : silenzio. Perch�? Non � gradito? Non capite? Non credete? Non volete perdere tempo? Scusate,questo sfogo non � indirizzato ai presenti. Perch� sprecare tempo a scrivere un libro, quando sul WEB,tutto il mondo conosce subito. Non conosco l'inglese,il testo � semplice, adatto per la traduzione in ALTAVISTA, spero. Cordiali saluti Raf.
Good day gentlemen. You worked university professors in order to help the stutterers. If a person comes to house yours, she says that she knows the origin, i mechanisms to you, etc of the stutter, you what fairies? Up to now the only answer that I have had: Hush. Why? It is not appreciate? Not understood? You do not believe? You do not want to lose time? Excused, this vent is not addressed to the present ones. Why to waste time to write a book, when on the WEB, all the world knows endured. I do not know English, the text is simple, adapted for the translation in ALTAVISTA, I hope. Cordial Raf salutes.
Re: The end of stuttering - a try at translating what Raf is saying
From:
Judy Kuster
I hope I am getting the meaning of what Raf is saying here. My Italian is limited to cao!
Hello everyone. You work as university professors in order to help people who stutter. If a person comes to you and says that she knows the origin of stuttering, what do you think? Until this time, the only answer I have had is "Be still." I don't understand why. Is it not appreciated? Or is it not understood? Or don't people believe me? Or don't people want to waste their time on my ideas? Excuse me for venting. It is not really addressed to you. It seems to me that it is a waste of time to write a book when all the world can access information on the Internet. I do not know English. I have tried to translate this with the translation service in AltaVista. I hope you can understand what I am trying to say.
From:
Jimmy
I began stuttering at the age of 15. The cause is unknown, no head injuries, no illness... nothing. There is also no family history of stuttering. What are some of the other possible causes of such a late onset of stuttering? I am now 21 and attending speech therapy sessions regularly which have been very helpful and have definetly improved my fluency. Your insight would be very much appreciated.
From:
Ken St. Louis
Dear Jimmy,
Thanks for your question. I wish I knew the answer to it. Unfortunately, all I can say is that there are cases of late onset of stuttering that we cannot explain. You mentioned some of the common questions that we might ask. Is there a family history of stuttering? Were there any accidents or injuries coincident with the onset of stuttering? Were there any psychological traumas that occurred prior to or near the onset? Of course, we look for these kinds of explanations, but often there is nothing out of the ordinary that can be associated with beginning to stutter.
I never suggest that cause in unimportant. Nevertheless, even if your stuttering had begun, say, after an illness, all we would have is a correlation of two events. We could not possibly know if one actually caused the other.
Yours in the kind of case that get me thinking of new kinds of research projects. If a substantial number of people like yourself could be located close to a laboratory, I could think of lots of comparisons that I would like to make between your histories, your stuttering, your motor behavior, your brain function, etc. and those of more typical stutterers whose stuttering began in their preschool years.
Thanks for your question. Others may have the illusive answer for you, but I doubt it. I hope this helps a little.
The important thing is that you are in therapy and that you are doing well. Best wishes for continued success.
From:
Jessie
Hi,
I'm 13 years old and have been stuttering since I think around 6. I never thought it was a real problem until just recently. My teacher this year is going to help me find an end to my stuttering because it is destroying my life and making me have a lower self-esteem. We don't exactly know what method to use to stop stuttering or what we can do yet so I'm asking for suggestions and help on this.
From:
Lynne Shields
Jessie,
There are several things that you might do to begin to address your stuttering. First, it is a good thing to understand stuttering better. I'm glad you posted on this website. Reading some of the papers on this conference may help you begin to learn more about stuttering. You might also want to visit the Stuttering Homepage website, and look at some of the information posted there in the "Just for Teens" section.
In addition to learning more about stuttering, I think it is important for you to locate a speech-language pathologist (also known as speech therapist, speech clinician, or speech teacher) who knows how to treat stuttering. If you visit the website of The Stuttering Foundation of America, they have a resource list, where you can research the names of speech therapists who have experience with stuttering in the United States and abroad. You can also contact the National Stuttering Association for information, or FRIENDS: The Association of Young People Who Stutter. There may be a speech therapist at your school who knows alot about stuttering. Getting good help is important.
It would also be a really good thing for you to get to know other people who stutter, both teens and adults. There may be a local chapter of the National Stuttering Association or FRIENDS near where you live. Both of these organizations have phone numbers where you can call to talk to someone who knows about stuttering, and who can help you. There are people who stutter working in all kinds of jobs. It is important to see that you can stutter and be a successful and happy person, and do whatever it is that you want to do in life.
I wish you well, and I also commend you for deciding to do something to help yourself.
From:
Dick Mallard
Hi Jessie! Thanks for your post. Tell me some more about your speech! Why do you think you are having such a problem now? Look forward to hearing back from you.
From:
Dale Williams
Katie:
In general, 4 seems pretty early to do stuttering modification. It sounds like you�re looking for ways to better manage what goes on at home. Can you brainstorm with the parents re. increased situations where they can model & elicit the type of speech you're after? You could also consider the Lidcombe treatment as a way of adding structure to the home program.
Fluency/phonology is, as you note, a tricky combo. My greatest worry in these situations is that direct artic. therapy often increases disfluency. I always meet with the parents & lay the cards on the table. I can work on the stuttering & handle the artic indirectly (which I recommend) or work more directly (and effectively) on artic, which seems to be making the stuttering worse (and is inconsistent with easy speech techniques-if that's what you're using with him — in that the SLP could spend half the session teaching relaxed speaking & the other half forcing the kid to focus on articulator placement, manner, etc.). They always choose the former.
The 17 year old is unlike any case I�ve had. I would have thought that with a minor, his parents could be told, particularly since the behaviors are illegal and harmful. I suppose you could ask ASHA first.
From:
katie Dauer
Dr. Williams,
Thanks much for your information. In regard to the teenager, we did call ASHA and their lawyer says we can not tell the parents. I agree with you. His behavior to himself is harmful, it is his parent;s insurance, etc, yet we have to keep it confidential. Very confusing and seems not right to me.
From:
Woody
Katie:
I agree with Dale's about the younger children. As far as the adolescent is concerned, Janet and I have seen a number of adults and adolescents who are actively using and/or drinking compulsively. We always refuse to work with them until they stop using. There is no point anyway. An addict or alcoholic is unable to focus on themselves in a meaningful way until they have stopped focusing on the substance.
This is an area that I wish ASHA would devote more published pages to.
From:
Katie Dauer
I would consider myself experienced with treating stuttering disorders, but I would like a little advice. I am seeing a little girl who stutters and her dad also stutters. She was in a therapy program for 6 months before me and actually got worse.
I have been following her for approximately 4 months and we have been using a fluency enhancing approach where I am teaching her smooth and easy speech and I have also worked with her parents regarding positive interaction techniques, etc. SHe has made significant progress with me during a session and I even take her out of the room and we use smooth and easy speech in those areas. She also does quite well during special time at home with mom and dad. However, she is a very high strung little girl who is very controlling in personality. They have a busy household and mom is soon going to have a baby. I also coordinate services with a SLP at the school. She has become very fluent for weeks at a time, but has many relapses which seem to last too long. I have been considering beginning some stuttering modification by taking turns and making choices about using hard bumpy talking or easy smooth talking and then discussing how it feels in the mouth, etc. I believe it may alleviate a need for her and for her mom to always be fluent. What do you think? Am I way off base. It may also help her to think that she has a choice in the matter.
From:
Nan Ratner
I think that moving to stuttering modification would in fact be a good thing. Sorry it took so long to respond, it has been really hectic here!
From:
Steve Stringham
As a father of eight children and one who has been involved with youth leadership for twenty-five years, I have noticed a tremendous difference between the speech and language development of girls and boys. It seems that the boys are seriously deficit from birth when compared with girls and don't really catch up (if at all) until late teenage years. There is a great deal of public effort and public law to enforce an equal treatment of boys and girls in their education.
I wonder if we don't put to much pressure on boys to equal the girls in their speech and language development.
Is there any studies that the panel can point me to that discuss the research on stuttering differences between boys and girls, or explain why the male to female ratio exists?
From:
Ken St. Louis
Hi Steve,
Wow. Eight children and 25 years of working with kids. I am sure that your observations point to some important differences between girls and boys.
One of the first things that anyone who deals with stuttering notices is that about three times as many males as females stutter. "Why is that?" you ask. As I replied to another good question in this conference, I don't really know and doubt that anyone knows for certain. As you have observed, males clearly are not the stronger sex when it comes to speech and language related skills.
I would rather emphatically assert that the reason why there are more boys who stutter than girls is *not* because we put more speech pressure on them. That used to be a fairly common corollary to the Johnson diagnosogenic theory (i.e., stuttering beginning in the parent's ear rather than the child's mouth). (I recognize that you are not necessarily implying that.) Instead it appears that males are more vulnerable to whatever genetic, physiological, and psychological variables that combine to produce stuttering.
Girls tend to be more likely to recover from stuttering as children than boys as well. This "fact" fits nicely into a finding by Kenneth Kidd and his associates several years ago that females who stutter had more close relatives who stutter (mostly male, of course) than males who stutter. This means that whatever genetic influences there are to promote stuttering, chronic female stutterers seem to have more of them than chronic male stutterers.
From:
Woody Starkweather
Hey Ken:
In addition to all those excellent points you made about the physical reasons why boys may stutter more than girls, there is probably also at least one psychological one: little boys, at a remarkably young age, seem to learn that they are supposed to be strong and not let fear, or other feelings show too much. Of course this is a generality and there are lots of exceptions, but on the whole I think it is true and probably doesn't help the little guys who are trying to deal with stuttering.
From:
Ken St. Louis
Hi Woody,
Yes, teaching little boys to hide their feelings certainly occurs. Honestly, I have not seen it as much as the literature suggests that I should. Maybe I am not recognizing the signs.
I'll try to be more vigilant.
From:
Raf
Il linguaggio del balbuziente � un linguaggio di testa, chiuso. Gli uomini balbettano di pi� rispetto le donne perch� hanno un modo di parlare di testa, cio� pi� simile ai balbuzienti. Le donne usano un linguaggio pi� del corpo, pi� emotivo, pi� ricco, per questo la donna � meno esposta alla balbuzie.
Raf
The language of the stutterer is a language of head, closed. The men stutter more respect the women because they have a way to speak about head, that is more similar to the stutterers. The women more use a language of the body, the more emotional, richer, for this the woman less are exposed to the stutter.
From:
Ken St. Louis
Dear Raf,
There is always so much lost or mixed up with translations. I am not sure I completely understand your two messages. I will try to reply anyway.
In your first message, I understood that you are upset that professors and others do take seriously your theory of the cause of stuttering. Unfortunately, you do not tell us what that theory is. Therefore, I cannot respond to that.
I don�t really know what you are trying to communicate when you say that there is no value in writing a book when information is available on the Internet. Do you have a theory that is on the Internet, and someone has asked you to write a book about it?
In your second message about the sex ratio in stutterers, again, I have problems comprehending exactly what you intend to say. I wonder if this is the theory you refer to in your first message. As I understand it, you are saying that stutterers are more similar in brain organization for language to typical males than typical females, which explains the sex ratio. (Your message, however, is written in the reverse. You seem to be saying that men are similar to stutterers, which is quite different.)
There are data to suggest differences between typical males and females in the way that they perceive and use language. (I am not an expert in that research!) It may also be the case that those differences can partly explain the sex ratio difference in stuttering. But you need to ask yourself the following questions, it seems to me: (1) Why don�t all males stutter? (2) Why do some females stutter? (3) Do all males have the �head� oriented approach to language? (4) Do all females have the �body, emotional, rich� oriented approach to language? (5) Can you reliably measure the type of language orientation a person might have not knowing the person�s sex?
If you are identifying a valid explanation for the sex ratio, it is still only describes a correlation (two things vary together and may well be caused by something else) rather than a cause (one thing causes the other).
Best wishes and thanks for the contribution in Italian.
Cara Raf, Sempre cos� tanto � perso o mescolato in su con le traduzioni. Non sono sicuro io completamente capisco i vostri due messaggi. Prover� a rispondere comunque. Nel vostro primo messaggio, ho capito che siete rovesciati che i professori ed altri prendono seriamente alla vostra teoria della causa di balbuzie. Purtroppo, ci non dite che cosa quella teoria �. Di conseguenza, non posso rispondere a quello. Il don?t I realmente conosce che cosa state provando a comunicare quando dite che non ci � valore nella scrittura del libro quando le informazioni sono disponibili sul Internet. Avete una teoria che � sul Internet e qualcuno vi ha chiesto di scrivergli un libro? Nel vostro secondo messaggio circa il rapporto del sesso in stutterers, ancora, ho problemi che comprendo esattamente che cosa intendete dire. Mi domando se questa � la teoria che vi riferite a nel vostro primo messaggio. Come lo capisco, state dicendo che gli stutterers sono pi� simili nell'organizzazione del cervello per la lingua ai maschi tipici che le femmine tipiche, che spiega il rapporto del sesso. (il vostro messaggio, tuttavia, � scritto nell'inverso. Sembrate dire che gli uomini sono simili agli stutterers, che sono abbastanza differenti.) Ci sono dati per suggerire le differenze fra i maschi e le femmine tipici nel senso che percepiscono ed usano la lingua. (non sono un esperto in quella ricerca!) Pu� anche essere il caso che quelle differenze possono spiegare parzialmente la differenza di rapporto del sesso nella balbuzie. Ma dovete chiedersi che le seguenti domande, esso sembri a me: (1) perch� don?t tutta la balbuzie dei maschi? (2) perch� alcune femmine balbettano? (3) tutti i maschi hanno il?head? metodo orientato alla lingua? (4) tutte le femmine hanno il?body, impressionabile, ricco? metodo orientato alla lingua? (5) potete misurare attendibilmente il tipo di orientamento che di lingua una persona potrebbe avere non conoscere il sesso dei person?s? Se state identificando una spiegazione valida per il rapporto del sesso, � ancora soltanto descrive una correlazione (due cose variano insieme e possono scaturire sono causate dal qualcos'altro) piuttosto che una causa (una cosa causa l'altra). Non ho idea se questa risposta aiuter�, ma la invier� comunque. Auguri e ringraziamenti per il contributo in italiano. Ken
From:
Jay
I would like to know the panel's opinion regarding the possible link between a phonological deficit and stuttering. Is it reasonable to assume, based on the research thus far, that any phonological deficit in stuttering would be specific to production and not a general deficit extending to both perception and production? Is there any research that provides evidence to the contrary?
From:
Nan Ratner
I will try taking a stab at this one. There is a high degree of "comorbidity" of articulation disorders and stuttering, which, when combined with the obvious problems in fluently progressing from sound to sound, have led some researchers to speculate that stuttering is a disorder of speech encoding. The levels that have been investigated range from accessing the phonological representations of words, to programming them, to executing them, to even, with the Covert Repair Hypothesis (Postma & Kolk), problems in overactive self-monitoring of the correctness of speech output (I have greatly simplified this). To my knowledge, not much has been investigated in the realm of speech perception in stuttering, although I would be curious to have you enlarge on your question to explain why you think this could be the case.
From:
Peter Levine
I am a 23yr old Canadian citizen who has been dealing with stuttering all of my life. I came upon a very unique and I think amazing theory and approach to stuttering that I believe needs at the very least to be looked at by both speech professionals and teachers as well as patients. With greater demand and research into this theory/therapy i believe it could provide a lot of the answers stutters are looking for. The basic ideas and the book/supplement can be found at www.streicherpublications.com....the book is called "The Pebble in The Shoe" by John Streicher. This is a plea to both professionals and sufferers to look closer at this theory. It is truly worthwhile. I can be contacted at petelevine@hotmail.com for anyone with more questions.
From:
Ken St. Louis
Dear Peter,
Call me the skeptic mentioned below, but when I read such things as the following quote from the website you mention, I get worried.
"Streicher's book spells it all out � the research, the findings, the clinical proof, and the impact his discoveries could have on several professions...Streicher always wanted and tried to share his work. We believe from experience that anyone who approaches this new body of information with an open mind and a willingness to accept change will be highly rewarded as we have. We also would love to see open-minded researchers pursue with more rigor the line of thought that Streicher has developed. And we encourage skeptics to replicate any of Streicher's studies."
My cursory look at the website seemed mainly designed to get me to buy the book, not give me the secret of Streicher's work. (Maybe I missed the important link.) I don't dismiss any *new* approach out of hand--wholistic, spiritual, unconventional--but I am always a skeptic, nonetheless. How else can a clinician differentiate credible approaches from those that are "too good to be true." Therefore, I don't think I'll buy the book just now.
Thanks just the same.
From:
Peter
Ken,
I understand your skepticism, there are a lot of promises out there, plus the very non-clinical and open approach can catch one off guard, it did to me too, but if you notice although the website is designed for one to purchase the book, it is at a very moderate cost, furthermore I having been speaking to the co-author directly for many months now as well as meeting her and I am assured of both her positive and uneconomically based intentions, as well as the sincerity and effort of their work. Myself, I have no economic benefit in advocating the theory, but I have great empathy for stutters, myself being one, and wanted to make everyone aware of something that has helped me tremendously and i think has a lot of potential to help others. Especially if it can be looked at more closely by those in positions of authority in the medical community/ speech-language world
From:
Ken St. Louis
Thanks for the reply Peter. An idea.... Why don't you ask the coauthor you are in touch with to describe the secret very succinctly in this exchange?
From:
Jennifer Miller
I am the mother of a three year old who stutters and has extremely complex language. Should I be trying to model simpler phrases and sentences? She has SO much to say and tends to have the most trouble when she can't get out all her thoughts quickly to get her needs met.
From:
Ken St. Louis
Hi Jennifer,
This question is perfect for Woody. I hope he answers it and tells you about the subgroup of young stutterers he has identified that fits your daughter quite closely. Maybe Nan Ratner will weigh in as well with some of the recent, questionable, data about the effectiveness of parents slowing or simplifying their language.
But here is my answer. I have found that if you can slow your rate of speech and increase turn-taking pauses a little without sounding robotic, breathy, stilted, or low pitched, and if you can simplify your language to about the level your daughter can comfortably handle (not baby-talk though), try it. I would suggest one or two times a day only when things are as calm as possible and when you can structure the situation so that there is less need/opportunity for your daughter to tell you all she can. These sessions should have no other distractions and competition (e.g., no other kids present) and might last 15 minutes or so. If possible, they should become part of her daily routine. If you find that you are getting comfortable doing this and your daughter is still stuttering, try inserting a few easy repetitions into your speech as you model the slow, easy, simple speech, e.g., "Ba-Ba-Barney is funny in that picture."
Whether it is the rate change, linguistic complexity change, or overall ambiance change that is responsible, I have found that a routine of these kinds of interactions tend to reduce a child's propensity to "get it all out," "tell you all she knows," and simply relax a bit more that usual. Modeling an easier form of stuttering often helps the child to speak in an easier way.
My last bit of advice is to seek an evaluation of a qualified speech-language pathologist.
From:
Nan Ratner
Thanks, Ken, for the . The research that we have done here at Maryland does not suggest that you need to model less complex language. The major parental adjustments that tend to reduce the frequency of stutter events somewhat are, as Ken notes, slower conversational pace (rate of speech, increased turn taking latencies, reduction of interrupting behaviors by family members). I agree with everything else that Ken has said, so won't repeat it here, but am happy to pursue additional questions you might have.
From:
Woody
Hi Jennifer:
Sorry for the late reply. I have been meeting my two new grandchildren in Ohio and away from my computer.
In the Temple Clinic we did not find that modeling simpler language was very helpful. We did find, however, that it was helpful to have mothers tone down the language stimulation, which was in some cases, very extreme. It was more the quantity than the quality of the stimulation that was the problem. Just getting the parents to talk less was most helpful. But we tried to have them not cut down on time spent with the child, so it came down to finding more nonverbal, but fun, things to do together. A slower rate is also always helpful, apparently because it gives the child a sense that she has lots of time to talk. In many of these families where language overstimulation seems related to stuttering, there is a huge amount of verbal activity, usually with long sentences that tend naturally to be spoken very quickly. So, less talking and slower talking seems to take care of the problem.
From:
Darrell Dodge, MA, CCC-SLP
I hope these very experienced SLP's don't mind me butting in here . . . but it's good to remember that children also listen to their parents conversing *with each other*, not just with the child. Some of the complex language I hear from stuttering preschool children seems to be imitations of adult conversations at adult rate. Slowing or moderating rate just when talking with the child may not be enough. The child's entire conversational environment may need to be moderated for a while, if the parents can manage it.
From:
Carol Delton
One of the kindergarteners in the school where I serve as a speech and language specialist has some advanced stuttering characteristics, including laryngeal blocks, eye blinks and facial grimaces. I've spoken to his Dad by telephone, and while this boy has not been in therapy previously, his preschool teacher seems to have done a good job of talking to the family about using 'easy speech' with him. This is a first job for me . . . and while I've worked with a number of fluency clients, this child has more secondary characteristics at a younger age than others I've worked with. He is also very bright, with fabulous oral language, and a good grounding in pre-K skills -- so the kindergarten environment is not unduly stressful. I would like your opinions on how much increasing or raising his awareness of his speech should be a concern in working with him.
From:
Lynne Shields
Hi, Carol,
I'm not sure if you are asking whether seeing this child for therapy will unduly increase his awareness, or, if it is advisable for you to directly talk about his stuttering as a part of therapy. Perhaps you can clarify that for me.
Given the child's reactions to his speech, as indicated by struggle behaviors, I'd say that he is certainly aware, at some level, that he is having trouble talking. It might be helpful for you to interview him to find out exactly what he thinks about his speech. I generally start off asking young children to tell me what things they are good at doing, then what things are hard for them to do. If speech doesn't come up, I work my way around to asking them how good they are at talking. If this little guy is quite aware and can talk about it, it would probably be a good idea to be very open about his stuttering, using the vocabulary that he uses to describe his speech (bumpy, rough, stuck speech, etc.).
In my experience, young children who are aware of their stuttering are often interested to learn about stuttering and ways they can manage their speech. It helps them develop a good attitude about their speech and keeps stuttering from becoming a taboo topic.
I'll be interested to hear more about your specific concerns.
From:
Woody
It has always seemed to me that awareness of stuttering in young children is not really the issue. How does the clinician know that the child is aware or not? What is important is whether the child is reacting to the stuttering, and in the case you mention, the reactivity is evident in the struggle. So, I would not hesitate to work with the child, but I would do so at a level that is appropriate to his or her understanding of speech -- usually pretty low in little kids, even in some adults! Helping the child learn how to talk about his stuttering, and helping the parents learn how to talk about it with him, are also very helpful.
From:
esdream
I am having trouble keeping speech services for my son with the school district. There is a history of stuttering in the family, so we know its not a growth stage. My husband and daughter are both also stutterers as well as some of my husbands cousins.
My son has improved allot over the years with therapy, but now the school is trying to stop and I don't feel he is ready. The speech therapist at school recently "evaluated" him. I don't feel it was an adequate evaluation. She asked my son what he did over the summer, in the middle of a math assignment the class was doing together and that was it. She called me to tell me he should continue services on his own but he does not qualify for their program. I don't understand how she can say he does not qualify in one breath and then say he needs to continue services privately. At least 2 or 3 1/2 hour sessions weekly.
As well as the stuttering, there is something else going on with his behavior that I do not understand but I feel may be related. He has a great deal of difficulty making eye-contact when someone is speaking to him. But when he is speaking to you, he has to be very close - like nose to nose. He cannot control himself from touching everything he sees. He understands right from wrong and when I ask him why did you touch that if you know you weren't supposed to, he looks so confused and says I don't know Mommy. I know that he just could not stop himself from touching whatever it was. He has been like this for as long as I can remember. Its not a new behavior. It has always been pushed to the side because the focus was the speech.
Upon meeting his new teacher for the year, she said to me, I just want to let you know I'm going to have the speech therapist evalute your son. I asked her if she knew he was a stutterer and she did not, but she picked up on it right away. Now she sent home a note about how my son is touching the other students hair and invading their personal space. I have been going over this with him for years. He knows that arms length is my space and you don't touch anybody unless they say its OK. He doesn't mean any harm. I know he just likes to touch things that are soft and he can't stop himself. I know that when he is speaking to you, he gets very close to you and touches your arm or face. But I can't seem to make him stop. everyday at the bus stop, I have to remind him, don't touch, back-up. And he shakes his head like he's fighting himself and I know I know.
He is very bright. No problem understanding. He catches on to anything quick as a whip and remembers it forever. He has no problem with his school work. Since I have an older child, I can see how much more he can do than she did at his age and she's an A student.
I think there is something more than the stuttering going on and I would like to know if you have any advise on what it may be and how I can help him.
The ADD or ADHD came up last year, in kindergarten. But he doesn't always have the symptoms and they said well he sleeps through the night etc so they push that to the side. I don't want a "label" on my son, but I'd rather have a label and get him the help than just leave it and hope it goes away. I would really like to help him before the other children start to notice that something is different.
The school speech therapist says I'm over concerned. I told her that I understood her education and her dealings with all different speech disorders regularly. But when I asked her if she ever had to live with a grown man that struggles everyday how would she feel, she had no answer. I watch my husband order chicken for dinner because he has difficulty saying steak or burger. I watch him cringe when the kids want him to read them a story. He hates the telephone. He would pay a bill that is incorrect rather than call to correct it. I don't want to see my son have these struggles. I am going to do all I can to help him.
From:
Nan Ratner
Public law requires that children be served if they show difficulties in areas that impact all areas of participation in school activities, not just, as is usually believed, behaviors that are "educationally handicapping." If your son has affective and cognitive components to his stuttering problem (in addition to the other issues you raise) that impair his ability to benefit fully from the school environment, he should be eligible for services. Counting stutters is not enough to decide this question.
From:
Woody
Difficulty controlling impulses is at least one symptom of ADHD, and, as Nan says, it will probably have a serious impact on his ability to socialize with other children, which is plenty of reason for the school to intervene.
I couldn't help but wonder if the speech therapist felt that she was not quite up to the kind of intervention he might need and was hinting to you that you should get a private therapist, which the school is required to pay for if they cannot provide it from the staff. It is sometimes hard for a school SLP to come right out and say this to a parent because (a) it makes them look inadequate, and (b) it costs the school money. I have seen Special Ed. Directors get very upset when an SLP makes this kind of a recommendation.
From:
esdream4
Thank you so very much for your replies. I will follow your advise.
I did meet with my sons teacher earlier today and she sees that he is having difficulty. She said she is going to evaluate and help my son get the services he needs. She said it may take a while because quite often, this early in the school year, she is often told that its too soon for her to tell or its developmental. But finally - someone who sees what I see!! And wants to help. She said she will go to committee if necessary and over some heads if we have to.
My son is a good boy with a heart of gold. He just needs a little help in a few areas. I was so relieved when his teacher and I were on the same page - and I think she was too. Some parents try to deny there's anything wrong. I told her - no mother wants a "label" on their child - but if he needs help - I'll do whatever it takes.
She also agrees with me that he still has a stutter. The problem is that, just like his father, he is a master at word substitution. He has an extended vocabulary and appears not to stutter with fillers and replacement words - so it may take a while for you to catch him if your not trained to look for it. After all these years with my husband and going through therapies with both kids, I know when they're substituting! But most teachers don't - until I point it out to them.
From:
jian yu
In Howard Hodges' paper, "YOU'RE THE NARRATOR, SERGEANT" - an unusual path toward recovery, I found his situation same with my husbands: they do not stutter in pubic speech, while they have problem in everyday conversation. Is it common in people who stutters? Why?
From:
Woody
I don't think it is common for a stutterer to be more fluent when speaking in public, but I have seen a number of stutterers for whom this was true. One said that he felt in control when he was speaking to a group; he had power in that situation and could control the topic. Another talked about feeling that he was playing the "teacher role", which felt quite different to him. He probably talked differently when playing that role.
From:
Jian Yu
Thank you, Woody. So, can we ask these persons who stutter to imagine/suppose he/she is talking to a group of people and help them to reduce the severity of stuttering?
From:
Woody
There are a number of reasons why this wouldn't work very well. It is a kind of mental game, which would get tiresome quickly. It is a kind of self-dishonesty. Any effect would quickly wear off, I am pretty sure. Besides, we should teach people how to be comfortable with their speech and to communicate easily and well in whatever situation they find themselves in, without having to pretend that something is true that is not.
From:
Jian Yu
Yes, your are right. I absolutely agree with you. The most important thing is to make the person who stutters feel comfortable whenever he is giving speech in whatever situation. This is easy to understand, literally. But sometimes I forget it and may focus on helping him to 'fix' the problem. I need more time to adapt to the new way of thinking, which is also the appropriate one.
From:
[no name]
My daughter, 5 years, has now been evaluated by 3 different SLPs (initial eval, person wasn't qualified, one moved, and her current one) who all say she stutters (severely at one point). However her Grandmother, friends etc all say "I don't ever hear it" and other such things. Is this common? I mean, she doesn't usually do initial sound prolongations, so is this why people say this?
From:
John Tetnowski
Dear parent,
I won't say that this is common, but I have certainly heard it before. My first reaction is to retell a story that happened to me a few years ago. A friend (from a basketball team) told me one day that his daughter stammers and gets stuck on words. I said, "you mean she stutters". He said, "No she doesn't stutter, she just gets stuck on some of her words". I demonstrated for him, and he said, "Yeah, that's what she does, and that's not stuttering". Well, education takes place in some strange places, and this education took place in a gymnasium. His daughter certainly was stuttering, but not in the m-m-m-mode that he thought. Could this be part of the issue with your daughter?
Now, for the most likely answer. She may not stutter with those that she feels comfortable with and she is familiar with. One thing about stuttering that most of us know is that it is "consistently inconsistent". It occurs in some settings and situations and not others (inconsistently, by the way!).
I recommend that you ask your speech pathologist to record a session with her when she is stuttering. Then sit down and review the tape together.
From:
Gert Reunes Belgium
What do you think of this situation: a teacher in a class of SLP's who doesn't want to make publicity for the Belgian self-help groups in a class of 250 slp's students... Can this be the way to help stutterers? Or what is the reason that teachers are afraid of self-help groups???
From:
Judy Kuster
Gert,
There was a time here in the US where the feelings between the self-help movement and the professionals was, what shall I say, "tense." A lot of that came from our not communicating with each other and because of our expectations of each other. Some slps felt frustrated because they discovered they were not able to "cure" stuttering and some people who stutter seemed to have a lot of anger that SLPs didn't have all the answers. In the past 10-15 years, a lot of that attitude has dissipated and we understand each other better BECAUSE we are communicating with each other. This conference is a small example of that. Personally I credit a lot of the change to the community of people who stutter, who although they are frustrated, and some are even angry that slps can't "fix" everything, have welcomed professionals to join them in their support organizations. Maybe a first step would be to invite the professor to your support group meetings and to any national conferences you have. Enlist her support with her knowledge, too. Try not to create an adversarial atmosphere that pushes into a defensive mode -- trying to defend her field, her training, her ideas because of strong ideas people in the self-help organizations have as well.
From:
a alvarez
with my stuttering I lost most of a normal life as a child and a young. Now I am an adult I feel very uncomfortable because time never returns and I lost many things to do in work, academic, love, family etc. Now my stuttering has diminished too much compared with my previous years, but I am in a closed way because of time
From:
Judy Kuster
You say that your stuttering has improved over the years but that you are really sad about what you feel are the missed opportunities you had because of stuttering. Those feelings are important and a big part of what stuttering is all about. It is not just the outward speech symptoms. Others have talked about the feelings of missed opportunities, too. If you have a chance, read an excellent article from a previous conference. There are people that can help you with those feelings. Support groups, counselors, speech therapists, rehabilitation counselors, medical doctors and others.
From:
Woody
This is one of the areas that Janet and I are most interested in. It is quite a common sequel to stuttering. We call it the "lost childhood." It is most natural to feel sad about what has been lost because of stuttering. The best thing to do is, as Judy said, find a therapist who can help you grieve over this loss. It is possible to get beyond this grief and move forward, but it will be much better and easier if you do not try to do it by yourself.
From:
Miodrag H.
To all,
What are the latest scientific findings about the causes of the stuttering? As a PWS, I know that stuttering is a complex problem that requires the multidimensional therapy approach and that the key for successful overcoming of stuttering (or becoming the good communicator) is the long-term personal change that requires great effort and persistence, but is there EVER going to be some "pill" that would neutralize stuttering or the physical causes of stuttering? Thank you......
From:
Woody
I don't think there are any recent findings that bear conclusively on the initial causes of stuttering. The brain imaging studies have not controlled adequately for the effects that stuttering has on brain function.
What we do know, however, is that for most stutterers the reactions, behaviors, feelings, and beliefs that develop after stuttering has already begun constituting most of the disorder. The initial cause is almost irrelevant. And we do know how to help stutterers get past all those reactions, behaviors, thoughts, and feelings. Usually, when stutterers get beyond the reactive part of stuttering, they find that there is little, and often nothing, left to deal with.
Woody
From:
Peter Levine
If you're interested about the cause of stuttering i suggest you take a look at the post i posted above entitled "under-recognized stuttering therapy"
From:
Raf
Ciao a tutti
Scusate e scordate il mio primo messaggio, mi sentivo frustrato a causa di esperienze passate. Anche per me � difficile capire con le traduzioni. Ringrazio per la vostra attenzione e disponibilit�, siete persone gentili. Circa l' argomento male to female ratio � un dato di fatto, una questione secondaria, possiamo parlarne in un secondo tempo, mia e-mail: boblatte@yahoo.it Descrivo ora brevemente i meccanismi della balbuzie secondo l' interpretazione di Pagnuti Raffaele. Dividiamo il complesso balbuzie in due parti : la parte sotto lo scudo di difesa , che possiamo chiamare: il nocciolo, o in maniera pi� colorita la pentola a pressione; la parte sopra lo scudo, cio� i meccanismi della balbuzie ( l' iceberg secondo l' amico Russ ). Posizioniamo il nostro punto d' osservazione non dalla parte della balbuzie, ma sotto l' iceberg, subito dopo lo scudo. Formato il nocciolo, creato lo scudo, la persona sente dentro un vuoto, un deficit, una mancanza importante. La vita continua, questa persona contro la sua volont� si sente spinta, coinvolta nella ruota della vita. La mente interviene, cerca di compensare a suo modo il vuoto. Il " non posso " diventa un " devo ". La mente crea immagini, fantasie di potenza, di vittoria, di riuscita. Devo fare cos� per chiudere il vuoto, se foss... , non voglio ma devo... ecc. Cos� sar� per sempre finch� esiste il deficit. Purtroppo queste fantasie di vittoria hanno come sfondo la sacra figura della madre genitrice della vita e come risultato, ad ogni tentativo di parlare bene, ha forti sensi di colpa. La sua vittoria sorge sopra un furto, la sconfitta, la ferita, la morte della madre. Il senso di colpa censura, la parola deve essere soffocata , impedita, la balbuzie trova spazio diventa una necessit�. Diventa il sintomo del conflitto interno: deficit � riuscire � colpa � censura � blocco � balbuzie - deficit � e cos� vi... � un cerchio che si alimenta da solo. L' iceberg diventa un polimero per le reazioni a catena, non si sa pi� dove � la testa e dove la coda. Da qualsiasi punto si interviene le reazioni vanno avanti. Maggiore � lo sforzo, maggiore � la balbuzie perch� maggiore diventa il conflitto. Questo � ci� che attanaglia , morde lo stomaco del balbuziente. Balbettato o non balbettato, come si sente bene, libero dopo lo forzo di parlare. Questo � il parlare di testa, il lavoro � tutto della mente che cerca di compensare, ma complica solamente la situazione. Per questo dopo aver grattato la superficie dell� iceberg la balbuzie torna; si riesce, si cade. Per questo distraendo la mente, usando il corpo, pubblicizzando la propria balbuzie si sta meglio dentro e si parla meglio. Per questo curando la dizione ( la superficie ) i risultati sono scarsi. Purtroppo sono solo palliativi, finch� la pentola a pressione si trova dentro. A proposito suggerisco un palliativo interessante per rompere gli schemi della mente: affidare le proprie decisioni al caso. � stato scritto un libro oltre 30 anni fa. DADO MEN di RHINEAT( forse RHINEART ) Quando si vuole, si affidano le proprie decisioni quotidiane al dado. Si scrivono varie alternative su un foglio, le solite pi� alcune diverse, ad ognuna si affianca un numero, si tira il dado, si esegue quello che � uscito; il dado ha deciso, il responsabile � il dado. Si ottengono i seguenti vantaggi: meno conflitti, pi� divertimento, pi� coraggio, pi� adrenalina, meno balbuzie, esperienze nuove, maggiore consapevolezza, meno disperazione, pi� pubblicit�, meno sensi di colpa, la mente libera, ecc. Gradirei la Vostra opinione circa i meccanismi della balbuzie ? BYE Raf.
Hello to all Excused and scordate my first message, I felt frustrated because of experiences passages. Also for me it is difficult to understand with the translations. Ringrazio for your attention and availability, you are kind persons. Approximately l' argument badly end female ratio is a fact data, a secondary issue, can speak of in according to time, my email: boblatte@yahoo.it Descrivo hour shortly the mechanisms of the second stutter l' interpretation of Pagnuti Raffaele. We divide the complex stutter in two parts: the part under the defense shield, that we can call: the kernel, or in way more coloured the pot to pressure; the part over the shield, that is the mechanisms of the stutter (l' iceberg second l' Russ friend). Posizioniamo our point d' observation does not give the part of the stutter, but under l' iceberg, endured after the shield. Formed the kernel, created the shield, the person feels within an empty one, a deficit, one important lack. The continuous life, this person against its will is felt pushed, been involved in the wheel of the life. The mind takes part, tries to compensate to its way the empty one. I "cannot" it becomes on "I must". The mind creates images, fantasies of power, victoria, resolution. I must make therefore in order to close the empty one, if pits. I do not want but I must. etc. Therefore it will be in order always finch� exists the deficit. Unfortunately these fantasies of Victoria have like background the sacred figure of the genitrice mother of the life and like result, to every attempt to speak well, it has strong senses of guilt. Its Victoria rises over a theft, the defeat, the wound, the dead women of the mother. The guilt sense censorship, the word must be suffocated, be prevented, the stutter finds space becomes one necessity. It becomes the symptom of the inner conflict: deficit-to succeed-guilt- censorship- block- stutter - deficit- and therefore via. It is a circle that is fed alone. L' iceberg it becomes a polymer for the chain reactions, more is not known where it is the head and where the tail. From whichever point one takes part the reactions go ahead. Greater it is the effort, greater is the stutter because greater it becomes the conflict. This is that that it grips, bites the stomach of the stutterer. Stuttered or stuttered, as it is felt well, free after I do not force it to speak. This is to speak about head, the job is all of the mind that tries to compensate, but complicates only the situation. For this after to have grattato the surface dell' iceberg the stutter returns; it is succeeded, is fallen. For this distracting to the mind, using the body, pubblicizzando the own stutter is better within and it is spoken better. For this curing the dizione (the surface) turns out to you is insufficient. Unfortunately they are solos palliati to you, finch� the pot to pressure is found within. On purpose I suggest an interesting palliative in order to break off the outlines of the mind: to entrust the own decisions to the case. It has been written a book beyond 30 years ago. Perhaps DICE MEN of RHINEAT(RHINEART) When it wants, the own daily decisions to the dice are entrusted. Several alternatives on a sheet, the usuals are written more some various ones, to ognuna place side by side a number, pull the dice, are executed what it is exited; the dice has decided, the responsible is the dice. The following advantages are obtained: little conflicts, the more divertimento, the more courage, the more new adrenalin, little stutter, experiences, greater knowledge, the less desperation, the more publicity, little senses than guilt, the free mind, etc. I would appreciate Your opinion approximately the mechanisms of the stutter? BYE Raf.
Attempt to translate: The mechanisms of the stutter
From:
Judy Kuster
For Raf - It is too difficult to try to figure out such long messages. I am sorry. If you write short messages I will attempt to put them into English, but cannot understand these long messages.
Thank you. Judy Kuster
For the rest of you: It is really a challenge to try to translate these long messages from Raf, especially since she uses a lot of figurative language (metaphors) in her own language. It is a good lesson for all of us when we try to communicate with people who aren't familiar with our own language. Figurative writing (e.g. metaphors and idioms) are good tools when people are familiar with the language. They sometimes increase confusion across languages. Again, what is below is what I THINK she is saying at the beginning and end of her long message below. I cannot figure out a lot of what she is trying to say in the middle of her message. If anyone knows Italian or can figure it out, feel free to provide a translation.
Hello everyone,
Excuse my first message. I was frustrated because of previous experiences. It's also difficult for me to understand the translations. I appreciate your attention and availability. You are kind people. I presented my question poorly. The male to female data is factual and not one that can be debated. What I was trying to say is a bit different than my question was interpreted. My email address is boblatte@yahoo.it. I will describe below the interpretation of stuttering from Pagnuti Raffaele. Complex stuttering is divided into two parts: the part that is hidden under our "defense shield" is what is the kernel or core of stuttering. I've described that hidden part colorfully as a pressure cooker (or boiling pot). The outward part (the part that is not hidden under the shield) is what you can observe. The analogy is like what Russ Hicks describes in his Iceberg analogy).
[Judy here - I'm sorry but I can't understand this next long section very well and this is only a very tentative guess at a translation for some of this section].
This analogy does not explain the stutter, but what is under the iceberg or covered by the shield. It forms the key and has created the shield. The stutterer feels empty, lacking. His whole life, the stutterer feels pushed against his will. The mind tries to compensate, to deal with the empty feelings. I "cannot" changes to "I must." The mind creates images, dreams of power, victory, resolution. ???? Unfortunately the dream of victory has an image in the background ??? every attempt at speaking well creates a lot of guilt ??? it is not known where it begins and where it ends??? The greater the effort, the greater the stutter??? To fix only the surface behaviors of stuttering is insufficient. Unfortunately in the case of single approaches to therapy, the boiling pot (what is under the surface) is still inside. I suggest an interesting approach ??? It was written in a book 30 years ago. ????
There are several advantages: fewer conflicts, more ??, greater courage, additional adrenalin, less stuttering experiences, greater knowledge, less desperation, more publicity, less sense of guilt, a freer mind, etc. I would appreciate your opinion on the mechanisms of stuttering.
Bye,
Raf
From:
a. alvarez
hi all, Can you say me where can I obtain books about recent new studies on brain morphology in people who stutter. I copy this from the reply you give to another person in this conference thank you
From:
Nan Ratner
I know of only two studies of brain morphology, one by Foundas et al. and the other by Sommer et al. I am away from my desk and don't have the citations here, but you should be able to get the article titles and more information on them from PubMed free on the web. Nan
From:
Gunars Neiders
Yesterday I received my copy of Robert Logan's The Three Dimensions of Stuttering: Neurology, Behavior, and Emotion. This is the second edition published in 1999 in London by Whurr publishers.
The blurb in the back reads: Beginning with a history of the neuro-physiologic bases of both emotina and stuttering, this revised and updated text presents a review of historical and current knowledge concerning those areas and structures of the central nervous system contributing to internal emotional responses, external manifestations of those responses, and the interconnections between emotional centres , learning and the initiation and fine motor control of speech. The sub-cortical limbic system is discussed as the origination point of cortical, sub-cortical, cerebellar and brainstem areas identified in recent research as inappropriately activated during stuttered speech. The implications of these data for the diagnosis and treatment of stuttering are examined in the concluding chapter of the book.
Just thumbing through the book I saw that Damasio, LeDoux, as well as Ingham's studies are included. Much of what I am learning in neuropsychology is reflected here.
From:
Raf
Ciao a tutti
La ruota della balbuzie gira solo quando la persona che balbetta deve parlare. Terminato di parlare il balbuziente prova una sensazione di rilassamento, il conflitto cessa, la ruota � ferma.
> deficit > > > balbuzie > > compensazione < ( potenza ) < > < > < > blocco Madre < > < > censura < < < < colpa
Non � cos� lineare, ci sono altri fattori, certe posizioni possono variare, tuttavia l� esenziale � descritto, il concetto � chiaro, e spiega molti lati oscuri della balbuzie.
Per esempio una bella domanda : perch� il balbuziente non balbetta quando � solo? Risposta : perch� quando � solo o quando canta, non si sente spinto a parlare, non sente il deficit, non compensa con la testa, non c� � la figura della madre, non sente la colpa, non censura, non balbetta. � tranquillo.
Cordiali saluti Raf
Hello to all The wheel of the stutter only turns when the person who stutters must speak. Finished speaking the stutterer it tries a relaxation feeling, the conflict stops, the wheel is firm.
deficit > > > > stutter compensation < (power) < > < > block Mother < > < > censorship < < < guilt
It is not therefore to delineate, are other factors, sure positions can vary, however l� esenziale is described, the concept is clear, and explains many dark sides of the stutter.
As an example one beautiful question: why the stutterer does not stutter when it is alone? Answer: why when it is alone or when it sings, it is not felt pushed to speak, it does not feel the deficit, it does not compensate with the head, not c� it is the figure of the mother, it does not feel the guilt, not censorship, does not stutter. It is calm.
Cordial Raf salutes
Attempt to translate: The wheel of the stutter
From:
Judy Kuster
Again, I tried to get the meaning of what Raf is saying below. I do not know Italian and am not sure I am getting her meaning. I can attempt these shorter statements, but the long posts take far too much time right now. And again, she talks in figurative language that is hard to cross languages. But I think this is what she is saying:
Hello everyone,
The wheel of stuttering only turns when the person who stutters has to talk. After finishing talking, the stutterer relaxes, the conflict stops, and the wheel no longer turns.
The deficit leads to stuttering which decreases confidence causes blocks which causes the stutterer to stop talking with decreases the guilt.
There are probably other factors and ideas, but I believe the essense is what I described. The concept is clear and it explains the many dark sides of stuttering.
An example: why doesn't the stutterer stutter when he is alone? The answer is that when he is alone or when he sings, he doesn't feel forced into speaking, doesn't feel the deficiti, doesn't try to compensate. He doesn't feel guilt or censorship and he does not stutter. He is calm or relaxed.
Cordially,
Raf
From:
Tara McKinney
As other's views of stuttering often effects how soon parent's seek help, and how a person who stutters looks upon therapy and their stuttering, what do you think is the most common and influential misconception the public holds about stuttering?
From:
John Tetnowski
Tara,
In my clinical world, I think the biggest misconception by the public is that we (the so called experts) know exactly what causes stuttering. They think there is one cause, they think we know exactly what it is, and they want to hear it from us.
From:
Lynne Shields
Tara,
Another comment that I hear many times is that if the person who stutters would just relax and slow down, they would stop stuttering. This and other similar suggest to me that many people believe that stuttering is a simple problem that is easily remedied.
From:
Nicholas Pappano
As an SLP working in a special services school district in New Jersey I have a question about a six year old male student. This child is classified multiple disabled. He demonstrates phonological, word finding, and memory issues. His fluency has been addressed since the 2002-2003 school year. Previously, he was in a program for preschool handicapped. During meetings with the family it was stated that they tend to stop him and ask him to repeat words correctly during his verbal exchanges at home. The family has ceased doing this as requested by the team. They were told to just repeat what he said in a very non-threatening way. This year there has been a great improvement involving his fluency, which could be characterized as mostly blocks. Therapy has been on a more indirect model. The child continues to make nice gains involving his fluency and phonological skills. When is it the best time period to let him know that what he does when he speaks has a name ? And since the indirect therapy continues to work should it continue as long as there is improvement ? It is difficult to ascertain whether the "stuttering" is due in a major part to the phonological and severe word finding issues. These tow issues could exascerbate the fluidity of his verbal attempts.
From:
Lynne Shields
Dear Nicholas,
You asked several questions about your six-year-old client. Regarding when it is appropriate to give his stuttering a name, I'd say that it isn't really necessary to do this unless he asks about it or shows awareness by referring to his fluency in some way himself. I rarely label it with preschool children, and with kindergarten and first grade children, I talk about their speech using the terms they use. If they seem unaware, then I don't feel the need to label their stuttering at all. Concerning your second questions about therapy approach, you report thaT this child is doing well with an indirect method of treatment. I would not suggest making any changes at this point, if that is the case. You also pointed out that this child has phonological issues as well as fluency ones. As long as you are not seeing an increase in stuttering when speech sounds are addressed, I would see no need for concern. It is a good idea to be aware that at tiems, focusing directly on speech sounds may lead to an increase in stuttering, so that you can modify your treatment if this occurs.
Best wishes as you continue to work with this child.
From:
Javier Sangorrin
As speech therapist, I found especialy difficult for these stutterers with comorbid O.C.D. to get significant improvement in fluency. I would appreciate your opinions, suggestions or references on this topic.
From:
Judy Kuster
For a child diagnosed with OCD, it seems to me that it is important that a medical doctor be part of the team that is following this child. Check with his doctor about the kind of medicine he may be taking and talk with the doctor about your concerns with the stuttering. You might also do a search on the search engine scirus.com and in peer-reviewed literature from Medline http://www.ncbi.nlm.nih.gov/PubMed/
From:
Gunars Neiders
Dear Professors,
In writing my term paper on stuttering I was required to redefine stuttering in my own terms without using the accepted usage in the field of stuttering therapy so as to avoid inadvertently taking on any prejudices and assumptions with me from the diverse therapies such as Fluency Shaping, Stuttering Modification, Wendell Johnson's General Semantics based approach, Martin Schwartz's "Stuttering Solved" approach, Stanley Goldberg's Behavior Cognitive Stuttering Therapy, etc.
Starting with the most basic assumption of natural speaker versus stuttering speaker, I categorized the natural way of speaking, cognitive processing, emoting, hearing, having proprioceptive and tactile feeling, seeing, and behaving versus disrupted speaking, cognitive processing, emoting, hearing, having proprioceptive and tactile feeling, seeing, and behaving.
Defining the differences using only the criteria what a natural (fluent) speaker does as compared to a person who has a history of being self-labeled or other labeled as a stutterer, it soon became obvious that even after successful stuttering therapy there are many disruptions that remain although these provide for a better communication, are often less offensive to the listener, and less aggravating to the speaker.
For example, when the client has successfully completed his or her therapy instead of blocking or having involuntary repetitions, he or she may well use easy onsets or pullouts. Regardless of whether the easy onsets or pullouts were in response to the real or imagined footsteps of an on-coming block or whether they were introduced prophylactically, they ARE disruptions to the natural speech and prosody and should be counted as instances of disfluency. I further posit that it does not matter whether these easy onsets or pullouts are voluntary (the result of controlled speech) or involuntary (the result of the brain having learned to perform this task automatically) they are nevertheless instances of disruption or disfluency.
The naive or partisan reader might well ask, "What is the purpose of pursuing this type of definition of disfluency. Surely, the listener would rather hear an easy onset or a pullout instead of the original highly disruptive, struggled and forced block! And how about the speaker, he certainly would rather have an easy onset or a pullout instead of the original highly disruptive, struggled and forced block!" If those were the only two choices I would tend to agree with this argument. However, we only need to look back a half a century and rediscover Wendell Johnson's "Iowa bounce", or as it is called in modern times "voluntary pseudo-repetition," to see that we have at least a third choice. Are there any advantages to this third choice? The answer is a resounding YES! A re-repetition, just like laughter ("ha-ha") is a natural release of tension which is the building block of stuttering. I also posit that our nervous system (see Logan, R. (1999) The Three Dimensions of Stuttering: Neurology, Behaviour, and Emotion (2nd ed.) London: Whurr Publishers) may recognize the "Iowa bounce" as the erstwhile instance of stuttering. If that is so, use of this technique may truly rewire the brain. Logan on page 94 also states that, rational emotive behavior therapy visualization and psychodramas can be generated to prepare the client for rational productive pre-and post-reactions. "Failure" can be discussed as well as success. We want to change both behaviour and emotion in order to effect a neurological change. Both emotion and behaviour affect beliefs and it is the belief system of the client that is contributing so heavily to reinforcement of the inappropriate neurological component that forms the basis or stuttering.
So where does it leave us with respect to easy onsets, pullouts, and Iowa bounces? If we are going to count speech disruptions (i.e. stuttering frequencies) All of the above have to be counted. What is the advantage of therapy then? At first the minimization of the severity of struggle, the length of disruption, and the disturbance to the natural prosody of speech can be judged and valued. Eventually, the frequency may find a natural occurrence rate if Eugene Cooper is right and some people are truly chronic stutterers. If Logan and I am right then the frequency may also be drastically reduced, though not eliminated.
My questions to you, professors are: 1) Disrupted Speech. Should not the outcome be based on the frequency, severity, and unnaturalness of disrupted speech: including blocks (with or without sounds); involuntary and voluntary repetitions (Iowa bounces); elongations in speech; easy onsets; pullouts; pre-formed speech/pre-pullouts; talking while taking on the role as an orator or actor; use of low vibrant voice a la James Earl Jones; breathy voice a la Marilyn Monroe; continuous phonation, light articular contacts; sing song voice; elongation of vowels; going floppy (a la Martin Schwartz); passing "invisible, inaudible breath over the vocal folds" (a la Martin Schwartz) etc?
2) Disrupting Actions. Should not the therapy be also judged on the number and severity of avoidance behaviors? Aren't the continued therapeutic assignments also a disruption that has to be taken into account by letting the client judge how obnoxious they are to him or her (of course, after the right counseling is performed)? And are not the avoidance of life's challenges both vocationally and avocationally to be considered?
3) Disrupting Emotions. Should not the disturbing emotions of shame, guilt, anxiety, self-downing, and conditional self-esteem (based on how fluent one is) be taken into consideration when evaluating a therapy?
4) Disrupting audio-input (feedback). Should we not also consider the need for audio feedback, Non-Altered Feedback (NAF), Delayed Audio Feedback (DAF), Frequency Adjusted Feedback (FAF), or just plain noise in the ear, as produced by SpeechEasy device and Edinburgh Masker be considered when evaluating the outcome of stuttering therapy?
5) Quality of life attained. And, finally, should not the quality of life attained be also factored into the treatment outcome? How does the individual stack up in his or her achievements with respect to somebody of an equal Socio-Economic Status? At first glance this may not seem to be in the purview of stuttering therapy but as Yaruss and Manning maintain counseling is an integral part of the therapy of a person who stutters. In conclusion, don't you agree with the special section in Journal of Fluency Disorders on Evidence-based Treatment of Stuttering, as long as all of the dimensions of disruption in life caused by stuttering are addressed?
From:
Lynne Shields
Hi Gunars,
I'm not sure that I can do justice to your entire post in the short amount of time I have at the moment. It seems that, if I may summarize your post, you are asking what criteria are to be used in evaluating treatment outcome. Briefly, I think it is quite important to look at a variety of indicators in determining whether intervention is successful for a particular person. You can split hairs about whether or not some of the methods for managing the disfluencies themselves should be considered to be disfluencies. If the client has a goal of increasing his/her ability to move forward in a smoother, more controlled way, then acquiring that control through use of easy onset, slides, pull-outs, etc. would constitute progress for them in my book. I also consider it important to address during treatment (and therefore include in our evaluation of progress) the client's feelings and thoughts about themselves and their speech, the degree of control that stuttering has over their life choices, the ways in which they communicate with significant others about their preferences regarding their speech and so forth.
From:
Woody
Hi Gunars:
If I understand your post correctly, I think I and most other knowledgeable people in the field would agree with you that outcome evaluations should include an assessment of the stutterer's emotional and cognitive state, the extent to which he or she is able to avoid (covertly or overtly) and the change in the person's quality of life. I think there should also be an assessment of the amount of effort that the new way of talking requires, since most stutterers who give up on fluency shaping do so because it is just too hard for them to sustain. Also, the actual quality of their speech, not just naturalness which is too narrow a concept, but the way in which their speech is evaluated by their listeners.
The studies cited in the special issue were very poorly controlled, having no controls for placebo, no controls for experimenter bias or the subject's knowledge of the hypothesis under test, and no controls for avoidance behavior, overt or covert.
The fact is that we do not have any adequate way to test for the efficacy of therapy. No one, for example, has ever designed a study with a placebo control that effectively mimicked actual therapy without itself being therapeutically useful. And there are no studies of outcome that control for the demand characteristics of research done with human subjects. I can't imagine how these studies can actually be designed.
From:
Gunars Neiders
My current textbook, Kolb & Whishaw's Fundamentals of Human Neuropsychology Fifth Edition (2003), is simply marvelous. The illustrations, done in two colors, give a view of our central and peripheral nervous systems that are beyond compare.
In my opinion this text is sine non qua for anybody trying to follow the new studies in brain and what they may or may not yield about the stuttering problem.
The 4th edition IS BAD in comparison. I would not waste my time on even acquiring it for a door stop. :-)
From:
Valentina Radic (Croatia)
I wrote this two weeks ago as a comment on the story 'Passing as Fluent' by Terry Dartnall. In the meantime I started the speech therapy and working on my speech. John asked me to put this on Professors panel to hear what you have to say. Thank you. Valentina
' My experience with covert stuttering is much like yours in some aspects. I am 23 years old and the main part of my live I lived with hiding from stuttering. I was seeing psychiatrists and was taught how to cope with stress but as you wrote my stress was mainly because of my stutter, will my avoidance mechanisms work or not, will I be unmasked etc. Of course, I don't have to mention here that my attitude about stuttering was very negative. I was stuttering in school, with unknown people and on the phone but my parents and nearest friends haven't ever heard me stutter (although they all knew why I wanted to attend speech therapies). I made a big step few months ago deciding to stutter on purpose with my parents just to see their reaction which I was so afraid of. They reacted normally...no one killed me! After that, I felt as I released myself completely and felt full of energy as I can do what ever I want in my life. And I don't have to hide my stutter! Also I gain more confidence and some kind of control of my stutter. I'm the one who can control my speech and choose if I want to stutter or not. However this is not the end of my story. During last few months I lost my avoidance mechanism and somehow my stutter progressed. Now I really block on almost every world for almost 15 minutes or more and just can't help myself to say a word. In a way I can't get back to my avoidance mechanism cause it made my brain feeling tired but this kind of stuttering make my whole body tired. Funny but it seems as I got stronger my 'enemy' got stronger too. Now everyone can hear me stutter and I'm not ashamed of it (or I don't want to admit myself that I am) but somehow my confidence fall down and now I feel a rejection in myself for almost every situation where I need to speak. I don't want to avoid the stutter but I don't want to stutter in this severe way either. I feel as life is passing quickly and I'm still circling around with the same fears and limits I've put to myself. At the moment I don't know what next step to make.
However, this is just a short story of mine and I've just concentrate on the stuttering subject.I totally agree that we should focus on what we have achieved and on what we can still achieve. Thank you for your story.'
From:
Lynne Shields
Dear Valentina,
It seems as if you are feeling as if you are between a rock and a hard place, as the English saying goes. You gave up trying to hide your stuttering, which is a big step, as you said. I applaud you for taking that step. It certainly was a brave choice. Now you are experiencing much more difficulty with your speech and it sounds as if you are having more tension and struggle when you stutter (and, you can't even go back to the old habits!). I can't say, not knowing you, what the best approach to this problem would be. But, in general, I would suggest finding a way to stutter more easily, letting the stuttering happen without the tension and pushing that seems to be going on. Voluntary stuttering is one way to approach breaking the cycle of severe blocks. You already used it to be more open about your stuttering, so perhaps voluntary stuttering may help you begin to break up the current pattern of struggle. You mentioned that you are not ashamed of stuttering, and you probably are correct about that, at least in part. After all, you were able to stop hiding your stuttering. I may be off base, but you still seem to be reacting to the stuttering if you are tensing up enough to cause severe blocks. It could be very useful to continue to attend to your feelings about your stuttering, along with addressing the tension itself. In my experience, shame is a pretty deep feeling that takes some period of time to address.
Thanks for sharing your experience. You made a significant life change in becoming open about your stuttering. This says to me that you have the strength and ability to move on in managing your stuttering.
From:
Sandy
I have a fourth grader who is unable to identify his dysfluencies. He has mostly word repetitions and hesitations, most notable when reading. He has been unable to self monitor and is totally unaware he is dysfluent. He is also ADHD. Any treatment ideas to help him be able to identify them?
From:
Judy Kuster
The following article provides some helpful suggestions:
ADHD and Stuttering: Issues & Strategies for SLPs 2001 ASHA Convention Presentation New Orleans, LA
There is no name on it, but it is on Charlie Healey's web site and I'm sure he was at least one of the presenters.
http://www.unl.edu/fluency/adhdstutter.pdf
Healey also co-authored a paper on this subject on a former ISAD conference. See
this site.
From:
oliver long
What reliable research has been done on the prevalence of depression and suicide in PWS? Does it exceed the rates for fluent speakers of the same sex, nationality and age group? My concern was raised some years ago when told about cases of teens committing suicide because of their stutter. Depression & melancholy seem common to many famous PWS; Examples include Winston Churchill & his "black dog".
I am a senior PWS involved with PWS self-help. I have learned to accept that even though I have benefitted from therapy, I will always stutter. But I struggle with depression & now feel that this is a more serious problem than my stutter (though severe for my first 40 years) ever was.
From:
Ellen-Marie Silverman
I hope you are seeking help for the depression you experience. Some people turn to counselors and physicians. Some turn to exercise and nutrition. An increasing number turn to spiritual advisors as we, as a society, recognize more and more that, in middle age, some can experience an existential anxiety that can lead to depression when we begin to examine/re-examine the big issues in life, i.e., why are we here? what is my purpose in life?, without guidance and support from clergy and religious and spiritual traditions. There are many professionals who are ready and experienced who can help.
From:
oliverlong
Much of the literature, pamphlets(NSA etc)mention that approx. 1% of the population for just about any country stutter. I have now met hundreds of people who stutter, but never one who was surveyed for such data. Years ago I was told it was 2%. Many PWS would not admit to stuttering. What research supports the incidence of stuttering by both age, sex and country?
From:
Luc De Nil, University of Toronto
I think there were a number of sources:
1. the 1950-60's study by Andrews, et al in Newcastle-on-Tyne where they found an incidence rate of approximately 5% in 1000 kids and a prevalence of about 1% in older children. Also, Bloodstein summarized the data from a group of international studies, listed in his Handbook of Stuttering, which averaged out to about 1%. To the best of my knowledge, those are the two main sources for the figures of incidence and prevalence. These data seem to confirm pretty well with the data typically found in smaller studies - but it is true that to my knowledge there have not been any systematic large scale epidemiological studies done in stuttering. To my knowledge, the closest we come to such a study is one that Dr. Carla Johnson, a professor in our department, has been involved in . She is completing the last phases of a longitudinal study in which she and her colleagues followed about 140 kids from the age of 5 until they were in their mid-twenties. At the age of 5 (in the early 1980's), about 1600 children in a school board in Ottawa were tested for speech and language problems - of those, approximately 140 were found to have such problems - 9 children were assessed to have stuttering difficulties - this is a prevalence figure of about 0.5%. An interim report of her study can be found in JSLHR (june 1999).
From:
Ken St. Louis
Dear Oliver,
In 1968-69, I was an examiner on a National Speech and Hearing Survey of randomly selected school children in the USA. We tested nearly 39,000 kids from grades 1-12. The *prevalence* of stuttering was 0.8% in that sample. It was higher in the earlier grades and lower in the later grades.
We talk about the "lifetime incidence" of stuttering (i.e., the percentage of people who will stutter at sometime in their lives) to be about 5%, as Luc indicates. I think that generally works, but Bobbie Lubker, who is an epidemiologist, wrote
an article a few years back in the ISAD Conference
which stated rather emphatically that we really don't know what the incidence of stuttering is at this time. Incidence, for epidemiologists, typically implies the *rate* of *new* occurrences of a condition among *at risk* individuals *in a given period of time*. Obviously, it is hard to know who is and who is not at risk for stuttering, but it must certainly exclude those who already stutter. It is also not clear if a former stutterer should be included in the group of at risk people.
From:
[no name]
I and my brother stutter. Also a nephew. I don't have previous history family. Are there studies that suggest that stuttering is hereditary like other diseases?. Also, have you any information about stuttering by birth problems, like lack of oxygen, etc?
From:
Ken St. Louis
Yes, we are quite sure that stuttering has a significant genetic component. There is absolutely no doubt that stuttering runs in families, like yours. Nevertheless, genetic influences are not the only cause of stuttering; there are environmental influences as well.
Every few years we hear that the stuttering gene or genes are about to be described. To my knowledge, this has not yet occurred, and I would be surprised if we locate one specific genetic pattern that is responsible for all stuttering.
A few studies (mostly pretty old) suggest that stuttering is correlated with various disease and birth conditions, but the weight of the evidence from carefully controlled studies seems to suggest that stutterers are no more prone to such things as anoxia as nonstutterers.
From:
Marija, Croatia
Firstly, my deepest bows to all of you! If this was a real situation, I would feel a big noodle in my throat, standing in front of 15 of you and posing this question:
Do you think the PWS are too self-absorbed, or we should be?
From:
Steve Hood
Hi Marija
Thanks for your question. I took a stab at answering in the context of my own ISAD paper, and suggested you post the question to those of us on this panel. I am glad you did, because it is an interesting one.
I don't think I had really ever quite considered this in terms of self absorbed, self centered, egocentric, etc. I'll try to keep thinking about it.
It seems to me that the answer is yes-- PWS do tend to be self absorbed/self centered, in that they are concerned about themselves as a PERSON who stutters, and concerned about their own issues of stuttering, escaping and avoiding, etc.
And I think it goes beyond this, in the sense that they are also very concerned about their listeners' perceptions: listeners' perceptions of their stuttering, their ability to communicate, and perception of them as a person.
As to the question of "should you be" I would think yes, because all of us have these feelings and attitudes about ourselves and how others perceive us. I think the issue is the degree or extreme to which we carry this. If we overdo it and become obsessed by it, then we have possibly crossed the line and gone too far.
From:
Marija
Thank you, Dr. Steve, for making such an effort to give me your opinion on this. I really, really appreciate it! I wish I'd posed this question earlier in the Conference, I can't believe it's almost over. My greetings to all the professors in "The Professor is In"!
From:
John Tetnowski
Marija,
Great question. I hate to generalize, but here is my attempt to answer your question. I think some PWS are very self-absorbed with their problem (as Steve mentioned), but I know that if I stuttered, I would be self-absorbed with it myself. As it stands, I am too self-absorbed with cooking, working, and other things that interest me. Why wouldn't people who stutter be wrapped up and interested in stuttering? Musicians are wrapped up in music, moms are wrapped up in parenting, athletes are wrapped up in athletics, etc.
The people that I am more concerned about however, are the people who stutter and say they want help, but make it a low priority. If the PWS is not interested in changing, fine....but don't pretend to be interested and waste valuable resources. If you are interested in change, (or even interested in exploring change) you must really "get into it" in order to make significant progress. As a result, the people that we often see in therapy, in support groups, in self-help groups, etc. are really self-absorbed ......... THEY WANT TO MAKE CHANGES. Therefore, when I see PWS that are self-absorbed, I am very thankful! They usually do quite well! (They often motivate others as well!)
From:
marie-claude monfrais-pfauwadel
marija ! great question . I do think my patients are close to the end of the therapy or the treatment (according to my own point of view) when they are able at last not to be so "centered" on or around their stuttering problem and they can at least open themselves to the other. The aim of therapy is "communication" and not perfect speech. may I advise you read a philosopher named Levinas. He did write about "facing" the other, talking to him in open face...and that's something you cannot do if you are self-centered on ANY kind of problem, stuttering included.
What is your definition for "healing" ?
From:
Marija
Hello Marie-Claude! Thank you for giving me your point of view on this and I agree with it. I must admit that I've never read a philosophical book but I'm sure my library will have Levinas.
I can't remember anyone's definition of healing to agree or not to agree with, so I'll have to make up my own definition: healing is the end of a process that includes
From:
Elisabeth Lukong, member of SCAC, Cameroon
Dear Professors, I was clarified last year during this conference on the use of Speech Language Therapists and Speech Language Pathologist. I read some year a term which I do not know whether it is has the same meaning as those above. The word is LOGOPEDIC ( I do not know whether the spelling is right as I did not see it in the Dictionary I have). I have read all the answers you have been giving to questions posed by many other persons and I believe you are doing a great job in answering all those questions.
From:
Judy Kuster
The word logopedics is another word that means the study and treatment of speech disorders.
From:
Fabian Lukong, Member of the SPEAK CLEAR ASSOCIATION OF CAMEROON, Africa
During one of our support group meeting, we were discussing on the rate of speech as a cause of stuttering. Some members said when they speak fast; they are able to control their stuttering. Another group said when they speak slowing and using some good pauses; they are able to have control over their stuttering. What according to you should be the better way of speaking so as to have control over stuttering? Rapid speech or slow speech.
From:
Peter Ramig
I know of no evidence pointing to rapid or slow speech CAUSING stuttering; however, people who stutter often change their speaking rate as a way of attempting to cope with existing stuttering. For example, some will increase their rate in attempts to "skim" over stuttering; while others may slow down in attempts to prevent or avoid stuttering moments. I discourage avoidance of stuttering at all costs, but because evidence does support a vulnerable speaking mechanism in those of us who stutter, it makes some sense to add additional milliseconds of time (slowing down) to make the complex motor coordinations necessary in producing fluent speech. In supporting slowing down, I do not mean a stutterer should use ABNORMALLY slow speech in attempts to avoid impending stuttering. Rather, I support slowing down slightly as one is encouraged to stutter in a forward flowing fashion with air and voicing turned on.
From:
Caron Lye
Are there specific recommendations for the amount of time per week that an intermediate stutterer should spend in speech therapy? Any suggestions or research articles you could direct me to would be most appreciateed. I have called a national stuttering organization and received little direction regarding the topic of therapy effectiveness related to treatment time.
From:
Dick Mallard
Caron, this is a good question. I assume by time in therapy you mean the time you spend face-to-face with a speech-language pathologist. If that is incorrect, please let me know.
I believe that time in therapy has nothing to do with progress made in stuttering therapy. In my view, "therapy" starts as soon as you leave the professional's office. Every time you speak is an opportunity to change the way you talk, to learn to control the next moment of stuttering better than you did the last one. I am working with a client presently who consistently goes beyond my suggested activities. She looks for opportunities to enter speaking situations and be more open with her speech. Our sessions are quite short since all she wants to know is "What do I do next?" I had that same attitude when I was in therapy and I learned to control my stuttering in a relatively short period. The actual time I spent with Norman Barnes was very short relative to the amount of time I was actually working to control my speech.
In case you are wondering, I worked with Norman in 1966. I still have to monitor how I talk but it has become more automatic and much easier than when I started.
From:
Ed Feuer
Below is part of Luc De Nil's answer to the question "What causes stuttering?" on the Scientific American website at http://www.sciam.com/askexpert_question.cfm?articleID=00003C9F-EFAB-1ECC-8E1C809EC588EF21& catID=3 I wonder how the neural activation of covert stutterers would appear on the neuroimaging technology he describes. Would expectancy, word and sound fears followed by "successful" substitution show up?
"Recently a number of research groups, including the one in our lab, have started to use modern functional neuroimaging technology such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) to investigate differences in neural activation between people who stutter and those who do not. The results from these investigations have revealed some interesting differences in how the brain is active in people with stuttering difficulties. Stuttering individuals typically show a general overactivation of the neural systems involved in motor control, including the cerebellum. Many of these neural systems are known to cause difficulties with speech motor control and disruptions of speech fluency in patients who suffer damage to these areas. Conditions that enhance fluency, such as speaking in unison with someone else or behavioural fluency treatment, seem to result in a partial normalization of the activation in these cortical and subcortical regions."
From:
J.S. Matney
It has been really interesting to read the posts here. I was especially pleased to see the on acting and public speaking, as well as late onset. I am a pastor who began to stutter seven years ago, after many years of fluent preaching. It is most severe in the pulpit and other public speaking situations, as well as other "formal" settings (court, radio, interviews, etc.) I am almost totally fluent in conversations, on the phone, etc. This began after I left a long pastorate that ended unpleasantly, and moved to another town. My son also left for college at the same time. It's hard to pinpoint this as a cause, even tho it was a major life change. But this is my best guess. Is there any research on adult-onset stuttering, or stuttering following transitions, or trauma, etc.? I have tried various therapies, some of which work for a time, but am still struggling.
From:
Lynne Shields
Dear J.S.,
Yes, there are several papers reporting on adult-onset stuttering, related to either psychogenics (trauma, for example) or neurological disorders (e.g., stroke or other brain injury). Helms-Eastabrooks wrote on this topic in a chapter in a book edited by Richard Curlee entitled "Stuttering and Related Disorders of FLuency" published in 1999. She also has an article in volume 19 of "Seminars of Speech & Language (1998) entitled 'Sudden onset of "stuttering" in an adult: Neurogenic or psychogenic?'. Van Borsel and colleagues published a paper on the topic of acquired stuttering following injury in the brain in volume 23 (1998) of the Journal of Fluency Disorders.
There are other reports of adult-onset stuttering, so you are not alone in this experience.
From:
Ken St. Louis
Dear Pastor Matney,
Lynne Shields has provided some excellent sources for both psychogenic and neurogenic stuttering. It is certainly possible that you are suffering from the former (but unlikely the latter). However, in my opinion, it is also likely that you stutter in the more traditional sense, that is without any clear pyschogenic or neurogenic cause.
Obviously, the onset of your stuttering is atypical. Most stuttering begins in childhood, but I have seen numerous cases in which stuttering did not begin--or occur with sufficient frequency to be noticed particularly--until adulthood. In these cases, even those that seemed to be coincident with periods of significantly elevated stress or pressure in life, the problems and treatment has been very similar to the more typical stuttering with childhood origins.
What you say of your temporary success with some therapies leads me to suspect that you are approaching therapy (understandably of course) from the perspective of finding something to return you to your previous fluent self. This sort of mind set often results in using the various techniques learned "TO TRY NOT TO STUTTER" rather than "TO TRY TO TALK IN A NEW WAY." Often, this makes all the difference. If you could get hold of "Advice to Those Who Stutter" from the Stuttering Foundation of America, you will see numerous authors recommend facing, advertising, and otherwise not avoiding the stuttering. This often results in a new mind set in which previous approaches that provided only temporary benefit become useful tools to assist you in speaking in a more controlled manner IN SPITE OF THE STUTTERING THAT MAY STILL OCCUR.
I would suggest you try these approaches first, if possible with a competent speech-language pathologist who specializes in stuttering. From the little you wrote, I would suspect this might well be successful. However, if this approach is not successful, perhaps you should follow Lynne's line of reasoning and obtain an evaluation from a clinical psychologist or psychiatrist. I would say that a neurological examination would probably be your least beneficial course, unless you have exhausted all other possibilities.
From:
Paola Migliozzi-Di Matteo
I have a 45 month old was diagnosed having autism at 39 months. He has been classified as 'high functioning'. He is verbal, has an EXTENSIVE vocabulary, he has many songs, books, videos memorized which he reiterates all the time. He 'converses' with learned sentences, mostly requesting, but we are not all to clear as to whether or not he fully understands all his words. As of January 2003, his diagnosis with a SLP was quite bleak to say the least, he has made these strides in language development all in the last 8 months. He seemed to take off lets say by about the time we had his diagnosis and has not stopped. To top it all off he has begun stuttering. It isn't severe, but it started to become more and more noticeable late spring/early summer and seems to be coming up a little more frequently. It seems to happen most often when he is attempting some spontaneous speech/is angry/trying to communicate a need he hasn't done before and other times. We have implemented the use of a schedule board and a first and next board at home and at his daycare which seems to be working well. The SLP we are currently working with has recommended the use of PECS to help him with the stuttering, etc. Any input would be appreciated?
From:
Judy Kuster
I'm not sure this relates to your situation or not, but there was an interesting answer to a question regarding Tourette syndrome and autism that might interest you from Joe Donaher elsewhere on this conference. He said,
"There is some interesting work on TS and autistic spectrum disorders. For example, patients with Asperger's Syndrome frequently exhibit motor and phonic tics which meet the diagnostic criteria for TS. Researchers have estimated as high as a 6.5% prevalence rate of TS in individuals with Autism (Baron-Cohen et al., 1999; Kadesjo & Gillberg, 2000; Ringman JM, & Jankovic J, 2000). This is substantially higher than the estimated 3% prevalence in the general population. Kadesjo & Gillberg (2000) suggest that approximately two thirds of the individuals with TS also demonstrate Autistic Spectrum Disorders (Kadesjo & Gillberg, 2000)."
From:
susan
Can you tell me which treatment methods have been studied on young children and shown to have good results.
From:
Nan Ratner
I'd like to help, but the question is a little vague. What age child are we talking about, and what are the symptoms of the problem? Some children are fairly oblivious to their speech and some are very disturbed. Also, depending upon the age of onset, and other factors, therapy may not be warranted if the child is not concerned, because of data that can inform the probability of spontaneous remission. Can you be more specific in your inquiry? What symptoms does your child have? What advice have you received and/or followed with what results?
From:
[no name]
A 5 year old who has little awareness but has been stuttering for a couple of years. I was mostly wondering about different treatment methods for children this age in general though, that have some type of data regarding effectiveness.
From:
Nan Ratner
The most efficient way to "survey" approaches might be to pick up a book such as The handbook of early stuttering intervention", edited by Onslow and Packman (1999, Singular), which contains a number of different approaches that have been used successfully with children of this general age range. The various program authors describe treatment approaches, their rationales, and their effectiveness. Sorry to be late in responding, it has been a busy busy week!
From:
Martha Reidel, Educ. speech/language clinician, Wayzata Public Schools
Requesting professional insight and recommendations re: female 3rd grade (9-10 yrs.) student adopted from China 5 mos. ago. Limited English: 2-4 word expression emerging , i.e. "We have cat". Appears to have WNL receptive language understanding. Parent is very concerned about speech disfluencies. She exhibits some whole word and initial consonant sound repetitions with no secondary characteristics or frustration speaking. The parent says that Chinese-speaking friends have observed that she is disfluent in Chinese; and does not have a strong Chinese language base when compared to her sibling. Mom is insisting on an fluency evaluation. She currently receives ESL services and participates in a weekly social skills group. Should a fluency assessment be done at this time or should more time be allowed for her to acquire more language in English? If she is evaluated; should it be done with a Chinese interpreter? How would therapy look with limited English and would it be productive at this time?
From:
Nan Ratner
If there is no struggle, awareness, or self-concept as a person who is dysfluent, I would say that the pattern is consistent with (not IS, but is consistent with) disfluency from language formulation problems. We have done some work on this topic (Boscolo, Bernstein Ratner & Rescorla, AJLSP, 2001), as has Nancy Hall, and repetitions, prolongations and even hesitations that resemble blocks are not uncommon when language production proficiency is compromised.
From:
L. Harr
Hello, I have read some of the responses about why SLPs fear treating stuttering. I believe that one of the main reasons is lack of education. Why doesn't ASHA require that a fluency/stuttering class be necessary at the undergraduate and graduate level?
Also, this semester, our graduate class was given an assignment by our professor to pseudo-stutter in 3 situations. Many of us had the same results, the public was not sensitive and did not understand how to communicate appropriately with a person who stutters. I believe that if more people were educated about stuttering the fear of both treating the disorder and communicating with PWS would lessen. Have any of you considered educating the public on talk shows, news shows (i.e., "The Today Show") so the general public has a better overall awareness about stuttering.
From:
Heather Powell
I understand that it is important for the person who stutters to accept that they stutter. They should learn that stuttering is only a small part of who they are and does not define them as a person. My question is, when doing therapy with a PWS, do you suggest that the PWS tell their listener right away that they may stutter, or is it best to attempt fluent speech first? It would seem that telling each new person you meet that you may stutter would get old pretty quickly, especially when you may not stutter at all during the conversation.
From:
Lynne Shields
Heather,
Good question about advertising. I really believe that the answer varies from person to person. Many of the adult clients whom I have worked with find that letting their listener(s) know early on is a real tension-breaker. It makes them more at ease with their audience, and also sets their listener at ease, as a byproduct. Others decide not to advertise in any way, and just talk about their stuttering if it comes up in conversation. For those who elect to advertise, there are many ways to do it. Some decide to do some voluntary stuttering right away when they first speak, so that it is obvious that they are a person who stutters. Others actually say something about their stuttering. Each person decides what feels most natural for them to say. One man decided to simply say something to the effect, 'I stutter sometimes, so be patient with me!' A teenaged client elected to make a little joke about his speech in some situations to break the ice and let their audience know about their stuttering.
If you do decide to advertise, it isn't necessary to do so every time you talk to someone new. That's a personal decision, as well. Short exchanges on the phone or with a salesperson may not warrant any sort of declaration for some folks, while a situation where you are seated next to an unfamiliar person at a party or speaking to a group in a presentation format may be places to consider advertising.
From:
S�rgio Bunioto - Brazil
I'd like to know if reading out loud may help me in my treatment for stutter. I'm a stutterer since I was 3 years old. Is it possible to improve my fluency through this way?
From:
Ken St. Louis
Dear Sergio,
Many speech-language pathologists in the USA would probably say that reading aloud to oneself is not particularly helpful to people who stutter, especially if they have not been in speech therapy. Oral reading generally does not deal in a direct way with the emotional problems of stuttering. It also may or may not deal with the specific problems that occur with the stuttering, such as tension, blocks, and so on. Nevertheless, I have been impressed with the number of people who stutter who have told me or reported that reading aloud helps or has helped them. Generally, oral reading is part of a homework regimen that accompanies or follows speech therapy. Yet, I have a friend who never had speech therapy but in college was able to overcome a mild stuttering problem that began in childhood by reading aloud to himself.
My advice would be to seek speech therapy if possible. If that is not possible, I would suggest you order "Advice to People Who Stutter" which is published by the Stuttering Foundation of America. Their address can be found through an Internet search. In general it is better to approach the stuttering by analyzing it, facing it, and becoming desensitized to it than by seeking activities that tend to avoid, minimize, or hide it.
From:
Julie
It is painful to observe my child's interactions with his friends and how many times he is interrupted and his attempts ignored. How can I help educate his 8-9 yr. old peers and/or help facilitate their interactions?
From:
Steve Hood
Hi Julie
You asked a good question. I wish that this were not the last night of the interactive component so that others could chime in with their ideas. Time does not permit a complete reply, but I can give you some ideas.
When we think of competition in general, or sibling rivalry in particular, we think of "physical things" like pushing and shoving and even fighting. There is another form of competition and maybe this is that you are referring to-- verbal competition: interrupting, contradicting, etc. And of course, this is a two way street, and usually there are several simultaneous culprits-- among friends, siblings, parents, children, etc.
When we see a lot of this we try to work with "verbal turn taking" to reduce this aspect of communicative stress. Like green and red traffid lights that tell cars to stop or go, we need a signal system to work on the stop-go- between speaker and listener. This sounds pretty mechanical-- but it is the idea of allowing a pause of about a full second between the time each person is the speaker and the listener, so that not more than one person is talking at the same time..... (Sometimes you need a referee to keep score, and sometimes there are arguments about which person gets "jipped" and not allowed to talk as much as the others. But in time, all parties become more aware of this, and can then try to act accordingly.
Gosh-- you asked a great question on the last night of ISAS... I hope others have time to weigh in on this one.
From:
Lynne Shields
Julie,
Steve gave you a good suggestion for helping your son's friends learn to give everyone their fair turn. You may also want to consider talking with your son to figure out good ways for him to get this message across himself, so he can handle the situation when you aren't around. For example, he could decide that he is O.K. with telling his friends "stop, please let me finish" or "please let me talk", or work out a signal with them (e.g., index finger or hand up in the air) to let them know he wants a turn. Being interrupted is a typical problem for all of us, and we all need to be armed with techniques that let us get a word in edgewise in a positive way!
From:
Alan Badmington
Hi,
It has been my experience that many persons who stutter are somewhat deficient of interpersonal skills, as they tend to remain on the fringes of conversation and social interaction. 'Fluent' people develop these skills throughout their lives - it is an ongoing process.
Should such essential communication skills be included as a part of speech therapy?
I am, in fact, holding such a seminar for PWS in the near future.
From:
Lynne Shields
Interpersonal communication skills are quite important, as you point out in your post. When I work with both children or adults, we talk about good communication skills in general, along with the skills that can help them manage their stuttering. Some of the clients I see have quite good skills already in relating to others, while others are more shy or hesitant about interacting in a variety of situations, either because of concern over their stuttering or a lack of experience. If this is the case, I think you are quite correct in suggesting that the skills need to be addressed in therapy. Treatment can be structured so that both sets of skills are addressed simultaneously. For example, I might have the client develop a hierarchy of social situations going from least to most stressful for them. Beginning with the least stressful situations, we discuss and how to use their fluency management tools, as well as how to interact in those settings. Role playing can be used to good effect, followed by going out and experiencing real situations with me or another person with whom the client is comfortable.
I'm pleased that you are planning to provide assistance through your seminar. I wish you the best.
From:
Walt Manning
Lynne is correct. I believe that treatment and a successful outcome is more about improving communication than about fluency. They go hand in hand obviously, but I have worked with people who are "fluent" in a technical sense, even somewhat natural in their speaking. But their nonverbal behaviors take away from communication. Finding and developing communication skills and natural ability to interact with others is (or should be) an important part of the change process.
From:
Steve Hood
Hi, Alan
I agree with Lynn--- you raised a very good issue for discussion. I agree with what Lynn said.
Pragmatic skills and interpersonal relationships are important, and some PWS who remain on the side lines do not develop the social chit-chat, banter-back-and-forth skills. I think we see this developing in middle childhood, and becoming a real issue frequently in the teen years. For some, it persists into the adult years. Some for some PWS is it not the stuttering, per se, that is the issue. They are uncomfortable in groups, with "authority figures" in situation where they are not sure whether to maintain a topic or change a topic or shut down a topic-- and not sure to do it, if they even want to.
When we see this as an issue, we attempt to deal with it.
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